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ACR Ultrasound Liver Reporting and Data System: Multicenter Assessment of Clinical Performance at 1 Year. Journal of the American College of Radiology : JACR Millet, J. D., Kamaya, A. n., Choi, H. H., Dahiya, N. n., Murphy, P. M., Naveed, M. Z., O'Boyle, M. n., Parra, L. A., Perez, M. n., Pirmoazen, A. n., Rodgers, S. K., Wasnik, A. P., Maturen, K. E. 2019

Abstract

The aim of this study was to evaluate the clinical performance of the ACR's Ultrasound Liver Reporting and Data System (US LI-RADS™) for detecting hepatocellular carcinoma (HCC) in patients at high risk for HCC.In this retrospective, multicenter study, 2,050 patients at high risk for HCC (1,078 men and 972 women; mean age, 57.7 years) at five sites in the United States had undergone screening liver ultrasound from January 2017 to February 2018, and US LI-RADS observation categories and visualization scores were assigned on a clinical basis. Ultrasound reports and patient records were retrospectively reviewed and follow-up imaging studies and/or pathologic reports recorded. Descriptive statistics were generated, and multivariate logistic regression analysis was used to analyze the relationship of clinical and reader-based predictors of limited visualization. Diagnostic performance data were calculated in the subset of patients with confirmatory testing.The most common indications for HCC screening were cirrhosis (n = 1,054 [51.4%]), noncirrhotic hepatitis B virus (n = 555 [27.1%]), and noncirrhotic hepatitis C virus (n = 234 [11.4%]). US LI-RADS observation categories assigned were US-1 (negative) in 90.4% (n = 1,854), US-2 (subthreshold) in 4.6% (n = 95), and US-3 (positive) in 4.9% (n = 101). Visualization scores were A (no or minimal limitations) in 76.8% (n = 1,575), B (moderate limitations) in 18.9% (n = 388), and C (severe limitations) in 4.2% (n = 87). Confirmatory tests including multiphase contrast-enhanced CT or MRI (n = 331) or histopathology (n = 18) were available for 349 patients (17.0%). The sensitivity of US LI-RADS in this subset of patients was 82.4%, specificity was 74.2%, positive predictive value was 35.3%, and negative predictive value was 96.1%.Approximately 90% of US LI-RADS screening examinations were negative, 5% subthreshold, and 5% positive. Visualization scores were diagnostically acceptable in the vast majority (>95%) of examinations. US LI-RADS emphasized sensitivity and negative predictive value, key characteristics of a screening test.

View details for DOI 10.1016/j.jacr.2019.05.020

View details for PubMedID 31173745