Association of advanced hepatic fibrosis and sonographic visualization score: a dual-center study using ACR US LI-RADS.

Purpose: To evaluate the association between imaging and clinical features and visualization scores, as specified by American College of Radiology (ACR) Ultrasound Liver Imaging Reporting and Data System (LI-RADS), on hepatocellular carcinoma (HCC) screening ultrasound examinations.
Methods: In this dual-center retrospective study, HCC screening ultrasound reports containing ultrasound elastography measurements (January to September, 2017) were reviewed. Ultrasound point shear wave elastography and 2-dimensional shear wave elastography were used to assess liver stiffness; median shear wave velocity was translated to METAVIR fibrosis scoring, per previously published data. Reports were analyzed for subject age, sex, reason for HCC screening, spleen size, fibrosis scores, and assigned ultrasound visualization scores. Jonckheere-Terpstra trend and Kendall's tau-b coefficient analyses were performed.
Results: 714 subjects (mean age 55; 51% male, 49% female) were included. 308 (43%) subjects had clinically declared cirrhosis; 406 (57%) did not. Majority (535, 75%) of exams were adequate (Visualization Score A), 156 (22%) moderately limited (Visualization Score B), and 23 (3%) severely limited (Visualization Score C). Increasing spleen size and patient age were associated with worsening visualization scores (p < 0.001). Suboptimal visualization was also associated with clinically significant fibrosis (≥ F2) by elastography (Kendall's tau-b = 0.181, p < 0.001) and clinically declared cirrhosis (Kendall's tau-b = 0.433, p < 0.001). There was no association with patient sex.
Conclusion: Using ACR Ultrasound LI-RADS visualization score assessment, majority (75%) of HCC screening exams were diagnostically adequate, and only 3% were severely limited. Sonoelastographic diagnosis of clinically significant fibrosis, as well as clinical cirrhosis, increased patient age, and spleen size, were associated with greater diagnostic limitations.