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Abstract #1072

Long-Term Prognosis of Indeterminate Lesions in the Cirrhotic Liver: Insights from the LI-RADS 3 Neutral Category

Aymen Bahsoun1, Juliana Ramirez2, Meredith Reed3, Radhika Rajeev1, Reve Chahine1, Vikas Gulani1, Mishal Mendiratta-Lala1, Anum Aslam1, Shane Wells1, and Hero Hussain1
1Radiology, University of Michigan, Ann Arbor, MI, United States, 2University of Michigan Medical School, Ann Arbor, MI, United States, 3University of Toledo, Toledo, OH, United States

Synopsis

Keywords: Liver, Liver, Hepatocelullar Carcinoma

Motivation: Managing LI-RADS 3 (LR-3) liver observations is challenging due to high variability in risk of progression to hepatocellular carcinoma (HCC), leading to difficulties in management and costly follow-up imaging.

Goal(s): To identify imaging and clinical factors predicting LR-3 observation progression to LR-5.

Approach: A retrospective chart review and multivariable competing risk analysis were conducted on patients with LR-3 observations, evaluating outcomes based on characteristics and clinical factors.

Results: In 427 patients with 795 LR-3 lesions, 26% of lesions were upgraded and 58% downgraded. Size, ancillary features, prior liver directed therapy, and coexisting lesions were predictors of LR-3 upgrade.

Impact: The findings including key predictors of LR-3 lesion progression such as post-treatment liver status, larger lesion size, co-existence of other LR3+ lesions, older age, and alcoholic cirrhosis—offer guidance for personalized surveillance intervals and efficient resource allocation for HCC-risk patients.

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