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HCC screening with ultrasound: assessment of quality using ultrasound LI-RADS score

  • Hepatobiliary
  • Published:
Abdominal Radiology Aims and scope Submit manuscript

Abstract

Purpose

To describe ultrasound (US) quality for hepatocellular carcinoma (HCC) screening/surveillance using the US LI-RADS scoring system, and to assess predictive factors of worse US quality scores.

Methods

This retrospective study included adult patients (n = 470; M/F 264/206, median age 59y) at risk for HCC that underwent US for HCC screening/surveillance. US examinations were independently reviewed by 2 radiologists that assigned a visualization score (A: no/minimal, B: moderate, C: severe limitation) and US diagnostic category (US LI-RADS 1: negative, US LI-RADS 2: subthreshold, US LI-RADS 3: positive) to each study. A generalized linear mixed model was used to assess the predictive factors of worse visualization score using OR (odds ratio) statistics. Simple Kappa coefficient (K) assessed inter-reader agreement.

Results

For readers 1 and 2, 295/320 (62.8%/68.1%) cases were scored A, 153/134 (32.6%/28.5%) were scored B, and 22/16 (4.6%/3.4%) were scored C, respectively. There was moderate inter-reader agreement for US LI-RADS visualization score (K = 0.478) and 100% concordance for US diagnostic category (K = 1), with 30 (6.4%) cases scored as positive (US LI-RADS 3). Cirrhosis and obesity were significant independent predictors of worse visualization scores (B/C) (cirrhosis: OR 10.4 confidence intervals: [4.25–25.48], p < 0.001; obesity: OR 3.61 [2.11–6.20], p < 0.001). Of the 30 lesions scored as US LI-RADS 3, 9 were characterized as probable or definite HCC on confirmatory CT/MRI, yielding a PPV of 30% (9/30) and a false-positive rate of 70% (21/30).

Conclusion

Moderate to severe limitations in quality of US performed for HCC screening/surveillance was observed in approximately one-third of patients. Patients with cirrhosis and/or elevated BMI have poorer quality US studies and may benefit from other screening modalities such as CT or MRI.

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Abbreviations

AFP:

Alpha-fetoprotein

ALD:

Alcoholic liver disease

BMI:

Body mass index

CT:

Computed tomography

HBV:

Hepatitis B virus

HCV:

Hepatitis C virus

HCC:

Hepatocellular carcinoma

LI-RADS:

Liver imaging reporting and data system

MRI:

Magnetic resonance imaging

NASH:

Nonalcoholic steatohepatitis

US:

Ultrasound

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Acknowledgements

The remaining authors did not receive support from any organization for the submitted work.

Funding

The remaining authors have no relevant financial or non-financial interests to disclose.

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Authors and Affiliations

  1. Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1234, New York, NY, 10029-6574, USA

    Michael J. King, Karen M. Lee, Sonam Rosberger, Sara Lewis & Bachir Taouli

  2. BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Hsin-hui Huang, Sara Lewis & Bachir Taouli

  3. Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Hsin-hui Huang

  4. Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Gabriela Hernandez Meza

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  1. Michael J. King
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Contributions

Bachir Taouli, MD, MHA: Research support/grant: Bayer, Takeda, Regeneron, Helio Health, Siemens, Echosens. Consultant: Bayer, Guerbet.

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Correspondence to Michael J. King.

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King, M.J., Lee, K.M., Rosberger, S. et al. HCC screening with ultrasound: assessment of quality using ultrasound LI-RADS score. Abdom Radiol 48, 263–270 (2023). https://doi.org/10.1007/s00261-022-03702-2

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