Background/Aims To suggest a lexicon for liver ultrasonography and to identify radiologic features indicative of benign or malignant lesions on surveillance ultrasonography.
Methods This retrospective study included 188 nodules (benign, 101; malignant, 87) from 175 at-risk patients identified during surveillance ultrasonography for hepatocellular carcinoma. We created a lexicon for liver ultrasonography by reviewing relevant literature regarding the ultrasonographic features of hepatic lesions. Using this lexicon, two abdominal radiologists determined the presence or absence of each ultrasonographic feature for the included hepatic lesions. Independent factors associated with malignancy and interobserver agreement were determined by logistic regression analysis and kappa statistics, respectively.
Results Larger tumor size (odds ratio [OR], 1.12; 95% confidence interval [CI], 1.06-1.183; P<0.001), multinodular confluent morphology (OR, 7.712; 95% CI, 1.053-56.465; P=0.044), thick hypoechoic rim (OR, 5.878; 95% CI, 2.681-12.888; P<0.001), and posterior acoustic enhancement (OR, 3.077; 95% CI, 1.237-7.655; P=0.016) were independently associated with malignant lesions. In a subgroup analysis of lesions <2 cm, none of the ultrasonographic features were significantly associated with malignancy or benignity. Interobserver agreement for morphology was fair (κ=0.36), while those for rim (κ=0.427), echogenicity (κ=0.549), and posterior acoustic enhancement (κ=0.543) were moderate.
Conclusions For hepatic lesions larger than 2 cm, some ultrasonography (US) features might be suggestive of malignancy. We propose a lexicon that may be useful for surveillance US.
Citations
Citations to this article as recorded by
Focal Hyperechoic Hepatic Lesions in Northern Region of Saudi Arabia: Prevalence, Radiologic Features, and Clinical Relevance Fatimah M. Alonzi, Mohammed J. Alsaadi, Khaled Said Karam, Essa M. Alanzi, Noura K. Alhathal, Maram F. Alreshidi, Abdulrahman M. Alfuraih Journal of Clinical Medicine.2025; 14(19): 6987. CrossRef
Sonographic appearance of focal liver lesions and likelihood of hepatocellular carcinoma in adult Thais with chronic hepatitis B virus infection Sarana Suttivanich, Kamonwan Soonklang, Pantajaree Hiranrat, Surachate Siripongsakun Journal of Clinical Ultrasound.2024; 52(4): 377. CrossRef
Direct comparison of biopsy techniques for hepatic malignancies Shang-Chin Huang, Ja-Der Liang, Shih-Jer Hsu, Tzu-Chan Hong, Hung-Chih Yang, Jia-Horng Kao Clinical and Molecular Hepatology.2021; 27(2): 305. CrossRef
Liver Imaging Reporting and Data System (LI-RADS) is a system for interpreting and reporting of computed tomography and magnetic resonance imaging of the liver in patients at risk for hepatocellular carcinoma (HCC). LI-RADS has been developed to address the limitations of prior imaging-based criteria including the lack of established consensus regarding the exact definitions of imaging features, binary categorization (either definite or not definite HCC), and failure to consider non-HCC malignancies. One of the most important goals of LI-RADS is to facilitate clear communication between all the personnel involved in the diagnosis and treatment of HCC, such as radiologists, hepatologists, surgeons, and pathologists. Therefore, clinicians should also be familiar with LI-RADS. This article reviews the LI-RADS diagnostic algorithm, and the definitions and management implications of LI-RADS categories.
