Fig 1.

Algorithm for LI-RADS Eligibility Assessment. Patients were eligible if they had cirrhosis by pathology, imaging, or laboratory analysis. If background liver tissue was available to the interpreting pathologist, this assessment was preferentially used for risk status assessment. Notably, patients with fibrosis but without cirrhosis were excluded [20, 21]. If no background liver tissue was available (i.e., pathology specimen included mass only), patients were considered cirrhotic if the interpreting radiologist felt that the liver exhibited unequivocal surface nodularity. Because the assessment of cirrhosis by imaging provides a high degree of specificity (77.4-99%) but somewhat limited sensitivity (59-93%) [32], If the patient did not have cirrhosis on imaging, laboratory values (if available) were used to calculate a FIB-4 score. Patients with a FIB-4 greater than 3.25 were considered to have cirrhosis, as a FIB-4 > 3.25 specificity of 97% for the detection of advanced fibrosis [36]. Patients with chronic hepatitis B viral infection were included regardless of their cirrhosis status [20, 21]. Patients younger than 18 or with cirrhosis due to congenital hepatic fibrosis or other vascular disorders were excluded.