Variant 1: Indeterminate >1 cm lesion on initial imaging with ultrasound. Normal liver. (No suspicion or evidence of extrahepatic malignancy or underlying liver disease.)
Variant 2: Indeterminate >1 cm lesion on initial imaging with CT (without or with contrast). Normal liver. (No suspicion or evidence of extrahepatic malignancy or underlying liver disease.)
Variant 3: Indeterminate >1 cm lesion on initial imaging with noncontrast-enhanced MRI. Normal liver. (No suspicion or evidence of extrahepatic malignancy or underlying liver disease.)
Variant 4: Indeterminate >1 cm lesion on initial imaging with ultrasound. Known history of an extrahepatic malignancy.
Variant 5: Indeterminate >1 cm lesion on initial imaging with CT (without or with contrast). Known history of an extrahepatic malignancy.
Variant 6: Indeterminate >1 cm lesion on initial imaging with noncontrast-enhanced MRI. Known history of an extrahepatic malignancy.
Variant 7: Indeterminate >1 cm lesion on initial imaging with ultrasound. Known or suspected liver disease associated with a high risk of hepatocellular carcinoma (chronic hepatitis, cirrhosis, hemochromatosis, etc.)
Variant 8: Indeterminate >1 cm lesion on initial imaging with CT (without or with contrast). Known or suspected liver disease associated with a high risk of hepatocellular carcinoma (chronic hepatitis, cirrhosis, hemochromatosis, etc.)
Variant 9: Indeterminate >1 cm lesion on initial imaging with noncontrast-enhanced MRI. Known or suspected liver disease associated with a high risk of hepatocellular carcinoma (chronic hepatitis, cirrhosis, hemochromatosis, etc.)
Variant 10: Indeterminate <1 cm lesion on initial imaging with ultrasound. Normal liver. (No suspicion or evidence of extrahepatic malignancy or underlying liver disease.)
Variant 11: Indeterminate <1 cm lesion on initial imaging with CT (without or with contrast). Normal liver. (No suspicion or evidence of extrahepatic malignancy or underlying liver disease.)
Variant 12: Indeterminate <1 cm lesion on initial imaging with noncontrast-enhanced MRI. Normal liver. (No suspicion or evidence of extrahepatic malignancy or underlying liver disease.)
Variant 13: Indeterminate <1 cm lesion on initial imaging with ultrasound. Known history of an extrahepatic malignancy.
Variant 14: Indeterminate <1 cm lesion on initial imaging with CT (without or with contrast). Known history of an extrahepatic malignancy.
Variant 15: Indeterminate <1 cm lesion on initial imaging with noncontrast-enhanced MRI. Known history of an extrahepatic malignancy.
Variant 16: Indeterminate <1 cm lesion on initial imaging with ultrasound. Known or suspected liver disease associated with a high risk of hepatocellular carcinoma (chronic hepatitis, cirrhosis, hemochromatosis, etc.)
Variant 17: Indeterminate <1 cm lesion on initial imaging with CT (without or with contrast). Known or suspected liver disease associated with a high risk of hepatocellular carcinoma (chronic hepatitis, cirrhosis, hemochromatosis, etc.)
Variant 18: Indeterminate <1 cm lesion on initial imaging with noncontrast-enhanced MRI. Known or suspected liver disease associated with a high risk of hepatocellular carcinoma (chronic hepatitis, cirrhosis, hemochromatosis, etc.)
Appendix Key

A more complete discussion of the items presented below can be found by accessing the supporting documents at the designated hyperlinks.

Appropriateness Category:The panel’s recommendation for a procedure based on the assessment of the risks and benefits of performing the procedure for the specified clinical scenario.

SOE: Strength of Evidence. The assessment of the amount and quality of evidence found in the peer reviewed medical literature for an appropriateness recommendation.

  • References: The citation number and PMID for the reference(s) associated with the recommendation.
  • Study Quality: The assessment of the quality of an individual reference based on the number of study quality elements described in the reference.

RRL: Relative Radiation Level. A population based assessment of the amount of radiation a typical patient may be exposed to during the specified procedure.

Rating: The final rating (1-9 scale) for the procedure as determined by the panel during rating rounds.

Median: The median rating (1-9 scale) for the procedure as determined by the panel during rating rounds.

Final tabulations: A histogram showing the number of panel members who rated the procedure as noted in the column heading (ie, 1, 2, 3, etc.).

Additional supporting documents about the AC methodology and processes can be found at www.acr.org/ac.