Ultrasound liver imaging reporting and data system^®: Considerations for routine practice

Hepatocellular carcinoma (HCC) is a growing problem worldwide. In Australia, both the incidence and mortality of HCC have sharply increased over the last few decades. Unless detected in its early stage, prognosis of HCC is grim. Ultrasound represents the main screening tool for surveillance programmes worldwide and is recommended in the guidelines by all relevant bodies. The American College of Radiology introduced the first edition of Ultrasound Liver Imaging Reporting and Data System (US LI-RADS) in 2017 to propose an algorithm for reporting ultrasound studies performed in the setting of HCC screening and to provide technical recommendations. The algorithm has two components: detection scores and visualisation scores. More recently at our institution, we introduced a visualisation score to our routine work to assess visualisation of the liver. The score, which is applied by the sonographer performing the ultrasound study at the time of examination, comprises three categories that are not dissimilar to the score introduced by US LI-RADS; adequate, adequate with limitations and inadequate. We believe that adopting a visualisation score is easy and important. It provides clinicians with information regarding the quality of the ultrasound study and the confidence in excluding HCC based on ultrasound alone. Attempts to improve ultrasound screening efficiency such as applying targeted liver ultrasounds and recording of a visualisation score are encouraged with the aim of improving patients' outcomes.