ACR Appropriateness Criteria(R) Liver Lesion-Initial Characterization

UMMS Affiliation

Department of Radiology

Publication Date


Document Type



Analytical, Diagnostic and Therapeutic Techniques and Equipment | Digestive System Diseases | Health Services Administration | Neoplasms | Radiology


Incidental liver masses are commonly identified on imaging performed for other indications. Since the prevalence of benign focal liver lesions in adults is high, even in patients with primary malignancy, accurate characterization of incidentally detected lesions is of paramount clinical importance. This document reviews utilization of various imaging modalities for characterization of incidentally detected liver lesions, discussed in the context of several clinical scenarios. For each clinical scenario, a summary of current evidence supporting the use of a given diagnostic modality is reported. 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, Hepatocellular carcinoma, Liver lesion, Liver mass, Liver metastases, Liver nodule

DOI of Published Version



Expert Panel on Gastrointestinal Imaging, Chernyak V, Horowitz JM, Kamel IR, Arif-Tiwari H, Bashir MR, Cash BD, Farrell J, Goldstein A, Grajo JR, Gupta S, Hindman NM, Kamaya A, McNamara MM, Porter KK, Solnes LB, Srivastava PK, Zaheer A, Carucci LR. ACR Appropriateness Criteria® Liver Lesion-Initial Characterization. J Am Coll Radiol. 2020 Nov;17(11S):S429-S446. doi: 10.1016/j.jacr.2020.09.005. PMID: 33153555. 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