Rate of observation and inter-observer agreement for LI-RADS major features at CT and MRI in 184 pathology proven hepatocellular carcinomas

Eric Ehman, Spencer C. Behr, Sarah E. Umetsu, Nicholas Fidelman, Ben M. Yeh, Linda D. Ferrell, Thomas A. Hope

Research output: Contribution to journalArticle

33 Citations (Scopus)

Abstract

Purpose: To compare frequency and inter-reader agreement for LI-RADS v2014 major features at CT vs. MRI in pathology-proven cases of hepatocellular carcinoma. Methods: Pathology reports and imaging studies from patients having undergone liver transplant or hepatectomy for hepatocellular carcinoma were reviewed. Size, location, washout, and capsule appearance for each lesion were recorded by two radiologists. Cohen’s kappa and intraclass correlation coefficients (ICC) were calculated. Results: One hundred and thirty-four patients with 184 tumors were reviewed. Seventy-seven percentage of lesions were imaged by CT and 23% by MRI. No lesions were evaluated with both modalities. Mean lesion diameter was 2.6 ± 1.3 cm (ICC = 0.92). Arterial phase hyperenhancement was seen in 86% of lesions (κ = 0.75). Washout was seen in 82% of studies (κ = 0.61). Arterial phase hyperenhancement and washout were seen equally at CT and MRI (p = 1.00 and 0.46, respectively). Capsule was infrequently observed (27%) but was seen more commonly at MRI (44%) than at CT (17%) with p = 0.002 and (κ = 0.56). Forty-seven percent of lesions with at least one prior study met LI-RADS criteria for threshold growth. The rates of LI-RADS categories 3, 4, and 5 were 9%, 37%, and 54%, respectively. More 1–2 cm LI-RADS 5 lesions were seen at MRI (43%) than at CT (8%), p = 0.01. Conclusion: A combined LI-RADS 4/5 group was 91% sensitive for hepatocellular carcinoma. Arterial enhancement and washout were seen more frequently than capsule, the sole finding seen more frequently at MRI than at CT. Inter-reader reliability was substantial for arterial hyperenhancement and washout but moderate for capsule. Capsule remains an important finding in small arterially enhancing lesions (1–2 cm) which require a second major criterion to upgrade to a LI-RADS 5 lesion.

Original languageEnglish (US)
Pages (from-to)963-969
Number of pages7
JournalAbdominal Radiology
Volume41
Issue number5
DOIs
StatePublished - May 1 2016
Externally publishedYes

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Capsules
Hepatocellular Carcinoma
Observation
Pathology
Hepatectomy
Transplants
Liver
Growth
Neoplasms

Keywords

  • CT
  • Hepatocellular carcinoma
  • LI-RADS
  • MRI

ASJC Scopus subject areas

  • Radiological and Ultrasound Technology
  • Radiology Nuclear Medicine and imaging
  • Gastroenterology
  • Urology

Cite this

Rate of observation and inter-observer agreement for LI-RADS major features at CT and MRI in 184 pathology proven hepatocellular carcinomas. / Ehman, Eric; Behr, Spencer C.; Umetsu, Sarah E.; Fidelman, Nicholas; Yeh, Ben M.; Ferrell, Linda D.; Hope, Thomas A.

In: Abdominal Radiology, Vol. 41, No. 5, 01.05.2016, p. 963-969.

Research output: Contribution to journalArticle

Ehman, Eric ; Behr, Spencer C. ; Umetsu, Sarah E. ; Fidelman, Nicholas ; Yeh, Ben M. ; Ferrell, Linda D. ; Hope, Thomas A. / Rate of observation and inter-observer agreement for LI-RADS major features at CT and MRI in 184 pathology proven hepatocellular carcinomas. In: Abdominal Radiology. 2016 ; Vol. 41, No. 5. pp. 963-969.
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abstract = "Purpose: To compare frequency and inter-reader agreement for LI-RADS v2014 major features at CT vs. MRI in pathology-proven cases of hepatocellular carcinoma. Methods: Pathology reports and imaging studies from patients having undergone liver transplant or hepatectomy for hepatocellular carcinoma were reviewed. Size, location, washout, and capsule appearance for each lesion were recorded by two radiologists. Cohen’s kappa and intraclass correlation coefficients (ICC) were calculated. Results: One hundred and thirty-four patients with 184 tumors were reviewed. Seventy-seven percentage of lesions were imaged by CT and 23{\%} by MRI. No lesions were evaluated with both modalities. Mean lesion diameter was 2.6 ± 1.3 cm (ICC = 0.92). Arterial phase hyperenhancement was seen in 86{\%} of lesions (κ = 0.75). Washout was seen in 82{\%} of studies (κ = 0.61). Arterial phase hyperenhancement and washout were seen equally at CT and MRI (p = 1.00 and 0.46, respectively). Capsule was infrequently observed (27{\%}) but was seen more commonly at MRI (44{\%}) than at CT (17{\%}) with p = 0.002 and (κ = 0.56). Forty-seven percent of lesions with at least one prior study met LI-RADS criteria for threshold growth. The rates of LI-RADS categories 3, 4, and 5 were 9{\%}, 37{\%}, and 54{\%}, respectively. More 1–2 cm LI-RADS 5 lesions were seen at MRI (43{\%}) than at CT (8{\%}), p = 0.01. Conclusion: A combined LI-RADS 4/5 group was 91{\%} sensitive for hepatocellular carcinoma. Arterial enhancement and washout were seen more frequently than capsule, the sole finding seen more frequently at MRI than at CT. Inter-reader reliability was substantial for arterial hyperenhancement and washout but moderate for capsule. Capsule remains an important finding in small arterially enhancing lesions (1–2 cm) which require a second major criterion to upgrade to a LI-RADS 5 lesion.",
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T1 - Rate of observation and inter-observer agreement for LI-RADS major features at CT and MRI in 184 pathology proven hepatocellular carcinomas

