ACR Ultrasound Liver Reporting and Data System: Multicenter Assessment of Clinical Performance at One Year

Millet, John D.; Kamaya, Aya; Choi, Hailey H.; Dahiya, Nirvikar; Murphy, P.; Naveed, Mujtaba Zaki; O'Boyle, M K; Parra, Laura; Perez, Marcelina G.; Pirmoazen, Amir; Rodgers, Shuchi K.; Wasnik, Ashish P.; Maturen, Katherine E.

doi:10.1016/j.jacr.2019.05.020

Cited by 29 publications

(27 citation statements)

References 22 publications

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“…In our study, the percentage of cases with visualization scores of B or C is higher than previously reported by Millet et al 20 and Choi et al 25 In the study by Millet et al, US visualization scores B and C were 388/2050 (18.9%) and 87/ 2050 (4.2%) of cases, respectively, for a total of 23.2%. Choi et al found visualization score B in 22% and C in 3% of the cases.…”

Section: Discussioncontrasting

confidence: 72%

“…There are little data regarding interobserver agreement between radiologists using US LI-RADS visualization scores and clinical factors associated with US visualization scores. 20,21 Therefore, the objectives of this study were to a) evaluate the interobserver agreement between radiologists using the LI-RADS US visualization score and b) assess for the association between US visualization score and cause of liver disease, sex, and body mass index (BMI).…”

Section: Introductionmentioning

confidence: 99%

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US LI-RADS Visualization Score: Interobserver Variability and Association With Cause of Liver Disease, Sex, and Body Mass Index

et al. 2021

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Objectives: To evaluate the interobserver agreement between radiologists using the Ultrasound Liver Reporting And Data System (US LI-RADS) visualization score and assess association between visualization score and cause of liver disease, sex, and body mass index (BMI). Methods: This retrospective, single institution, cross-sectional study evaluated 237 consecutive hepatocellular carcinoma surveillance US examinations between March 4, 2017 and September 4, 2017. Five abdominal radiologists independently assigned a US LI-RADS visualization score (A, no or minimal limitations; B, moderate limitations; C, severe limitations). Interobserver agreement was assessed with a weighted Kappa statistic. Association between US visualization score (A vs B or C) and cause of liver disease, sex, and BMI (< or ≥ 25 kg/m2) was evaluated using univariate and multivariate analyses. Results: The average weighted Kappa statistic for all raters was 0.51. A score of either B or C was assigned by the majority of radiologists in 148/237 cases and was significantly associated with cause of liver disease ( P = 0.014) and elevated BMI ( P < 0.001). Subjects with viral liver disease were 3.32 times (95% CI: 1.44-8.38) more likely to have a score of A than those with non-alcoholic steatohepatitis ( P = 0.007). The adjusted odds ratio of visualization score A was 0.249 (95% CI: 0.13-0.48) among those whose BMI was ≥25 kg/m2 vs. BMI < 25 kg/m2. Conclusion: Interobserver agreement between radiologists using US LI-RADS score was moderate. The majority of US examinations were scored as having moderate or severe limitations, and this was significantly associated with non-alcoholic steatohepatitis and increased BMI.

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Section: Discussioncontrasting

confidence: 72%

Section: Introductionmentioning

confidence: 99%

US LI-RADS Visualization Score: Interobserver Variability and Association With Cause of Liver Disease, Sex, and Body Mass Index

et al. 2021

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“…Indeed, several studies demonstrated that periodic surveillance of hepatic nodules improves HCC detection in its early stages and promotes statistically significant increase in global survival rates 8,21–23 . Studies assessing HCC detection by surveillance programs based on US LI‐RADS technical guidelines are still scarce than those employing conventional ultrasound examinations 24 . Millet et al, in a retrospective, multicenter study conducted at 5 sites in United States including 2050 high‐risk patients, evaluated the clinical performance of the US LI‐RADS and found a rate of 5% of positive examinations.…”

