ACR Ultrasound Liver Reporting and Data System

Multicenter Assessment of Clinical Performance at One Year

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

Research output: Contribution to journalArticle

Abstract

Purpose: 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. Methods: 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. Results: The most common indications for HCC screening were cirrhosis (n = 1,054 [51.4%]), noncirrhotic hepatitis B virus infection (n = 555 [27.1%]), and noncirrhotic hepatitis C virus infection (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%. Conclusions: 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, which are key characteristics of a screening test.

Original languageEnglish (US)
JournalJournal of the American College of Radiology
DOIs
StatePublished - Jan 1 2019

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Information Systems
Liver
Hepatocellular Carcinoma
Virus Diseases
Observation
Hepatitis B virus
Hepacivirus
Multicenter Studies
Fibrosis
Retrospective Studies
Logistic Models
Regression Analysis

Keywords

  • hepatocellular carcinoma
  • LI-RADS
  • screening
  • surveillance
  • Ultrasound

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

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, Paul M.; Naveed, Mujtaba Z.; O'Boyle, Mary; Parra, Laura A.; Perez, Marcelina G.; Pirmoazen, Amir M.; Rodgers, Shuchi K.; Wasnik, Ashish P.; Maturen, Katherine E.

In: Journal of the American College of Radiology, 01.01.2019.

Research output: Contribution to journalArticle

Millet, JD, Kamaya, A, Choi, HH, Dahiya, N, Murphy, PM, Naveed, MZ, O'Boyle, M, Parra, LA, Perez, MG, Pirmoazen, AM, Rodgers, SK, Wasnik, AP & Maturen, KE 2019, 'ACR Ultrasound Liver Reporting and Data System: Multicenter Assessment of Clinical Performance at One Year', Journal of the American College of Radiology. https://doi.org/10.1016/j.jacr.2019.05.020
Millet, John D. ; Kamaya, Aya ; Choi, Hailey H. ; Dahiya, Nirvikar ; Murphy, Paul M. ; Naveed, Mujtaba Z. ; O'Boyle, Mary ; Parra, Laura A. ; Perez, Marcelina G. ; Pirmoazen, Amir M. ; Rodgers, Shuchi K. ; Wasnik, Ashish P. ; Maturen, Katherine E. / ACR Ultrasound Liver Reporting and Data System : Multicenter Assessment of Clinical Performance at One Year. In: Journal of the American College of Radiology. 2019.
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title = "ACR Ultrasound Liver Reporting and Data System: Multicenter Assessment of Clinical Performance at One Year",
abstract = "Purpose: 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. Methods: 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. Results: The most common indications for HCC screening were cirrhosis (n = 1,054 [51.4{\%}]), noncirrhotic hepatitis B virus infection (n = 555 [27.1{\%}]), and noncirrhotic hepatitis C virus infection (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{\%}. Conclusions: 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, which are key characteristics of a screening test.",
keywords = "hepatocellular carcinoma, LI-RADS, screening, surveillance, Ultrasound",
author = "Millet, {John D.} and Aya Kamaya and Choi, {Hailey H.} and Nirvikar Dahiya and Murphy, {Paul M.} and Naveed, {Mujtaba Z.} and Mary O'Boyle and Parra, {Laura A.} and Perez, {Marcelina G.} and Pirmoazen, {Amir M.} and Rodgers, {Shuchi K.} and Wasnik, {Ashish P.} and Maturen, {Katherine E.}",
year = "2019",
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doi = "10.1016/j.jacr.2019.05.020",
language = "English (US)",
journal = "JACR Journal of the American College of Radiology",
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TY - JOUR

T1 - ACR Ultrasound Liver Reporting and Data System

T2 - Multicenter Assessment of Clinical Performance at One Year

AU - Millet, John D.

AU - Kamaya, Aya

AU - Choi, Hailey H.

AU - Dahiya, Nirvikar

AU - Murphy, Paul M.

AU - Naveed, Mujtaba Z.

AU - O'Boyle, Mary

AU - Parra, Laura A.

AU - Perez, Marcelina G.

AU - Pirmoazen, Amir M.

AU - Rodgers, Shuchi K.

AU - Wasnik, Ashish P.

AU - Maturen, Katherine E.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Purpose: 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. Methods: 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. Results: The most common indications for HCC screening were cirrhosis (n = 1,054 [51.4%]), noncirrhotic hepatitis B virus infection (n = 555 [27.1%]), and noncirrhotic hepatitis C virus infection (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%. Conclusions: 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, which are key characteristics of a screening test.

AB - Purpose: 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. Methods: 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. Results: The most common indications for HCC screening were cirrhosis (n = 1,054 [51.4%]), noncirrhotic hepatitis B virus infection (n = 555 [27.1%]), and noncirrhotic hepatitis C virus infection (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%. Conclusions: 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, which are key characteristics of a screening test.

KW - hepatocellular carcinoma

KW - LI-RADS

KW - screening

KW - surveillance

KW - Ultrasound

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DO - 10.1016/j.jacr.2019.05.020

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SN - 1558-349X

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