Liver Imaging Group, Department of Radiology, University of California San Diego, La Jolla, CA, 92093, USA.
Department of Mathematics and Statistics, San Diego State University, San Diego, CA, 92182, USA.
Eur Radiol. 2021 Oct;31(10):7594-7604. doi: 10.1007/s00330-021-07924-8. Epub 2021 Apr 19.
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.
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.
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).
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.
• 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.
根据 LI-RADS，肝细胞癌（HCC）与非 HCC 恶性肿瘤的主要鉴别特征是动脉期强化（APHE）亚型。本研究旨在探讨在评估读者间一致性的同时，多动脉期（mHAP）MRI 采集时 APHE 亚型是否一致。其次，我们探讨了可能影响 APHE 亚型读者间一致性的因素。
本回顾性研究纳入了连续接受 mHAP 检查且有局灶性表现的肝硬化患者。5 名放射科医生在 2 次阅读会议中分别对 MRI 图像进行了回顾和评分。在第 1 次阅读会议中，对各动脉期序列进行评分，以确定是否存在 APHE 及其亚型。在第 2 次阅读会议中，读者对完整 MRI 检查中的主要和辅助特征及 LI-RADS 分类进行评分。采用 Fleiss'kappa 评估二分类资料的读者间一致性，采用 Kendall 系数评估 LI-RADS 分类的读者间一致性。采用单因素混合效应逻辑回归分析影响一致性的因素。
共分析了 61 例患者的 77 个局灶性观察结果。在所有一致被评为存在 APHE 的观察中，27.7%在 mHAP 上显示出边缘和非边缘亚型。在阅读会议之间，APHE 亚型的读者间一致性范围为 0.49（95%CI：0.33，0.64）至 0.57（95%CI：0.40，0.74）。观察大小对边缘型 APHE 一致性有趋势影响（p=0.052）。
在 mHAP 采集过程中，约有 1/3的观察结果显示出动脉期强化亚型不一致（边缘和非边缘）。小病变尤其具有挑战性。对动脉期强化亚型分类的进一步指导，特别是在应用于 mHAP 时，可能是 LI-RADS 细化的重点。
在 HCC 高危患者队列中，根据 5 名独立读者的多数评分，28%的观察结果在多动脉期成像上显示出不一致的动脉期强化（APHE）亚型（边缘型和非边缘型）。
不一致的 APHE 亚型可能会对 HCC 高危患者的局灶性肝脏观察结果的可靠影像学诊断（即 LI-RADS 分类）构成挑战。
