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Fowler et al. Hepatoma Res 2020;6:19 Hepatoma Research
DOI: 10.20517/2394-5079.2020.21

Review Open Access

Diagnosing non-hepatocellular carcinoma
malignancies on CT/MRI and contrast enhanced
ultrasound: the Liver Imaging Reporting and Data
System approach

Kathryn J. Fowler , Guilherme Moura Cunha , Tae Kyoung Kim
2
1
1
1 Department of Diagnostic Radiology, University of California at San Diego, San Diego, CA 92130, USA.
2 University of Toronto, Joint Department of Medical Imaging, University Health Network/Mount Sinai Hospital/Women’s
College Hospital, Toronto M5G 2N2, Canada.
Correspondence to: Dr. Kathryn J. Fowler, Department of Diagnostic Radiology, University of California at San Diego, 200 West
Arbor Drive #8756, San Diego, CA 92130, USA. E-mail: k1fowler@health.ucsd.edu
How to cite this article: Fowler KJ, Cunha GM, Kim TK. Diagnosing non-hepatocellular carcinoma malignancies on CT/MRI and
contrast enhanced ultrasound: the Liver Imaging Reporting and Data System approach. Hepatoma Res 2020;6:19.
http://dx.doi.org/10.20517/2394-5079.2020.21

Received: 2 Mar 2020 First Decision: 16 Apr 2020 Revised: 20 Apr 2020 Accepted: 24 Apr 2020 Published: 28 Apr 2020

Science Editor: Yuko Kono Copy Editor: Jing-Wen Zhang Production Editor: Tian Zhang

Abstract
The Liver Imaging Reporting and Data System (LI-RADS) provides a stepwise algorithmic approach that is proven
to be highly accurate in diagnosing hepatocellular carcinoma (HCC) in patients at risk. An essential and early
step in the algorithm is the diagnosis of malignancies other than HCC, such as cholangiocarcinoma and combined
tumors, by application of LR-M features and criteria. The LR-M category captures most non-HCC malignancies
and some atypical HCCs. The exclusion of non-HCC malignancies is important for maintaining the high specificity
of the LR-5, definite HCC category. This review provides an overview of the approach to diagnosing non-HCC
malignancies using LI-RADS CT/MRI and contrast enhanced ultrasound algorithms.

Keywords: Magnetic resonance imaging, computer tomography, contrast-enhanced ultrasound

INTRODUCTION
According to most major liver societies, screening/surveillance imaging is recommended for patients with
cirrhosis to detect early stage hepatocellular carcinoma (HCC). While HCC is the most common primary
liver malignancy, cirrhosis and chronic viral hepatitis also place patients at risk for non-HCC malignancies
such as intrahepatic cholangiocarcinoma (iCCA) and combined hepatocellular-cholangiocarcinomas
[1,2]
(cHCC-CCA) . As a result, these non-HCC malignancies are occasionally found on surveillance imaging

© The Author(s) 2020. Open Access This article is licensed under a Creative Commons Attribution 4.0
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