Citations
Citations to this article as recorded by
Radiomics-based differentiation of hepatocellular carcinoma and dysplastic nodules using noncontrast abbreviated MRI Jun Young Park, Yoonseok Lee, Young Jae Kim, Seung Kak Shin, Kwang Gi Kim DIGITAL HEALTH.2026;[Epub] CrossRef
Development of a Better Nomogram for Prediction of Preoperative Microvascular Invasion and Postoperative Prognosis in Hepatocellular Carcinoma Patients: A Comparison Study Jinxia Pei, Longsheng Wang, Huan Li Journal of Computer Assisted Tomography.2025; 49(1): 9. CrossRef
Is there a need for a CT scan of the pancreatic phase? A perfusion and simulation study of the pancreas, an HCC, and the kidney cortex Massimo Cressoni, Paolo Cadringher, Anna Colarieti, Fatemeh Darvizeh, Andrea Cozzi, Claudio Cina, Moreno Zanardo, Federico Ambrogi, Davide Ippolito, Francesco Sardanelli RöFo - Fortschritte auf dem Gebiet der Röntgenstrahlen und der bildgebenden Verfahren.2025; 197(12): 1405. CrossRef
Modified LR-5 criteria based on gadoxetic acid can improve the sensitivity in the diagnosis of hepatocellular carcinoma Yan Song, Yue-Yue Zhang, Qin Yu, Rui Ma, Yue Xiao, Jun-Kang Shen, Chao-Gang Wei World Journal of Radiology.2025;[Epub] CrossRef
Diagnostic value of using ancillary features to upgrade LI-RADS from LR-4 to LR-5 observations in the LI-RADS system: a systematic review Mohammad Hossein Golezar, Hamed Ghorani, Sara Hassanzadeh, Mohsen Rastkar, Faeze Salahshour, Reihaneh Mortazavi Ardestani, Shadi Nouri, Shiva Ebrahimi, Niloofar Ayoobi Yazdi Egyptian Journal of Radiology and Nuclear Medicine.2025;[Epub] CrossRef
Based on Gadolinium Ethoxybenzyl DTPA–Enhanced MRI: Diagnostic Performance of the Category-Modified LR-5 Criteria in Patients At Risk for Hepatocellular Carcinoma Shaopeng Li, Kexue Deng, Jun Qiu, Peng Wang, Dawei Yin, Yiju Xie, Yongqiang Yu Technology in Cancer Research & Treatment.2024;[Epub] CrossRef
Multimodality imaging of hepatocellular carcinoma and intrahepatic cholangiocarcinoma Haneyeh Shahbazian, Mohammad Mirza‐Aghazadeh‐Attari, Ali Borhani, Alireza Mohseni, Seyedeh Panid Madani, Golnoosh Ansari, Timothy M. Pawlik, Ihab R. Kamel Journal of Surgical Oncology.2023; 128(4): 519. CrossRef
What is CEUS LI-RADS? Yasunori MINAMI, Masatoshi KUDO, Yuko KONO Choonpa Igaku.2022; 49(3): 205. CrossRef
Extended application of subtraction arterial phase imaging in LI-RADS version 2018: a strategy to improve the diagnostic performance for hepatocellular carcinoma on gadoxetate disodium–enhanced MRI Seung-seob Kim, Sunyoung Lee, Heejin Bae, Yong Eun Chung, Jin-Young Choi, Mi-Suk Park, Myeong-Jin Kim European Radiology.2021; 31(3): 1620. CrossRef
Integrating baseline MR imaging biomarkers into BCLC and CLIP improves overall survival prediction of patients with hepatocellular carcinoma (HCC) Mounes Aliyari Ghasabeh, Mohammadreza Shaghaghi, Ankur Pandey, Sanaz Ameli, Bharath Ambale Venkatesh, Angela Jacob, Pallavi Pandey, Bita Hazhirkarzar, Yan Luo, Roya Rezvani Habibabadi, Pegah Khoshpouri, Maryam Ghadimi, Ihab R. Kamel European Radiology.2021; 31(3): 1630. CrossRef
Corona enhancement can substitute enhancing capsule in the imaging diagnosis of small (≤ 3 cm) HCCs on gadoxetic acid–enhanced MRI Ju Hyun Ham, Jeong-Sik Yu, Jeong Min Choi, Eun-Suk Cho, Joo Hee Kim, Jae-Joon Chung European Radiology.2021; 31(11): 8628. CrossRef
