ULTRASOUND AND MRI IN THE DIFFERENTIAL DIAGNOSIS OF FOCAL LESIONS IN THE CIRRHOTIC LIVER: CAPABILITIES OF THE LI-RADS SYSTEM (LITERATURE REVIEW)
TL;DR
It is concluded that the standardized use of LI-RADS within a sequential ultrasound–MRI approach increases the reliability of noninvasive diagnosis of HCC and reduces the number of unnecessary biopsies.
Abstract
Liver cirrhosis is the main background for the development of hepatocellular carcinoma (HCC), and the detection of a focal lesion in a cirrhotic liver always requires its differentiation from regenerative and dysplastic nodules, benign pseudolesions and non-hepatocellular malignancies. This review analyzes current data on the role of ultrasound (B-mode, Doppler imaging, elastography, contrast-enhanced ultrasound) and magnetic resonance imaging (MRI) with diffusion-weighted imaging, extracellular and hepatobiliary contrast agents in this patient group. The imaging correlates of multistep hepatocarcinogenesis are described. The structure of the Liver Imaging Reporting and Data System (LI-RADS) is presented, including its ultrasound surveillance, contrast-enhanced ultrasound and CT/MRI algorithms, diagnostic categories and management recommendations. The main pitfalls of differential diagnosis are discussed: arterioportal shunts, confluent fibrosis, siderotic nodules and intrahepatic cholangiocarcinoma. It is concluded that the standardized use of LI-RADS within a sequential ultrasound–MRI approach increases the reliability of noninvasive diagnosis of HCC and reduces the number of unnecessary biopsies.