ARRS 2022 Abstracts

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E1178. LI-RADS v2018 Ancillary Features Made Ridiculously Simple
Authors
  1. Aaron Marks; University of New Mexico
  2. Leila Nojaba; University of New Mexico
  3. Martha Terrazas; University of New Mexico
  4. Masoud Shiehmorteza; University of New Mexico
  5. William Thompson; University of New Mexico
  6. Steven Eberhardt; University of New Mexico
Background
Use of ancillary features are optional according to Liver Imaging Reporting and Data System (LI-RADS) version 2018. However, applying ancillary features with major features has been shown to provide added benefit. Specifically, ancillary features help assign a more accurate LI-RADS score and improves prediction of malignancy and specificity. Additionally, ancillary features have been shown to aid in determining tumor viability in LI-RADS treated observations. For these reasons, ancillary features should be used routinely when assigning a final LI-RADS lesion score. Here, we offer tools (i.e., hanging protocol selection and memorization tools) to facilitate its use for the practicing general radiologist.

Educational Goals / Teaching Points
The goals of this exhibit is for readers to know when to apply ancillary features, how to use ancillary features, recognize and be able to describe ancillary features (those favoring HCC, favoring malignancy but not necessarily HCC and features favoring benignity), gain insight into our hanging protocol and memorization tools and finally, and apply these with case-based examples.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
After applying major features to a LI-RADS lesion, ancillary features should be investigated. We recommend the mnemonic “Need No More Bloody Fat” to reflect the 5 ancillary features for favoring HCC, and “Ironman Is Happy” to indicate two of the features favoring benignity (the others within this category either being self-explanatory or suggesting the behavior/appearance of a hemangioma). We then apply this to our workflow and hanging protocols for a two 2 × 2 and separate 1 × 1 monitor layout to ensure all features are explored on the appropriate sequence.

Conclusion
Applying ancillary features is technically optional when deciding on a final LI-RADS score; however, there are many reasons to support its application. We provide tools to facilitate use of ancillary features and follow them with case-based examples to help solidify how they may be applied. After review, readers will take away practical tools and knowledge to help seamlessly integrate applying ancillary features into their practice.