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Abstract Details
Dynamic Changes in Ultrasound Quality for Hepatocellular Carcinoma Screening in Patients With Cirrhosis
Clin Gastroenterol Hepatol. 2022 Jul;20(7):1561-1569.e4. doi: 10.1016/j.cgh.2021.06.012.Epub 2021 Jun 10.
1Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas; Parkland Health & Hospital System, Dallas, Texas.
2Department of Radiology, UT Southwestern Medical Center, Dallas, Texas.
3Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas.
4Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan.
5Department of Surgery, UT Southwestern Medical Center, Dallas, Texas.
6Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas; Parkland Health & Hospital System, Dallas, Texas. Electronic address: amit.singal@utsouthwestern.edu.
Abstract
Background & aims: Identifying patients in whom ultrasound may be inadequate to exclude the presence of hepatocellular carcinoma (HCC) can inform interventions to improve screening effectiveness. We aimed to characterize correlates of suboptimal ultrasound quality and changes in ultrasound quality over time in patients with cirrhosis undergoing HCC screening.
Methods: We performed a retrospective cohort study of patients with cirrhosis who underwent ultrasound examination at 2 large health systems between July 2016 and July 2019. Exam adequacy was graded by radiologists using the LI-RADS Visualization Score (A, B, C); we evaluated changes in visualization over time among patients with >1 ultrasound exams. We performed multivariable logistic regression to identify characteristics associated with limited ultrasound visualization (scores B or C).
Results: Of 2053 cirrhosis patients, 1685 (82.1%) had ultrasounds with score A, 262 (12.8%) had score B, and 106 (5.2%) had score C. Limited visualization was associated with alcohol-related or nonalcoholic fatty liver disease cirrhosis and presence of class II-III obesity. Among 1546 patients with >1 ultrasounds, 1129 (73.0%) had the same visualization score on follow-up (1046 score A, 60 score B, 23 score C). However, 255 (19.6%) of 1301 with score A at baseline had limited visualization when repeated (230 score B, 25 score C), and 130 (53.1%) of 245 patients with baseline limited visualization had good visualization when repeated.
Conclusions: Nearly 1 in 5 patients with cirrhosis had moderately-severely limited ultrasound visualization for HCC nodules, particularly those with obesity or alcohol-related or nonalcoholic fatty liver disease cirrhosis. Ultrasound quality can change between exams, including improvement in many patients with limited visualization.