AU - Ehman, Eric

AU - Behr, Spencer C.

AU - Umetsu, Sarah E.

AU - Fidelman, Nicholas

AU - Yeh, Ben M.

AU - Ferrell, Linda D.

AU - Hope, Thomas A.

PY - 2016/5/1

Y1 - 2016/5/1

N2 - Purpose: To compare frequency and inter-reader agreement for LI-RADS v2014 major features at CT vs. MRI in pathology-proven cases of hepatocellular carcinoma. Methods: Pathology reports and imaging studies from patients having undergone liver transplant or hepatectomy for hepatocellular carcinoma were reviewed. Size, location, washout, and capsule appearance for each lesion were recorded by two radiologists. Cohen’s kappa and intraclass correlation coefficients (ICC) were calculated. Results: One hundred and thirty-four patients with 184 tumors were reviewed. Seventy-seven percentage of lesions were imaged by CT and 23% by MRI. No lesions were evaluated with both modalities. Mean lesion diameter was 2.6 ± 1.3 cm (ICC = 0.92). Arterial phase hyperenhancement was seen in 86% of lesions (κ = 0.75). Washout was seen in 82% of studies (κ = 0.61). Arterial phase hyperenhancement and washout were seen equally at CT and MRI (p = 1.00 and 0.46, respectively). Capsule was infrequently observed (27%) but was seen more commonly at MRI (44%) than at CT (17%) with p = 0.002 and (κ = 0.56). Forty-seven percent of lesions with at least one prior study met LI-RADS criteria for threshold growth. The rates of LI-RADS categories 3, 4, and 5 were 9%, 37%, and 54%, respectively. More 1–2 cm LI-RADS 5 lesions were seen at MRI (43%) than at CT (8%), p = 0.01. Conclusion: A combined LI-RADS 4/5 group was 91% sensitive for hepatocellular carcinoma. Arterial enhancement and washout were seen more frequently than capsule, the sole finding seen more frequently at MRI than at CT. Inter-reader reliability was substantial for arterial hyperenhancement and washout but moderate for capsule. Capsule remains an important finding in small arterially enhancing lesions (1–2 cm) which require a second major criterion to upgrade to a LI-RADS 5 lesion.

AB - Purpose: To compare frequency and inter-reader agreement for LI-RADS v2014 major features at CT vs. MRI in pathology-proven cases of hepatocellular carcinoma. Methods: Pathology reports and imaging studies from patients having undergone liver transplant or hepatectomy for hepatocellular carcinoma were reviewed. Size, location, washout, and capsule appearance for each lesion were recorded by two radiologists. Cohen’s kappa and intraclass correlation coefficients (ICC) were calculated. Results: One hundred and thirty-four patients with 184 tumors were reviewed. Seventy-seven percentage of lesions were imaged by CT and 23% by MRI. No lesions were evaluated with both modalities. Mean lesion diameter was 2.6 ± 1.3 cm (ICC = 0.92). Arterial phase hyperenhancement was seen in 86% of lesions (κ = 0.75). Washout was seen in 82% of studies (κ = 0.61). Arterial phase hyperenhancement and washout were seen equally at CT and MRI (p = 1.00 and 0.46, respectively). Capsule was infrequently observed (27%) but was seen more commonly at MRI (44%) than at CT (17%) with p = 0.002 and (κ = 0.56). Forty-seven percent of lesions with at least one prior study met LI-RADS criteria for threshold growth. The rates of LI-RADS categories 3, 4, and 5 were 9%, 37%, and 54%, respectively. More 1–2 cm LI-RADS 5 lesions were seen at MRI (43%) than at CT (8%), p = 0.01. Conclusion: A combined LI-RADS 4/5 group was 91% sensitive for hepatocellular carcinoma. Arterial enhancement and washout were seen more frequently than capsule, the sole finding seen more frequently at MRI than at CT. Inter-reader reliability was substantial for arterial hyperenhancement and washout but moderate for capsule. Capsule remains an important finding in small arterially enhancing lesions (1–2 cm) which require a second major criterion to upgrade to a LI-RADS 5 lesion.

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