Benefits of LI-RADS® Reporting in Abdominal Ultrasound

As ultrasound makes more and more inroads into primary care, abdominal scans are amongst the most common scans being offered in general practitioners' (GPs') offices.1 2 They can help to detect pathology in kidneys, pancreas, and gallbladder. Most notably, they can help with lesion assessment of the liver. For patients who are being evaluated for or diagnosed with liver disease, ultrasound enables GPs to provide confident diagnosis and helps them plan better treatment going forward.2  

The Liver Imaging Reporting & Data System (LI-RADS®) can help standardize reporting in liver ultrasound, specifically working to identify lesions and characterizing their properties as they appear. Developed and supported by the American College of Radiology (ACR), LI-RADS is designed to improve communication, patient care, education, and research. It can be used by radiologists, GPs, and any other healthcare professional involved in the diagnosis and treatment of liver lesions to ensure clinical consensus and alignment of decision-making regarding post-scan treatment or management. 

One of the recent updates to the LI-RADS guidelines includes that, whenever possible, surveillance ultrasound of the liver should be conducted in outpatient settings,3 such as primary care offices. This makes it an especially important and helpful tool for GPs who are looking to offer the convenience and promptness of performing scans within their practices rather than referring their patients to specialists.  

How are LI-RADS scores determined? 

In determining the risk of cancerous tissue, LI-RADS scoring is generally broken down into three primary categories: 

1. LI-RADS 1 - This score means there is no evidence of cancer and is usually followed by a recommendation for a follow-up scan six months after the original ultrasound. 

2. LI-RADS 2 - This score means that a small mass less than one centimeter in size has been detected. LI-RADS 2 scores call for a follow-up scan within three to six months. 

3. LI-RADS 3 - This score means a large mass of more than one centimeter in size has been identified, and further imaging with contrast is recommended. LI-RADS scores of three are generally referred to a radiologist or imaging specialist. 

Another important element of LI-RADS reporting is that it's able to inform other clinicians who are reviewing results of the expected sensitivity of the ultrasound examination-based homogeneity of liver, beam attenuation or shadowing and amount of liver visualized on ultrasound during the exam. Liver visualization scores for ultrasound range from A to C: 

• A = No or minimal limitations 

• B = Moderate limitations 

• C = Severe limitations 

Knowing these visibility variables will help physicians determine if further imaging is needed or if they're able to proceed confidently with the development of a treatment plan. 

Hepatocellular Carcinoma (HCC) is one of the most common types of primary liver malignancy and the third leading cause of cancer-related mortality around the world. Early and accurate detection is critical to improving treatment outcomes and has been shown to increase survivability and quality of life.4 It can also help reduce the need for invasive biopsy. 

How can LI-RADS improve abdominal ultrasound? 

LI-RADS reporting enriches the abdominal ultrasound process in multiple ways, including: 

Improving diagnostic confidence for new users - Having a condensed, practical, and universally applied set of guidelines gives clinicians a roadmap for what to look for in liver lesions and how to proceed with treatment. LI-RADS can dramatically simplify liver scan assessment and further empower GPs in their patients' treatment. 

When interpreting studies in patients at risk for HCC, newer readers are often less consistent in reporting.5  LI-RADS may help close the gap between clinicians with less experience in liver imaging and those with significant expertise in liver imaging.6 

Less reader variability of scan results - Consensus between GPs and radiologists, and any other care provider who will be reading scan results is critical to ensure everyone is on the same page. Reader variability is often high with liver scans, and LI-RADS can provide the standardization necessary to increase consensus. 

This improved communication and collaboration can accelerate care, facilitate scan comparison at all stages of the treatment journey, and improve outcomes. Its two-pronged approach of HCC risk assessment and visibility variable reporting lets readers at all stages of the scan understand how to proceed. 

Greater understanding and convenience for patients - By integrating LI-RADS reporting into the abdominal scan process, GPs have a clear and simplified way to explain the significance of the diagnosis and give patients the best information available as they move forward with treatment. Breaking things down with a simple, standardized scale can help patients more readily comprehend their prognosis. 

Leveraging LI-RADS with the right ultrasound system 

LI-RADS has proven helpful in augmenting the quality and accuracy of abdominal ultrasound, but it's important that you have a system that can leverage its benefits and ensure proper utilization. 

The right system will have features like anatomy-specific preset packages that leverage LI-RADS® to make it considerably easier to create and share reports. The system should also offer time-saving software packages specifically for liver assessment, voice command features that can enrich reporting, and robust training and education to help new users better understand these functionalities. 

These tools help users generate and read LI-RADS reports and share accurate and easily understandable scan results with other members of patients' care teams. 

As liver ultrasound becomes increasingly democratized among different segments of healthcare, new users need a layer of support, education, and context that LI-RADS provides. While moderate variability and learning curves persist, LI-RADS helps to standardize the scan process in ways that are vital to patients and providers alike. 

Having a system that can properly coordinate and utilize LI-RADS reporting is a benefit for any clinician who will be performing abdominal scans to reduce imaging interpretation errors, enhance communication with referring clinicians, and facilitate continued quality assurance and scan efficacy. 

Learn more about primary care ultrasound systems with LI-RADS.  

RESOURCES 

6. Rich, N. E., & Chernyak, V. (2023). Standardizing liver imaging reporting and interpretation: LI-RADS and beyond. Hepatology communications, 7(7), e00186. https://doi.org/10.1097/HC9.0000000000000186 
   
   

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