Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan Road 2, Guangzhou, 510080, People's Republic of China.
Departments of Hepatobiliary Surgery, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.
Eur Radiol. 2021 Sep;31(9):6758-6767. doi: 10.1007/s00330-021-07777-1. Epub 2021 Mar 6.
To investigate the inter-reader agreement of contrast-enhanced ultrasound (CEUS) of Liver Imaging Reporting and Data System version 2017 (LI-RADS v2017) categories among radiologists with different levels of experience.
From January 2014 to December 2014, a total of 326 patients at high risk of hepatocellular carcinoma (HCC) who underwent CEUS were included in this retrospective study. All lesions were classified according to LI-RADS v2017 by six radiologists with different levels of experiences: two residents, two fellows, and two specialists. Kappa coefficient was used to assess consistency of LI-RADS categories and major features among radiologists with different levels of experience. The diagnostic performance of HCC was described by accuracy, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under the curve (AUC).
Inter-reader agreement among radiologists of different experience levels was substantial agreement for arterial phase hyperenhancement, washout appearance, and early or late washout. Inter-reader agreement for LI-RADS categories was moderate to substantial. When LR-5 was used as criteria to determinate HCC, the AUC of LI-RADS for HCC was 0.67 for residents, 0.72 for fellows, and 0.78 for specialist radiologists. When compared between residents and specialists, accuracy, sensitivity, and AUC were significantly different (all p < 0.05). However, there were no significant differences in specificity, PPV, and NPV between the two groups.
CEUS LI-RADS showed good diagnostic consistency among radiologists with different levels of experience, and consistency increased with experience levels.
• The inter-reader agreement for LI-RADS categories was moderate to substantial agreement (κ, 0.60-0.80). • When compared between residents and specialists, accuracy, sensitivity, and AUC showed significantly different (all p < 0.05). However, there were no significant differences for specificity, PPV, and NPV between these two groups. • Among the radiologists with more than 1 year of experience, there was no significant difference in the diagnostic performance of HCC, suggesting that CEUS LI-RADS is a good standardized categorization system for high-risk patients.
研究不同经验水平的放射科医师对肝脏影像报告和数据系统 2017 版（LI-RADS v2017）分类的对比增强超声（CEUS）的读者间一致性。
本回顾性研究纳入了 2014 年 1 月至 2014 年 12 月期间 326 例高危肝细胞癌（HCC）患者。所有病变均按照 LI-RADS v2017 标准由六名具有不同经验水平的放射科医师进行分类：两名住院医师、两名研究员和两名专家。采用 Kappa 系数评估不同经验水平的放射科医师之间 LI-RADS 类别和主要特征的一致性。通过准确性、敏感性、特异性、阳性预测值（PPV）、阴性预测值（NPV）和曲线下面积（AUC）描述 HCC 的诊断性能。
不同经验水平的放射科医师之间在动脉期强化、洗脱外观以及早期或晚期洗脱方面具有显著的一致性。LI-RADS 类别的读者间一致性为中度至显著。当 LR-5 作为 HCC 的诊断标准时，LI-RADS 对 HCC 的 AUC 分别为住院医师 0.67、研究员 0.72 和专家放射科医师 0.78。与专家相比，住院医师的准确性、敏感性和 AUC 差异有统计学意义（均 P < 0.05）。然而，两组间特异性、PPV 和 NPV 差异无统计学意义。
CEUS LI-RADS 显示出不同经验水平的放射科医师之间具有良好的诊断一致性，并且一致性随着经验水平的提高而增加。
LI-RADS 类别之间的读者间一致性为中度至显著（κ，0.60-0.80）。
与专家相比，住院医师的准确性、敏感性和 AUC 差异有统计学意义（均 P < 0.05）。然而，两组间特异性、PPV 和 NPV 差异无统计学意义。
在具有 1 年以上经验的放射科医师中，HCC 的诊断性能没有显著差异，这表明 CEUS LI-RADS 是一种针对高危患者的良好标准化分类系统。
