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

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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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Authors and Affiliations

  1. Department of Radiology and Biomedical Imaging, UCSF, 505 Parnassus Ave., San Francisco, CA, 94143-0628, USA

    Eric C. Ehman, Spencer C. Behr & Nicholas Fidelman

  2. Department of Pathology, UCSF, 505 Parnassus Ave., Room 580, San Franicsco, CA, 94143-0628, USA

    Sarah E. Umetsu

  3. Department of Radiology and Biomedical Imaging, UCSF, 513 Parnassus Ave., Med Sci Room M372, San Francisco, CA, 94143-0628, USA

    Ben M. Yeh

  4. Department of Pathology, UCSF, 505 Parnassus Ave., Moffitt Room 590A, San Francisco, CA, 94143-0628, USA

    Linda D. Ferrell

  5. Department of Radiology, VAMC San Francisco, 4150 Clement St., Room 2D007, San Francisco, CA, 94121, USA

    Thomas A. Hope

Authors
  1. Eric C. Ehman
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  2. Spencer C. Behr
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Correspondence to Eric C. Ehman.

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Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

Study performed with approval from UCSF Committee on Human Research (IRB) approval.

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Ehman, E.C., Behr, S.C., Umetsu, S.E. et al. Rate of observation and inter-observer agreement for LI-RADS major features at CT and MRI in 184 pathology proven hepatocellular carcinomas. Abdom Radiol 41, 963–969 (2016). https://doi.org/10.1007/s00261-015-0623-5

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  • DOI: https://doi.org/10.1007/s00261-015-0623-5

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