Liver Imaging Reporting and Data System Category on Magnetic Resonance Imaging Predicts Recurrence of Hepatocellular Carcinoma After Liver Transplantation Within the Milan Criteria: A Multicenter Study Sunyoung Lee, Kyoung Won Kim, Woo Kyoung Jeong, So Yeong Jeong, Jeong Ah Hwang, Jin Sub Choi, Sung-Gyu Lee, Jae-Won Joh Annals of Surgical Oncology.2021; 28(11): 6782. CrossRef
Should Threshold Growth Be Considered a Major Feature in the Diagnosis of Hepatocellular Carcinoma Using LI-RADS? Jae Hyon Park, Yong Eun Chung, Nieun Seo, Jin-Young Choi, Mi-Suk Park, Myeong-Jin Kim Korean Journal of Radiology.2021; 22(10): 1628. CrossRef
Subtraction Images From Portal Venous Phase Gadoxetic Acid–Enhanced MRI for Observing Washout and Enhancing Capsule Features in LI-RADS Version 2018 Jae Won Chung, Jeong-Sik Yu, Jeong Min Choi, Eun-Suk Cho, Joo Hee Kim, Jae-Joon Chung American Journal of Roentgenology.2020; 214(1): 72. CrossRef
Comparison of the diagnostic performance of the 2017 and 2018 versions of LI-RADS for hepatocellular carcinoma on gadoxetic acid enhanced MRI A. Ko, H.J. Park, E.S. Lee, S.B. Park, Y.K. Kim, S.-Y. Choi, S. Ahn Clinical Radiology.2020; 75(4): 319.e1. CrossRef
Targetoid hepatic observations on gadoxetic acid-enhanced MRI using LI-RADS version 2018: emphasis on hepatocellular carcinomas assigned to the LR-M category H.J. Park, Y.K. Kim, D.I. Cha, S.E. Ko, S. Kim, E.S. Lee, S. Ahn Clinical Radiology.2020; 75(6): 478.e13. CrossRef
Liver Imaging Reporting and Data System Version 2018: What Radiologists Need to Know Ahmed Abdel Khalek Abdel Razek, Lamiaa Galal El-Serougy, Gehad Ahmad Saleh, Walaa Shabana, Rihame Abd El-wahab Journal of Computer Assisted Tomography.2020; 44(2): 168. CrossRef
Deep Learning for Accurate Diagnosis of Liver Tumor Based on Magnetic Resonance Imaging and Clinical Data Shi-hui Zhen, Ming Cheng, Yu-bo Tao, Yi-fan Wang, Sarun Juengpanich, Zhi-yu Jiang, Yan-kai Jiang, Yu-yu Yan, Wei Lu, Jie-min Lue, Jia-hong Qian, Zhong-yu Wu, Ji-hong Sun, Hai Lin, Xiu-jun Cai Frontiers in Oncology.2020;[Epub] CrossRef
CT and MRI Liver Imaging Reporting and Data System Version 2018 for Hepatocellular Carcinoma: A Systematic Review With Meta-Analysis Sunyoung Lee, Yeun-Yoon Kim, Jaeseung Shin, Shin Hye Hwang, Yun Ho Roh, Yong Eun Chung, Jin-Young Choi Journal of the American College of Radiology.2020; 17(10): 1199. CrossRef
Autoimmune Hepatitis in Cuban Patients: A Retrospective Analysis of Clinical and Histological Profiles, Treatments, and Outcomes Marlen Ivón Castellanos Fernández, Maria Edelina Cepeda Mullo, Deyanira la Rosa Hernández, Hector Vega Sánchez, Licet González Fabian, Robert G. Gish, Ana Luisa Torres González, Zaily Dorta Guridi Current Therapeutic Research.2020; 93: 100594. CrossRef
The need for standardization of nuclear cardiology reporting and data system (NCAD-RADS): Learning from coronary artery disease (CAD), breast imaging (BI), liver imaging (LI), and prostate imaging (PI) RADS Majid Assadi, Erik Velez, Mohammad Hosein Najafi, Ali Gholamrezanezhad Journal of Nuclear Cardiology.2019; 26(2): 660. CrossRef
Radiomics and radiogenomics of primary liver cancers Woo Kyoung Jeong, Neema Jamshidi, Ely Richard Felker, Steven Satish Raman, David Shinkuo Lu Clinical and Molecular Hepatology.2019; 25(1): 21. CrossRef
The utility of diffusion-weighted imaging in improving the sensitivity of LI-RADS classification of small hepatic observations suspected of malignancy Mohammad Abd Alkhalik Basha, Rania Refaat, Faten Fawzy Mohammad, Mai E. M. Khamis, Ahmed Mohamed El-Maghraby, Ahmed A. El Sammak, Rania M. Al-Molla, Heba A. E. Mohamed, Ahmad Abdullah Alnaggar, Hanan Abdelhameed Hassan, Taghreed M. Azmy, Ahmed M. Alaa Eld Abdominal Radiology.2019; 44(5): 1773. CrossRef
