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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