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Am Coll Radiol. 2020 Nov;17(11S):S429-S446.doi: 10.1016/j.jacr.2020.09.005.
Expert Panel on Gastrointestinal Imaging; Victoria Chernyak1, Jeanne M Horowitz2, Ihab R Kamel3, Hina Arif-Tiwari4, Mustafa R Bashir5, Brooks D Cash6, James Farrell7, Alan Goldstein8, Joseph R Grajo9, Samir Gupta10, Nicole M Hindman11, Aya Kamaya12, Michelle M McNamara13, Kristin K Porter13, Lilja Bjork Solnes14, Pavan K Srivastava15, Atif Zaheer16, Laura R Carucci17
Author information
1Montefiore Medical Center, Bronx, New York. Electronic address: vichka17@hotmail.com.
3Panel Chair, Johns Hopkins University School of Medicine, Baltimore, Maryland.
4University of Arizona, Banner University Medical Center, Tucson, Arizona.
5Duke University Medical Center, Durham, North Carolina.
6University of Texas Health Science Center at Houston and McGovern Medical School, Houston, Texas; American Gastroenterological Association.
7Interventional Endoscopy and Pancreatic Diseases, New Haven, Connecticut; American Gastroenterological Association.
8UMass Medical School, Worcester, Massachusetts.
9University of Florida College of Medicine, Gainesville, Florida.
10Rush University Medical Center, Chicago, Illinois; American College of Surgeons.
11New York University Medical Center, New York, New York.
12Stanford University Medical Center, Stanford, California.
13University of Alabama Medical Center, Birmingham, Alabama.
14Johns Hopkins Bayview Medical Center, Baltimore, Maryland.
15University of Illinois College of Medicine, Chicago, Illinois; American College of Physicians.
16Johns Hopkins Hospital, Baltimore, Maryland.
17Specialty Chair, Virginia Commonwealth University Medical Center, Richmond, Virginia.
Abstract
Incidental liver masses are commonly identified on imaging performed for other indications. Since the prevalence of benign focal liver lesions in adults is high, even in patients with primary malignancy, accurate characterization of incidentally detected lesions is of paramount clinical importance. This document reviews utilization of various imaging modalities for characterization of incidentally detected liver lesions, discussed in the context of several clinical scenarios. For each clinical scenario, a summary of current evidence supporting the use of a given diagnostic modality is reported. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.