Researchers find changes in ultrasound quality for HCC screening

Ultrasound quality changed between examinations for hepatocellular carcinoma detection in patients with cirrhosis, according to research published in Clinical Gastroenterology and Hepatology.

“While ultrasound remains the most cost-effective modality for screening, there are limitations associated with its use. One of the largest criticisms of ultrasound in HCC screening is variability in sensitivity, ranging between 32% and 89% when used alone,” Haley Schoenberger, MD, from The University of Texas Southwestern Medical Center, and colleagues wrote. “Although ultrasound visualization may remain stable over time, it is possible that it may vary between ultrasound exams given its operator dependent nature.”

In a retrospective cohort study, researchers evaluated 2,053 patients with cirrhosis (mean age 59.5 years; 58.1% men) who underwent repeat HCC screening to assess the quality of ultrasound measured by the Liver Imaging, Reporting and Data System (LI-RADS) Ultrasound Visualization Score. They further analyzed changes in visualization and identified characteristics associated with limited visualization.

According to LI-RADS Visualization Score, 82.1% of patients had ultrasounds with score A, 12.8% of patients had ultrasounds with score B and 5.2% of patients had ultrasounds with score C; limited visualization correlated with alcohol-related cirrhosis (OR = 2.69; 95% CI, 1.5-4.83) or NAFLD cirrhosis (OR = 2.54; 95% CI, 1.44-4.49) and class II obesity (OR = 2.57; 95% CI, 2.06-10.1) to class III obesity (OR= 9; 95% CI, 4.21-19.2). Of patients who underwent more than one ultrasound (n = 1,546), 73% had the same visualization score at follow-up while 19.6% of patients with score A at baseline had limited visualization when repeated and 53.1% of patients with limited visualization at baseline had improved visualization when screening was repeated.

“One in five patients with cirrhosis undergoing ultrasound exams have suboptimal liver visualization. ... However, exam quality was noted to change upon repeated ultrasound-based screening exams, with improvement in one-half of patients and worsening in one-fifth of patients among patients in whom ultrasound-based screening was repeated,” Schoenberger and colleagues concluded. “These data help identify patients at risk for ultrasound-based screening failure and the need for highly accurate alternative screening strategies.”