ACR LI-RADS

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RID: RID39453

Focal scar

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Macroscopically visible scar limited to a small area or volume of the hepatic parenchyma.

LI-RADS Categorization:

Observations thought to definitely represent focal scars should be categorized LR-1.
Observations thought to probably represent focal scars should be categorized LR-2.
Observations that are indeterminate for focal scars versus HCC should be categorized LR-3 or LR-4.

Imaging Manifestations:

Focal scars typically have the following features:

Small
Linear, band-like or wedge-like in shape
Peripherally located
Associated with focal, mild liver surface retraction
Unenhanced CT

Hypoattenuating

Unenhanced MRI

T1 hypointense
T2 hyperintense
DW hyperintense (due at least in part to T2 shine-through)

Hypo- or isoenhancing in the arterial phase
Increasing enhancement in portal venous and delayed phases (if extra-cellular contrast agent is administered).

Multiplanar images may help to depict the characteristic linear, band-like, or wedge-like shape.

Pitfalls, Challenges, Differential Diagnosis:

While focal scars typically are arterial phase hypo- or isoenhancing, they may be arterial phase hyperenhancing. Characteristic morphology and location usually permit correct interpretation and appropriate LI-RADS categorization as, depending on level of confidence, LR-1 or LR-2.

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