Contrast-enhanced Ultrasound LI-RADS for Nonradiation Treatment Response Assessment in Liver Tumor: A Pictorial Review Based on LR-TR v2024

  • Xu Junmei ,
  • Tahmasebi Aylin ,
  • Mohammed Amr ,
  • Pour Bahareh Kian ,
  • Liu Ji-Bin ,
  • Eisenbrey John R.
Expand
  • aDepartment of Radiology, Thomas Jefferson University, Philadelphia PA, USA
Department of Radiology, Thomas Jefferson University, 132 South 10th St, Philadelphia PA, USA (John R. Eisenbrey),e-mail: John.Eisenbrey@jefferson.edu (JR E).

Received date: 2025-09-25

  Revised date: 2025-10-13

  Accepted date: 2025-10-21

  Online published: 2025-11-06

Copyright

2576-2508/© AUDT 2025

Abstract

This pictorial review summarizes the Contrast-enhanced ultrasound (CEUS) Liver Imaging Reporting and Data System (LI-RADS) Treatment Response Algorithm (LR-TR, v2024) for response assessment after nonradiation locoregional therapies (NLT). The NLT covered by LR-TR v2024 includes embolization procedures such as conventional transarterial chemoembolization (cTACE), drug-eluting bead TACE (DEB-TACE), and bland transarterial embolization (TAE), as well as ablation techniques such as radiofrequency ablation (RFA), microwave ablation (MWA), and percutaneous ethanol injection (PEI). The algorithm independently evaluates intralesional and perilesional viability, using arterial-phase enhancement as the dominant criteria for intralesional evaluation and multiphasic enhancement (arterial, portal, and late phases) for perilesional evaluation. The results are then integrated into three standardized response categories, including LR-TR Viable, Equivocal, or Nonviable. Evidence from multicenter studies in hepatocellular carcinoma (HCC) indicates that CEUS LR-TR v2024 provides high reliability and strong reproducibility in detecting residual viable tumor following NLT. This review provides representative imaging features and interpretation tips to familiarize physicians with CEUS LR-TR v2024, aiming to improve accuracy in treatment response assessment (TRA) in HCC and facilitate timely therapeutic adjustments that ultimately benefits patients.

Cite this article

Xu Junmei , Tahmasebi Aylin , Mohammed Amr , Pour Bahareh Kian , Liu Ji-Bin , Eisenbrey John R. . Contrast-enhanced Ultrasound LI-RADS for Nonradiation Treatment Response Assessment in Liver Tumor: A Pictorial Review Based on LR-TR v2024[J]. ADVANCED ULTRASOUND IN DIAGNOSIS AND THERAPY, 2025 , 9(4) : 357 -374 . DOI: 10.26599/AUDT.2025.250102

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