P71 Standardising hepatocellular carcinoma ultrasound surveillance: integration of US LI-RADS into clinical practice

<h3>Introduction</h3> In the UK, national standards recommend 6-monthly ultrasound surveillance for patients with cirrhosis to detect early-stage hepatocellular carcinoma (HCC).¹ The Ultrasound Liver Imaging Reporting and Data System (US LI-RADS) is a framework to standardise US reporting in HCC surveillance. Images are categorised by visualisation: VIS-A (no/minimal limitations), VIS-B (moderate limitation), or VIS-C (severe limitation) and observation: US-1 (no lesions), US-2 (observation &lt;10mm; short-interval scan), or US-3 (observation &gt;=10mm/new thrombus; contrast-enhanced imaging).² This study reviewed the implementation of US LI-RADS at the Newcastle-upon-Tyne Foundation Trust following its adoption in September 2024. <h3>Methods</h3> All HCC surveillance ultrasounds performed between September 2024 and May 2025 were analysed. Electronic patient records were used to review the actions taken for any scans with suboptimal visualisation (non-VIS-A) or significant observations (non-US-1). <h3>VIS-Score Results</h3> A total of 1152 HCC surveillance ultrasound scans were reported in the analysis period. VIS-A and VIS-B score was reported in 74% (n=848) and 22% (n=254) of cases respectively. VIS-C occurred in 4% (n=50) cases, of these, 62% (n=31) were referred for further imaging within 3-months. <h3>US-Score Results</h3> US-2 score was reported in 2.4% of cases (n=28), with 43% of these (n=12) referred for repeat US within 3-months. 39% (n=11) had contrast-enhanced imaging, despite 73% (n=8) of these having VIS-A scores reported in their original US. In 14% (n=4) of cases with an original US-2 score, 6-monthly US screening was reinstated, following stable observations across scans. US-3 observation was reported in 2.2% (n=25) of cases. All US-3 cases were referred for contrast enhanced imaging, irrespective of VIS score. MRI liver was performed in 52% (n=13) cases, contrast-enhanced ultrasound in 24% (n=6) and CT in 20% (n=5). No HCCs have been diagnosed from the US-3 scans at the time of analysis, but 24% (n=6) have requested further imaging pending. <h3>Conclusions</h3> The majority of HCC surveillance US scans using LI-RADS standardisation report no/minimal limitations, comparable to published data in the United States (VIS-A=76.8%).³ For severe limitations, clinical practice varies significantly on follow-up imaging interval and modality. US-3 observations consistently prompt alternative imaging, aligning with international standards.² Our analysis showed varied current practice for US-2 findings; many patients had contrast-enhanced imaging after one US-2 result, rather than repeat US at 3–6 months as per LI-RADS standards. This potentially reflects low clinician confidence with LI-RADS guidance. Long-term US-2/VIS-C outcome data and subsequent education are needed for standardised patient follow-up and optimal resource use. <h3>References</h3> National Institute for Health and Care Excellence (NICE). Quality standard [QS152]: Chronic liver disease – Surveillance for hepatocellular carcinoma. NICE. Updated July 2017. Accessed June 2, 2025. https://www.nice.org.uk/guidance/qs152/chapter/Qualitystatement-4-Surveillance-for-hepatocellular-carcinoma American College of Radiology. Liver Imaging Reporting and Data System (LI-RADS). <i>American College of Radiology</i> 2011. Accessed June 2, 2025. https://www.acr.org/Clinical-Resources/Reporting-and-Data-Systems/LI-RADS American College of Radiology. ACR Ultrasound Liver Reporting and Data System. <i>J Am. Coll Radiol.</i> 2019;16(10):1421–1428. doi:10.1016/j.jacr.2019.06.015.