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Does quantitative assessment of arterial phase hyperenhancement and washout improve LI-RADS v2018–based classification of liver lesions?

  • Gastrointestinal
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

To compare interreader agreement and diagnostic accuracy of LI-RADS v2018 categorization using quantitative versus qualitative MRI assessment of arterial phase hyperenhancement (APHE) and washout (WO) of focal liver lesions.

Methods

Sixty patients (19 female; mean age, 56 years) at risk for HCC with 71 liver lesions (28 HCCs, 43 benign) who underwent contrast-enhanced MRI were included in this retrospective study. Four blinded radiologists independently assigned a qualitative LI-RADS score per lesion. Two other radiologists placed ROIs within the lesion, adjacent liver parenchyma, and paraspinal musculature on pre- and post-contrast MR images. The percentage of arterial enhancement and the liver-to-lesion contrast ratio were calculated for quantification of APHE and WO. Using these quantitative parameters, a quantitative LI-RADS score was assigned. Interreader agreement and AUCs were calculated.

Results

Interreader agreement was similar for qualitative and quantitative LI-RADS (κ = 0.38 vs. 0.40–0.47) with a tendency towards improved agreement for quantitatively assessed APHE (κ = 0.65 vs. 0.81) and WO (κ = 0.53 vs. 0.78). Qualitative LI-RADS showed an AUC of 0.86, 0.94, 0.94, and 0.91 for readers 1, 2, 3, and 4, respectively. The quantitative LI-RADS score where APHE/WO/or both were replaced showed an AUC of 0.89/0.84/0.89, 0.95/0.92/0.92, 0.93/0.91/0.89, and 0.91/0.86/0.88 for readers 1, 2, 3, and 4, respectively. Sensitivity of LR-4/5 slightly increased, while specificity slightly decreased using quantitative APHE.

Conclusion

Qualitative and quantitative LI-RADS showed similar performance. Quantitatively assessed APHE showed the potential to increase interreader agreement and sensitivity of HCC diagnosis, whereas quantitatively assessed WO had the opposite effect and needs to be redefined.

Key Points

• Quantitative assessment of arterial phase hyperenhancement shows the potential to increase interreader agreement and sensitivity to diagnose hepatocellular carcinoma.

• Adding quantitative measurements of major LI-RADS features does not improve accuracy over qualitative assessment alone according to the LI-RADS v2018 algorithm.

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Abbreviations

APHE:

Arterial phase hyperenhancement

AUC:

Area under curve

CM:

Contrast media

CT:

Computed tomography

HCC:

Hepatocellular carcinoma

IQR:

Interquartile range

LI-RADS:

Liver Imaging Reporting and Data System

LLCR:

Lesion-to-liver contrast ratio

MRI:

Magnetic resonance imaging

PAE:

Percentage of arterial enhancement

ROC:

Receiver operating characteristic

ROI(s):

Regions of interest(s)

SI:

Signal intensity

TACE:

Transarterial chemoembolization

WO:

Washout

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Funding

The authors state that this work has not received any funding.

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Authors and Affiliations

  1. Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland

    Daniel Stocker, Anton S. Becker, Borna K. Barth, Stephan Skawran, Malwina Kaniewska, Olivio Donati & Caecilia S. Reiner

  2. University of Zurich, Raemistrasse 71, 8006, Zurich, Switzerland

    Daniel Stocker, Anton S. Becker, Borna K. Barth, Stephan Skawran, Malwina Kaniewska, Michael A. Fischer, Olivio Donati & Caecilia S. Reiner

  3. MRI Stadelhofen: Medizinisch Radiologisches Institut, Goethestrasse 18, 8001, Zurich, Switzerland

    Michael A. Fischer

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  1. Daniel Stocker
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Corresponding author

Correspondence to Caecilia S. Reiner.

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Guarantor

The scientific guarantor of this publication is PD Dr. med. Caecilia S. Reiner

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors has significant statistical expertise.

Anton S. Becker, MD, PhD; Institute of Diagnostic and Interventional Radiology, University Hospital Zurich

Informed consent

The need for written informed consent was waived for this retrospective study.

Ethical approval

Institutional Review Board approval was obtained.

Study subjects or cohorts overlap

Some study subjects or cohorts have been previously reported in Eur J Radiol. 2017 Jan;86:33-40. doi: 10.1016/j.ejrad.2016.11.004. Epub 2016 Nov 3; and Acad Radiol. 2016 Sep;23(9):1145-53. doi: 10.1016/j.acra.2016.03.014. Epub 2016 May 9.

Methodology

• Retrospective

• Diagnostic or prognostic study

• Performed at one institution

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Stocker, D., Becker, A.S., Barth, B.K. et al. Does quantitative assessment of arterial phase hyperenhancement and washout improve LI-RADS v2018–based classification of liver lesions?. Eur Radiol 30, 2922–2933 (2020). https://doi.org/10.1007/s00330-019-06596-9

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  • DOI: https://doi.org/10.1007/s00330-019-06596-9

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