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European Radiology
Published in: European Radiology 10/2018

01-10-2018 | Hepatobiliary-Pancreas

Interobserver and intermodality agreement of standardized algorithms for non-invasive diagnosis of hepatocellular carcinoma in high-risk patients: CEUS-LI-RADS versus MRI-LI-RADS

Authors: Barbara Schellhaas, Matthias Hammon, Deike Strobel, Lukas Pfeifer, Christian Kielisch, Ruediger S. Goertz, Alexander Cavallaro, Rolf Janka, Markus F. Neurath, Michael Uder, Hannes Seuss

Published in: European Radiology | Issue 10/2018

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Abstract

Objectives

We compared the interobserver agreement for the recently introduced contrast-enhanced ultrasound (CEUS)-based algorithm CEUS-LI-RADS (Liver Imaging Reporting and Data System) versus the well-established magnetic resonance imaging (MRI)-LI-RADS for non-invasive diagnosis of hepatocellular carcinoma (HCC) in high-risk patients.

Methods

Focal liver lesions in 50 high-risk patients (mean age 66.2 ± 11.8 years; 39 male) were assessed retrospectively with CEUS and MRI. Two independent observers reviewed CEUS and MRI examinations, separately, classifying observations according to CEUS-LI-RADSv.2016 and MRI-LI-RADSv.2014. Interobserver agreement was assessed with Cohen’s kappa.

Results

Forty-three lesions were HCCs; two were intrahepatic cholangiocarcinomas; five were benign lesions. Arterial phase hyperenhancement was perceived less frequently with CEUS than with MRI (37/50 / 38/50 lesions = 74%/78% [CEUS; observer 1/observer 2] versus 46/50 / 44/50 lesions = 92%/88% [MRI; observer 1/observer 2]). Washout appearance was observed in 34/50 / 20/50 lesions = 68%/40% with CEUS and 31/50 / 31/50 lesions = 62%/62%) with MRI. Interobserver agreement was moderate for arterial hyperenhancement (ĸ = 0.511/0.565 [CEUS/MRI]) and “washout” (ĸ = 0.490/0.582 [CEUS/MRI]), fair for CEUS-LI-RADS category (ĸ = 0.309) and substantial for MRI-LI-RADS category (ĸ = 0.609). Intermodality agreement was fair for arterial hyperenhancement (ĸ = 0.329), slight to fair for “washout” (ĸ = 0.202) and LI-RADS category (ĸ = 0.218)

Conclusion

Interobserver agreement is substantial for MRI-LI-RADS and only fair for CEUS-LI-RADS. This is mostly because interobserver agreement in the perception of washout appearance is better in MRI than in CEUS. Further refinement of the LI-RADS algorithms and increasing education and practice may be necessary to improve the concordance between CEUS and MRI for the final LI-RADS categorization.

Key Points

• CEUS-LI-RADS and MRI-LIRADS enable standardized non-invasive diagnosis of HCC in high-risk patients.
• With CEUS, interobserver agreement is better for arterial hyperenhancement than for “washout”.
• Interobserver agreement for major features is moderate for both CEUS and MRI.
• Interobserver agreement for LI-RADS category is substantial for MRI, and fair for CEUS.
• Interobserver-agreement for CEUS-LI-RADS will presumably improve with ongoing use of the algorithm.
Appendix
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Metadata
Title
Interobserver and intermodality agreement of standardized algorithms for non-invasive diagnosis of hepatocellular carcinoma in high-risk patients: CEUS-LI-RADS versus MRI-LI-RADS
Authors
Barbara Schellhaas
Matthias Hammon
Deike Strobel
Lukas Pfeifer
Christian Kielisch
Ruediger S. Goertz
Alexander Cavallaro
Rolf Janka
Markus F. Neurath
Michael Uder
Hannes Seuss
Publication date
01-10-2018
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 10/2018
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-018-5379-1

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