Examining LI-RADS recommendations: should observation size only be measured on non-arterial phases?
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HEPATOBILIARY
Examining LI‑RADS recommendations: should observation size only be measured on non‑arterial phases? Guilherme M. Cunha1 · Heejin Kwon1,2 · Tanya Wolfson1,3 · Anthony C. Gamst3 · Yong Eun Chung4 · Min‑Jeong Kim5 · Sang Won Kim6 · Claude B. Sirlin1 · Kathryn J. Fowler1
© Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Objective To investigate if size measurements of liver observations is more variable in the arterial phase as suggested by LI-RADS and assess potential higher instability in categorization in this particular phase. Secondarily, to assess inter- and intra-reader agreement for size across phases. Materials and methods Patients with liver cirrhosis who underwent multi-arterial phase MRI between 2017 and 2018 were retrospectively selected. Three radiologists measured liver observations in each phase, independently, in a random order. Mean size between early and late arterial phases (AP), 2, 3 and 10 min delay and the number of observations crossing the LI-RADS size thresholds (10 and 20 mm) per phase were compared using McNemar’s test. Reader agreement was evaluated using intraclass correlation coefficient (ICC) and bootstrap-based comparisons. Bonferroni’s correction was applied to pairwise comparisons. Results 94 observations (LR-3, LR-4, LR-5, and LR-M) were included. Mean sizes (mm) were late AP: 19.9 (95% CI 17.2, 24.2), 2 min delay: 19.8 (95% CI 17.1, 24.0), 3 min delay: 19.8 (95% CI 17.2, 24.0), 10 min delay: 20.2 (95% CI 17.5, 24.5) (p = 0.10–0.88). There was no difference between phases in number of observations that could have changed category due to variability in size (p = 0.546–1.000). Inter- and intra-reader agreement was excellent (ICC = 0.952–0.981). Conclusion Measurements of focal liver observations were consistent across all post-contrast imaging phases and we found no higher instability in LI-RADS category in any particular phase. Inter- and intra-reader agreement for size was excellent for each phase. Based on these findings, size measurement could be allowed on any post-contrast phase, including the arterial phase, if deemed appropriate by the radiologist. Keywords Liver · Magnetic resonance imaging · Hepatocellular carcinoma Abbreviations LI-RADS Liver imaging reporting and data system HCC Hepatocellular carcinoma AP Arterial phase mHAP Multi-hepatic arterial phase
Guilherme M. Cunha and Heejin Kwon have contributed equally to this work and are first co-authors. * Guilherme M. Cunha [email protected] Extended author information available on the last page of the article
Introduction Hepatocellular carcinoma (HCC) is currently the fourth leading cause of cancer-related mortality in the world and its incidence has nearly doubled in the last decade [1]. In the majority of cases, the diagnosis of HCC and related management decisions are based on imaging alone, without the need of confirmatory histology. Specific imaging features are necessary for the non-invasive diagnosis of HCC and among these features, size is an important o
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