Is there increased risk of hepatocellular carcinoma recurrence in liver transplant patients with direct-acting antiviral therapy? Ashokkumar Jain, Danielle Miller, Ian Schreibman, Thomas R. Riley, Karen L. Krok, Takehiko Dohi, Rajeev Sharma, Zakiyah Kadry Hepatology International.2019; 13(2): 190. CrossRef
Digital subtract angiography and lipiodol deposits following embolization in cirrhotic nodules of LIRADS category ≥3 Zhen Kang, Nan Wang, Anhui Xu, Liang Wang European Journal of Radiology Open.2019; 6: 106. CrossRef
Modified CAIPIRINHA-VIBE without view-sharing on gadoxetic acid–enhanced multi-arterial phase MR imaging for diagnosing hepatocellular carcinoma: comparison with the CAIPIRINHA-Dixon-TWIST-VIBE Seung Baek Hong, Nam Kyung Lee, Suk Kim, Hyeong Il Seo, Hyun Sung Kim, Dong Uk Kim, Tae Un Kim, Hwa Seong Ryu European Radiology.2019; 29(7): 3574. CrossRef
Radiomics in hepatocellular carcinoma: a quantitative review Taiga Wakabayashi, Farid Ouhmich, Cristians Gonzalez-Cabrera, Emanuele Felli, Antonio Saviano, Vincent Agnus, Peter Savadjiev, Thomas F. Baumert, Patrick Pessaux, Jacques Marescaux, Benoit Gallix Hepatology International.2019; 13(5): 546. CrossRef
Liver imaging reporting and data system (LI-RADS) v2018: comparison between computed tomography and gadoxetic acid-enhanced magnetic resonance imaging Sei Nakao, Masahiro Tanabe, Munemasa Okada, Matakazu Furukawa, Etsushi Iida, Keisuke Miyoshi, Naofumi Matsunaga, Katsuyoshi Ito Japanese Journal of Radiology.2019; 37(9): 651. CrossRef
State-of-the-art MR Imaging of Fat-containing Focal Lesions of the Liver Joanna Podgorska, Agnieszka Anysz-Grodzicka, Andrzej Cieszanowski Current Medical Imaging Formerly Current Medical Imaging Reviews.2019; 15(5): 435. CrossRef
Risk assessment of hepatocellular carcinoma development for indeterminate hepatic nodules in patients with chronic hepatitis B Haneulsaem Shin, Yeon Woo Jung, Beom Kyung Kim, Jun Yong Park, Do Young Kim, Sang Hoon Ahn, Kwang-Hyub Han, Yeun-Yoon Kim, Jin-Young Choi, Seung Up Kim Clinical and Molecular Hepatology.2019; 25(4): 390. CrossRef
Hepatocellular carcinoma with central scar on gadoxetic acid-enhanced and diffusion-weighted magnetic resonance imaging Sol Bee Han, Young Kon Kim, Ji Hye Min, Sang Yun Ha, Woo Kyung Jeong, Won Jae Lee Acta Radiologica.2018; 59(4): 393. CrossRef
A fully automatic end-to-end method for content-based image retrieval of CT scans with similar liver lesion annotations A. B. Spanier, N. Caplan, J. Sosna, B. Acar, L. Joskowicz International Journal of Computer Assisted Radiology and Surgery.2018; 13(1): 165. CrossRef
Extracellular contrast agent-enhanced MRI: 15-min delayed phase may improve the diagnostic performance for hepatocellular carcinoma in patients with chronic liver disease Si Eun Lee, Chansik An, Shin Hye Hwang, Jin-Young Choi, Kyunghwa Han, Myeong-Jin Kim European Radiology.2018; 28(4): 1551. CrossRef
CAIPIRINHA-Dixon-TWIST (CDT)-VIBE MR imaging of the liver at 3.0T with gadoxetate disodium: a solution for transient arterial-phase respiratory motion-related artifacts? Leonhard Gruber, Vera Rainer, Michaela Plaikner, Christian Kremser, Werner Jaschke, Benjamin Henninger European Radiology.2018; 28(5): 2013. CrossRef
Does a combined CT and MRI protocol enhance the diagnostic efficacy of LI-RADS in the categorization of hepatic observations? A prospective comparative study Mohammad Abd Alkhalik Basha, Mohamad Zakarya AlAzzazy, Ayman F. Ahmed, Hala Y. Yousef, Samar Mohamad Shehata, Dena Abd El Aziz El Sammak, Talaat Fathy, Ahmed Ali Obaya, Eman H. Abdelbary European Radiology.2018; 28(6): 2592. CrossRef
