ACR Appropriateness Criteria(R) Chronic Liver Disease

UMMS Affiliation

Department of Radiology

Publication Date


Document Type



Diagnosis | Digestive System Diseases | Health Services Administration | Neoplasms | Radiology | Therapeutics


The liver fibrosis stage is the most important clinical determinate of morbidity and mortality in patients with chronic liver diseases. With newer therapies, liver fibrosis can be stabilized and possibly reversed, thus accurate diagnosis and staging of liver fibrosis are clinically important. Ultrasound, CT, and conventional MRI can be used to establish the diagnosis of advanced fibrosis/cirrhosis but have limited utility for assessing earlier stages of fibrosis. Elastography-based ultrasound and MRI techniques are more useful for assessment of precirrhotic hepatic fibrosis. In patients with advanced fibrosis at risk for hepatocellular carcinoma (HCC), ultrasound is the surveillance modality recommended by international guidelines in nearly all circumstances. However, in patients in whom ultrasound does not assess the liver well, including those with severe steatosis or obesity, multiphase CT or MRI may have a role in surveillance for HCC. Both multiphase CT and MRI can be used for continued surveillance in patients with a history of HCC, and contrast-enhanced ultrasound may have an emerging role in this setting. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.


AUC, Appropriate Use Criteria, Appropriateness Criteria, Cirrhosis, Elastography, Fibrosis, Hepatocellular carcinoma, Imaging, Liver disease

DOI of Published Version



Expert Panel on Gastrointestinal Imaging, Bashir MR, Horowitz JM, Kamel IR, Arif-Tiwari H, Asrani SK, Chernyak V, Goldstein A, Grajo JR, Hindman NM, Kamaya A, McNamara MM, Porter KK, Solnes LB, Srivastava PK, Zaheer A, Carucci LR. ACR Appropriateness Criteria® Chronic Liver Disease. J Am Coll Radiol. 2020 May;17(5S):S70-S80. doi: 10.1016/j.jacr.2020.01.023. PMID: 32370979. Link to article on publisher's site

Journal/Book/Conference Title

Journal of the American College of Radiology : JACR


Full author list omitted for brevity. For the full list of authors, see article.

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Link to Article in PubMed

PubMed ID