Müller Lukas, Jorg Tobias, Stoehr Fabian, Grunz Jan-Peter, Graafen Dirk, Halfmann Moritz C, Huflage Henner, Foerster Friedrich, Mittler Jens, Pinto Dos Santos Daniel, Bäuerle Tobias, Kloeckner Roman, Emrich Tilman
Department of Diagnostic and Interventional Radiology, University Medical Center Mainz, Langenbeckstr. 1, Mainz, 55131, Germany.
Department of Radiology, University of Wisconsin, Madison, WI, USA.
Cancer Imaging. 2025 Aug 14;25(1):99. doi: 10.1186/s40644-025-00922-9.
Photon-counting detector CT (PCD-CT) offers technical advantages over energy-integrating detector CT (EID-CT) for liver imaging. However, it is unclear whether these translate into clinical improvements regarding the classification of suspicious liver lesions using the Liver Imaging Reporting and Data System (LI-RADS). This study compared the intra- and intermodal agreement of EID-CT and PCD-CT with Magnetic resonance imaging (MRI) for liver lesion classification.
This retrospective study included patients who underwent EID-CT or PCD-CT and MRI within 30 days between 02/2023 and 01/2024. Three board-certified radiologists assessed LI-RADS classification and presence of LI-RADS major features. Fleiss' Kappa and intraclass correlation coefficients (ICC) were used to evaluate rater agreement.
Sixty-eight lesions in 26 patients (mean age 65.0 ± 14.2 years, 19 [73.1%] male) were analyzed. Intramodal inter-rater agreement for LI-RADS classification was 0.88 (0.62-0.88) for EID-CT, 0.90 (0.83-0.94) for PCD-CT, and 0.87 (0.81-0.91) for MRI. Agreement in PCD-CT was substantial for all LI-RADS major features, whereas in EID-CT only for washout. Intermodal agreement between CT and MRI ranged from 0.67 to 0.72. Final intermodal LI-RADS classification agreement was higher for PCD-CT (0.72-0.85) than EID-CT (0.52-0.64).
PCD-CT demonstrated higher intermodal and intramodal agreement for LI-RADS classification and major features than EID-CT. Additionally, PCD-CT shows significantly higher intramodal and inter-rater agreement for LI-RADS classification and greater concordance with MRI compared to EID-CT, reaching substantial to almost perfect agreement. These results suggest a potential benefit of PCD-CT in the management and treatment decision-making of HCC.
在肝脏成像方面，光子计数探测器CT（PCD-CT）相较于能量积分探测器CT（EID-CT）具有技术优势。然而，目前尚不清楚这些优势是否能转化为使用肝脏影像报告和数据系统（LI-RADS）对可疑肝脏病变进行分类时的临床改善。本研究比较了EID-CT和PCD-CT与磁共振成像（MRI）在肝脏病变分类方面的内部和模式间一致性。
这项回顾性研究纳入了在2023年2月至2024年1月期间30天内接受EID-CT或PCD-CT以及MRI检查的患者。三位获得委员会认证的放射科医生评估LI-RADS分类和LI-RADS主要特征的存在情况。使用Fleiss' Kappa和组内相关系数（ICC）来评估评分者间的一致性。
分析了26例患者（平均年龄65.0±14.2岁，19例[73.1%]为男性）的68个病变。EID-CT的LI-RADS分类的模式内评分者间一致性为0.88（0.62-0.88），PCD-CT为0.90（0.83-0.94），MRI为0.87（0.81-0.91）。PCD-CT对于所有LI-RADS主要特征的一致性都很高，而EID-CT仅在廓清方面一致性较高。CT和MRI之间的模式间一致性范围为0.67至0.72。PCD-CT的最终模式间LI-RADS分类一致性（0.72-0.85）高于EID-CT（0.52-0.64）。
对于LI-RADS分类和主要特征，PCD-CT显示出比EID-CT更高的模式间和模式内一致性。此外，与EID-CT相比，PCD-CT在LI-RADS分类方面显示出显著更高的模式内和评分者间一致性，并且与MRI的一致性更高，达到了高至几乎完美的一致性。这些结果表明PCD-CT在肝癌的管理和治疗决策中具有潜在益处。