Magnetic resonance imaging ancillary features used in Liver Imaging Reporting and Data System: An illustrative review David Campos-Correia, João Cruz, António P Matos, Filipa Figueiredo, Miguel Ramalho World Journal of Radiology.2018; 10(2): 9. CrossRef
Hepatobiliary MRI as novel selection criteria in liver transplantation for hepatocellular carcinoma Ah Yeong Kim, Dong Hyun Sinn, Woo Kyoung Jeong, Young Kon Kim, Tae Wook Kang, Sang Yun Ha, Chul Keun Park, Gyu Seong Choi, Jong Man Kim, Choon Hyuck David Kwon, Jae-Won Joh, Min-Ji Kim, Insuk Sohn, Sin-Ho Jung, Seung Woon Paik, Won Jae Lee Journal of Hepatology.2018; 68(6): 1144. CrossRef
Bifocal hepatocellular carcinoma: Magnetic resonance imaging features after transarterial embolization Simona Picchia, Maria Antonietta Bali Current Problems in Cancer.2018; 42(3): 319. CrossRef
LI-RADS v2017 for liver nodules: how we read and report Wolfgang Schima, Jay Heiken Cancer Imaging.2018;[Epub] CrossRef
The current role and future prospectives of functional parameters by diffusion weighted imaging in the assessment of histologic grade of HCC Vincenza Granata, Roberta Fusco, Salvatore Filice, Orlando Catalano, Mauro Piccirillo, Raffaele Palaia, Francesco Izzo, Antonella Petrillo Infectious Agents and Cancer.2018;[Epub] CrossRef
Potential application of ultrasound-guided thermal ablation in rare liver tumors Li-Li Wu, Jia-Xin Chen, Kai Li, Zhong-Zhen Su, Ying-Lin Long, Li-Ping Luo, Er-Jiao Xu, Rong-Qin Zheng Hepatobiliary & Pancreatic Diseases International.2018; 17(6): 531. CrossRef
Diagnostic précoce des carcinomes hépatocellulaires A. Luciani, E. Herin, F. Pigneur, J. Calderaro, R. Kharrat, B. Zegai, M. Djabbari, A. Laurent, A. Rahmouni EMC - Radiologie et imagerie médicale - Abdominale - Digestive.2018; 36(1): 1. CrossRef
Major and ancillary magnetic resonance features of LI-RADS to assess HCC: an overview and update Vincenza Granata, Roberta Fusco, Antonio Avallone, Orlando Catalano, Francesco Filice, Maddalena Leongito, Raffaele Palaia, Francesco Izzo, Antonella Petrillo Infectious Agents and Cancer.2017;[Epub] CrossRef
Diagnostic efficacy of the Liver Imaging-Reporting and Data System (LI-RADS) with CT imaging in categorising small nodules (10–20 mm) detected in the cirrhotic liver at screening ultrasound M. Abd Alkhalik Basha, D. Abd El Aziz El Sammak, A.A. El Sammak Clinical Radiology.2017; 72(10): 901.e1. CrossRef
Close observation versus upfront treatment in hepatocellular carcinoma: are the exception points worth the risk? Danielle M Tholey, Ben Hornung, Charles K Enestvedt, Yiyi Chen, Willscott S Naugler, Khashayar Farsad, Nima Nabavizadeh, Barry Schlansky, Joseph Ahn, Janice H Jou BMJ Open Gastroenterology.2017; 4(1): e000157. CrossRef
Diagnostic value of contrast-enhanced ultrasound in hepatocellular carcinoma: a meta-analysis with evidence from 1998 to 2016 Juanjuan Zhang, Yanyan Yu, Ying Li, Lunshou Wei Oncotarget.2017; 8(43): 75418. CrossRef
Critical analysis of the major and ancillary imaging features of LI-RADS on 127 proven HCCs evaluated with functional and morphological MRI: Lights and shadows Vincenza Granata, Roberta Fusco, Antonio Avallone, Francesco Filice, Fabiana Tatangelo, Mauro Piccirillo, Roberto Grassi, Francesco Izzo, Antonella Petrillo Oncotarget.2017; 8(31): 51224. CrossRef
First
Prev
