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Does a combined CT and MRI protocol enhance the diagnostic efficacy of LI-RADS in the categorization of hepatic observations? A prospective comparative study

  • Hepatobiliary-Pancreas
  • Published:
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Abstract

Objective

To compare diagnostic performance and agreement between CT, MRI and combined CT/MRI in reference to LI-RADS classification system to categorize hepatic observations detected in hepatic patients during screening ultrasound.

Methods

240 patients with 296 liver observations detected during ultrasound surveillance underwent hepatic CT and MRI examinations, histopathology, and clinical and radiological follow-up. Using LI-RADS v2014, six radiologists evaluated the observations independently and assigned a LI-RADS category to each observation using CT, MRI and combined CT/MRI.

Results

Combined CT and MRI in LI-RADS yielded better accuracy (91.29 %), sensitivity (90.71 %) and specificity (92.31 %) for hepatocellular carcinoma (HCC) diagnosis than using MRI or CT alone; accuracy, sensitivity and specificity decreased to 85.37 %, 86.34 %, and 83.65 %, respectively, for MRI and 67.6 %, 54.10 % and 91.35 %, respectively, for CT. The intraclass agreement of the LI-RADS scores between CT, MRI and combined CT/MRI was excellent (κ=0.9624 (95 % CI: 0.9318–0.9806)).

Conclusion

CT and MRI are complementary to each other. Combined CT/MRI enabled a more precise determination of LI-RADS category of hepatic observations; however, due to the expense and minor increase in accuracy, the combined methodology should only be utilized in cases of suspected HCC.

Key Points

• Hepatic observation may be categorized differently depending on the imaging modality used.

• We compared LI-RADS categorization between CT, MRI and combined CT/MRI.

• MRI produces higher accuracy and sensitivity, while CT produces higher specificity.

• Combining CT and MRI improves LIRADS categorization reports.

• Considering additional cost, combined methodology could be restricted to challenging cases.

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Abbreviations

AUC:

Area under the ROC curve

CI:

Confidence interval

CT:

Computed tomography

DWI:

Diffusion-weighted image

HCC:

Hepatocellular carcinoma

HU:

Hounsfield units

LI-RADS:

Liver Imaging Reporting and Data System

MDCT:

Multidetector computed tomography

MRI:

Magnetic resonance imaging

ROC:

Receiver operating characteristic

US:

Ultrasound

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Acknowledgements

The authors thank Prof. Khalid Lakouz, Prof. Ahmad Sabry and Dr. Mohammad Hisham for their assistance with the medical illustrations and image preparation. In addition, they express great gratitude to all staff members and colleagues in Radiology department-Zagazig University for their helpful cooperation.

Funding

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

Author information

Authors and Affiliations

  1. Department of Diagnostic Radiology, Zagazig University, Zagazig, Egypt

    Mohammad Abd Alkhalik Basha, Mohamad Zakarya AlAzzazy, Ayman F. Ahmed, Hala Y. Yousef, Samar Mohamad Shehata & Dena Abd El Aziz El Sammak

  2. Department of Tropical Medicine, Zagazig University, Zagazig, Egypt

    Talaat Fathy

  3. Department of Clinical Oncology, Zagazig University, Zagazig, Egypt

    Ahmed Ali Obaya

  4. Department of Pathology, Zagazig University, Zagazig, Egypt

    Eman H. Abdelbary

Authors
  1. Mohammad Abd Alkhalik Basha
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  2. Mohamad Zakarya AlAzzazy
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Corresponding author

Correspondence to Mohammad Abd Alkhalik Basha.

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Guarantor

The scientific guarantor of this publication is Mohammad Abd Alkhalik Basha, Radiology Department, Zagazig University, Egypt.

Conflict of interest

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

Statistics and biometry

The corresponding author has great statistical expertise

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Institutional review boards approval was obtained.

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Written informed consent was obtained from all patients.

Methodology

• Prospective.

• Diagnostic or prognostic study.

• Performed at multiple centres.

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Basha, M.A.A., AlAzzazy, M.Z., Ahmed, A.F. et al. Does a combined CT and MRI protocol enhance the diagnostic efficacy of LI-RADS in the categorization of hepatic observations? A prospective comparative study. Eur Radiol 28, 2592–2603 (2018). https://doi.org/10.1007/s00330-017-5232-y

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  • DOI: https://doi.org/10.1007/s00330-017-5232-y

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