Background: American College of Radiology Ultrasound LI-RADS includes the visualization score as a subjective measure of examination quality and expected level of sensitivity. Whether a single suboptimal visualization score warrants change in surveillance strategy is unknown. Objective: To determine the relative stability of visualization scores on serial surveillance ultrasound examinations in patients at risk for HCC. Methods: This retrospective study included patients at risk for HCC who underwent at least two HCC surveillance ultrasound examinations at one of three institutions between January 2017 and November 2020. Frequencies of score remaining unchanged after variable numbers of preceding examinations with the given score were determined. A mixed-effects logistic model was fitted to identify factors associated with a repeat score C (severe limitations) versus change to score A (no or minimal limitations) or score B (moderate limitations). Results: A total of 3169 patients underwent at least 2 ultrasound examinations, yielding a total of 9602 examinations. A total of 8030 (83.6%) examinations had score A, 1378 (14.4%) score B, and 194 (2.0%) score C. Frequency of score A was 88%, 91%, and 93% after 1, 2 and 3 consecutive prior examinations with score A. Frequency of score B was 45%, 48%, and 55% after 1, 2, and 3 consecutive prior examinations with score B. Frequency of score C was 42%, 67%, and 80% after 1, 2, and 3 consecutive prior examinations with score C. Among 109 examinations with score C in 91 patients with an available follow-up examination, no factor (including age, sex, severe steatosis, advanced cirrhosis, ascites, body mass index, and change in ultrasound machine, sonographer, or radiologist) was significantly associated with repeat score C (all p>.05). Although not statistically significant, presence of severe steatosis and advanced cirrhosis had the highest odds ratios (2.88 and 2.38, respectively) for repeat score C in multivariable analysis. Conclusion: Only 42% of patients with visualization score C on surveillances examination have score C on follow-up examination. Clinical Impact: The findings may inform decisions for alternative surveillance strategies in patients with visualization score C on ultrasound. This decision should consider the number of previous examinations with score C.
View details for DOI 10.2214/AJR.22.27405
View details for PubMedID 35383486