Section: Discussionmentioning

confidence: 99%

“…Millet et al, in a retrospective, multicenter study conducted at 5 sites in United States including 2050 high‐risk patients, evaluated the clinical performance of the US LI‐RADS and found a rate of 5% of positive examinations. In a subset of 349 patients for whom a confirmatory test was available (CT, MRI, or histopathology), US LI‐RADS had a sensitivity of 82.4%, specificity of 74.2%, positive predictive value of 35.3%, and negative predictive value of 96.1% 24 . These values were similar to those reported in a large meta‐analysis of studies that did not employ a specific structured reported method (pooled sensitivity of 84%) 25 .…”

Section: Discussionmentioning

confidence: 99%

HCC Detection on Surveillance US

Silva

Gomes

Matos

et al. 2021

J of Ultrasound Medicine

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Objective Focused US examinations of the liver in the routine hepatocellular carcinoma (HCC) screening reduce the time spent on evaluating other structures deemed irrelevant to the clinical setting. It is still unknown, however, if such a strategy may additionally improve the frequency of nodules detection. We aimed to assess the impact of an HCC surveillance program in high‐risk patients by means of targeted liver US following LI‐RADS technical guidelines in comparison to a complete upper abdominal scan. Methods In this IRB‐approved, single‐center, prospective study, patients at high‐risk for HCC enrolled from 06/2016 to 09/2019 were randomly assigned to 1 of the 2 institutional protocols: Group A (targeted liver US) or Group B (complete upper abdominal scan). Twenty examiners with similar experience in abdominal US were randomly assigned to perform the examinations exclusively in 1 of the groups (10 in each group). Frequency of hepatic nodules between groups was compared by using Fisher's exact test. Results Four hundred and sixty‐five patients were enrolled, with no significant differences in both groups regarding sex, age, etiology of liver disease, MELD scores, and alpha‐fetoprotein levels. A significantly higher frequency of nodules detection was found in Group A (230 patients; 23 nodules detected; 10% of the sample) in comparison to Group B (235 patients; 3 nodules; 1.3% of the sample) (p <.001). Five patients in Group A and 1 in Group B were positive for HCC after full diagnostic work‐up. Conclusion Adopting an HCC screening program based on targeted liver US improved the detection of hepatic nodules among high‐risk individuals.

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“…2), small size, and infiltrative tumor type, can significantly impair the sensitivity of US [48,50,53]. According to recently published multicenter studies from the United States, the US LI-RADS visualization score was C in 3.0%-4.2% of patients undergoing HCC surveillance [54,55]. Considering these drawbacks of US, several guidelines proposed alternative imaging modalities such as computed tomography (CT) or magnetic resonance imaging (MRI) for patients with an inadequate US surveillance results [26,29,30].…”

Section: Limitations Of Usmentioning

confidence: 99%

Current status of image-based surveillance in hepatocellular carcinoma

Kim

Choi

2021

Ultrasonography

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Although the overall prognosis of patients with hepatocellular carcinoma (HCC) remains poor, curative treatment may improve the survival of patients diagnosed at an early stage through surveillance. Accordingly, ultrasonography (US)-based HCC surveillance programs proposed in international society guidelines are now being implemented and regularly updated based on the latest evidence to improve their efficacy. Recently, other imaging modalities such as magnetic resonance imaging have shown potential as alternative surveillance tools based on individualized risk stratification. In this review article, we describe the current status of US-based surveillance for HCC and summarize the supporting evidence. We also discuss alternative surveillance imaging modalities that are currently being studied to validate their diagnostic performance and cost-effectiveness.

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ACR Ultrasound Liver Reporting and Data System: Multicenter Assessment of Clinical Performance at One Year

Cited by 29 publications

References 22 publications

US LI-RADS Visualization Score: Interobserver Variability and Association With Cause of Liver Disease, Sex, and Body Mass Index

US LI-RADS Visualization Score: Interobserver Variability and Association With Cause of Liver Disease, Sex, and Body Mass Index

HCC Detection on Surveillance US

Current status of image-based surveillance in hepatocellular carcinoma

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