CT/MRI LI-RADS v2018 vs. CEUS LI-RADS v2017-Can Things Be Put Together?

Simple Summary The LI-RADS system is nowadays the mainstream system used in classifying liver nodules in cirrhotic liver according to their risk of malignancy. Two main LI-RADS documents have been released-the CEUS LI-RADS v2017 document, and the CT/MRI LI-RADS v2018 document. In some circumstances, a nodule can be differently classified when using CEUS versus when using CT or MRI. In this paper, we also focus on the existing similitudes between the two documents but, essentially, on the differences between the two main documents and the complementarities between imaging techniques in characterizing liver nodules in cirrhotic livers. Awareness of the complementarity of imaging techniques may lead to an improvement in the characterization and classification of liver nodules and will reduce the number of liver biopsies. This paper proposes practical solutions in order to better classify and manage observations or nodules detected in cirrhotic livers. Different LI-RADS core documents were released for CEUS and for CT/MRI. Both documents rely on major and ancillary diagnostic criteria. The present paper offers an exhaustive comparison of the two documents focusing on the similarities, but especially on the differences, complementarity, and added value of imaging techniques in classifying liver nodules in cirrhotic livers. The major diagnostic criteria are defined, and the sensitivity and specificity of each major diagnostic criteria are presented according to the literature. The existing differences between techniques in assessing the major diagnostic features can be then exploited in order to ensure a better classification and a better clinical management of liver nodules in cirrhotic livers. Ancillary features depend on the imaging technique used, and their presence can upgrade or downgrade the LI-RADS score of an observation, but only as far as LI-RADS 4. MRI is the imaging technique that provides the greatest number of ancillary features, whereas CEUS has fewer ancillary features than other imaging techniques. In the final part of the manuscript, some recommendations are made by the authors in order to guidephysicians as to when adding another imaging technique can be helpful in managing liver nodules in cirrhotic livers.