epatocellular carcinoma (HCC) is the fifth most common cancer and the second largest cause of cancer-induced mortality in the world (1). The prognosis for patients with HCC largely depends on the tumor stage at the time of diagnosis. Patients with early-stage HCC who are potentially amenable to curative treatment have a 3-year survival rate of 60%-80% (2), but the prognosis for patients with advanced-stage HCC remains poor, with a 3-year survival rate as low as 10% (3,4). Because early tumor detection and application of curative treatment are associated with improved overall survival (5,6), it is important to detect HCC at an early stage when it is eligible for curative treatment.The American Association for Study of Liver Disease guideline recommends US surveillance every 6 months for patients with cirrhosis (7). US is a widely used imaging test for surveillance of HCC as it has the advantages of wide availability, cost-effectiveness, noninvasiveness, and lack of radiation hazard (8,9); however, there are several concerns regarding the diagnostic accuracy of US for early-stage HCC (10). Notably, the ability of US to clearly depict the liver in patients with morbid obesity or a very nodular liver may be impaired (10)(11)(12)(13)(14)(15)(16)(17)(18)(19). In addition, US has lacked standardized guidelines for interpretation, reporting, and management recommendations (7,(20)(21)(22).To address this need, the Liver Imaging Reporting and Data System (LI-RADS) working group recently introduced the US LI-RADS 2017 algorithm (8,23). This algorithm includes a US visualization score (score A, B, or C)

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