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Multi-arterial phase MRI depicts inconsistent arterial phase hyperenhancement (APHE) subtypes in liver observations of patients at risk for hepatocellular carcinoma

  • Magnetic Resonance
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

According to LI-RADS, a major discriminating feature between hepatocellular carcinoma (HCC) and non-HCC malignancies is the subtype of arterial phase hyperenhancement (APHE). The aim of this study was to investigate whether APHE subtypes are consistent across multi-arterial phase (mHAP) MRI acquisitions while evaluating reader agreement. Secondarily, we investigated factors that may affect reader agreement for APHE subtype.

Methods

In this retrospective study, consecutive patients with liver cirrhosis and focal observations who underwent mHAP were included. Five radiologists reviewed MR images in 2 reading sessions. In reading session 1, individual AP series were reviewed and scored for presence of APHE and subtype. In reading session 2, readers scored observations’ major and ancillary features and LI-RADS category in the complete MRI examination. Reader agreement was calculated using Fleiss’ kappa for binary outcomes and Kendall’s coefficient of concordance for LI-RADS categories. Univariate mixed effects logistic regressions were performed to investigate factors affecting agreement.

Results

In total, 61 patients with 77 focal observations were analyzed. Of observations unanimously scored as having APHE, 27.7% showed both rim and nonrim subtypes on mHAP. Inter-reader agreement for APHE subtype ranged from 0.49 (95% CI: 0.33, 0.64) to 0.57 (95% CI: 0.40, 0.74) between reading sessions. Observation size had a trend level effect on rim APHE agreement (p = 0.052).

Conclusion

Approximately 1/3 of observations demonstrated inconsistent APHE subtype during mHAP acquisition. Small lesions were particularly challenging. Further guidance on APHE subtype classification, especially when applied to mHAP, could be a focus of LI-RADS refinement.

Key Points

• In a cohort of patients at risk for HCC, 28% of the observations showed inconsistent arterial phase hyperenhancement (APHE) subtypes (rim and nonrim) on multi-arterial phase imaging according to the majority score of 5 independent readers.

• Inconsistent APHE subtypes may challenge reliable imaging diagnosis, i.e., LI-RADS categorization, of focal liver observations in patients at risk for HCC.

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Abbreviations

HCC:

Hepatocellular carcinoma

HIPAA:

Health Insurance Portability and Accountability Act

LI-RADS:

Liver Imaging Reporting and Data System

mHAP:

Multi-hepatic arterial phase

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Funding

This study was partially funded by epd12088-GE:SirlinA-22 grant.

Author information

Author notes

  1. Guilherme Moura Cunha and Kyle A. Hasenstab contributed equally to this work.

Authors and Affiliations

  1. Liver Imaging Group, Department of Radiology, University of California San Diego, La Jolla, CA, 92093, USA

    Guilherme Moura Cunha, Kyle A. Hasenstab, Timoteo Delgado, Claude B. Sirlin & Kathryn J. Fowler

  2. Department of Mathematics and Statistics, San Diego State University, San Diego, CA, 92182, USA

    Kyle A. Hasenstab

  3. Department of Radiology, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, 409-3898, Japan

    Shintaro Ichikawa

  4. Soonchunhyang University Bucheon Hospital, 170 Jomaru-ro, Jung 1(il)-dong, Bucheon-si, Gyeonggi-do, South Korea

    Min Hee Lee

  5. ABC Medical Center, Av. Carlos Fernández Graef 154, Santa Fe, Contadero, Cuajimalpa de Morelos, 05330, Ciudad de México, CDMX, Mexico

    Paulette M. Dautt Medina

  6. National Cancer Center, 809 Madu 1(il)-dong, Ilsandong-gu, Goyang-si, Gyeonggi-do, South Korea

    Soo Jin Kim

  7. Wonkwang University Hospital, 895 Muwang-ro, Iksan-si, Jeollabuk-do, South Korea

    Young-Hwan Lee

  8. Department of Radiology, Dong-A University Hospital, Dong-A University College of Medicine, 26, Daesingongwon-ro, Seo-gu, Busan, 49201, South Korea

    Heejin Kwon

Authors
  1. Guilherme Moura Cunha
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  2. Kyle A. Hasenstab
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  3. Timoteo Delgado
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  4. Shintaro Ichikawa
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  6. Paulette M. Dautt Medina
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  7. Soo Jin Kim
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  8. Young-Hwan Lee
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  9. Heejin Kwon
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  10. Claude B. Sirlin
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  11. Kathryn J. Fowler
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Corresponding author

Correspondence to Guilherme Moura Cunha.

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Guarantor

All authors take public responsibility for the content of this work. The data is also available by request to Dr Guilherme Moura Cunha, MD, the scientific guarantor of this publication.

Conflict of interest

CBS has received research grants from Foundation of NIH, Bayer Pharmaceutics, GE Healthcare, Gilead Sciences Inc., Philips, and Siemens. He also has consulting agreements with Blade, Boehringer, and Epigenomics and consulting agreements under auspices of University of California with AMRA, BMS, Exact Sciences, GE Digital, and IBM-Watson.

KJF has received research grants from Foundation of NIH, Bayer Pharmaceutics, GE Healthcare, and Siemens. She has consulting agreements with Bayer Pharmaceutics and Epigenomics.

All other authors involved in this work have no conflicts of interest or industry support to disclose with regard to the current manuscript. This includes financial or personal relationships that inappropriately influence his or her actions within 3 years of the work beginning submitted.

Statistics and biometry

One of the authors (KH) has significant statistical expertise.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• retrospective

• cross-sectional observational study

• performed at one institution

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Cunha, G.M., Hasenstab, K.A., Delgado, T. et al. Multi-arterial phase MRI depicts inconsistent arterial phase hyperenhancement (APHE) subtypes in liver observations of patients at risk for hepatocellular carcinoma. Eur Radiol 31, 7594–7604 (2021). https://doi.org/10.1007/s00330-021-07924-8

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  • DOI: https://doi.org/10.1007/s00330-021-07924-8

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