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Examining LI-RADS recommendations: should observation size only be measured on non-arterial phases?

  • Hepatobiliary
  • Published:
Abdominal Radiology Aims and scope Submit manuscript

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.

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Data availability

All data included in the manuscript is available at request to the corresponding author.

Abbreviations

LI-RADS:

Liver imaging reporting and data system

HCC:

Hepatocellular carcinoma

AP:

Arterial phase

mHAP:

Multi-hepatic arterial phase

References

  1. Kulik L, El-Serag HB. Epidemiology and management of hepatocellular carcinoma. Gastroenterology. 2019 Jan 1;156(2):477-91.

    Article  Google Scholar 

  2. Bruix J, Reig M, Sherman M. Evidence-based diagnosis, staging, and treatment of patients with hepatocellular carcinoma. Gastroenterology. 2016 Apr 1;150(4):835-53.

    Article  Google Scholar 

  3. Available at: https://optn.transplant.hrsa.gov/media/1200/optn_policies.pdf [Accessed Dec 10, 2019]

  4. Ayuso C, Rimola J, Vilana R, et al. Diagnosis and staging of hepatocellular carcinoma (HCC): current guidelines. Eur J Radiol. 2018 Apr 1;101:72-81.

    Article  Google Scholar 

  5. Marrero JA, Kulik LM, Sirlin CB, et al. Diagnosis, staging, and management of hepatocellular carcinoma: 2018 practice guidance by the American Association for the Study of Liver Diseases. Hepatology. 2018 Aug 1;68(2):723-50.

    Article  Google Scholar 

  6. Chernyak V, Fowler KJ, Kamaya A, et al. Liver Imaging Reporting and Data System (LI-RADS) version 2018: imaging of hepatocellular carcinoma in at-risk patients. Radiology. 2018 Sep 25;289(3):816-30.

    Article  Google Scholar 

  7. Available at: https://www.acr.org/Clinical-Resources/Reporting-and-Data-Systems/LI-RADS [accessed Dec 10, 2019]

  8. Francis IR, Cohan RH, McNulty NJ, et al. Multidetector CT of the liver and hepatic neoplasms: effect of multiphasic imaging on tumor conspicuity and vascular enhancement. AJR Am J Roentgenol. 2003 May;180(5):1217-24.

    Article  Google Scholar 

  9. Yacoub JH, Elsayes KM, Fowler KJ, et al. Pitfalls in liver MRI: Technical approach to avoiding misdiagnosis and improving image quality. J Magn Reson Imaging. 2019 Jan;49(1):41-58.

    Article  Google Scholar 

  10. Min JH, Kim YK, Kang TW, et al. Artifacts during the arterial phase of gadoxetate disodium-enhanced MRI: multiple arterial phases using view-sharing from two different vendors versus single arterial phase imaging. Eur Radiol. 2018 Aug 1;28(8):3335-46.

    Article  Google Scholar 

  11. Chernyak V, Fowler KJ, Heiken JP, Sirlin CB. Use of gadoxetate disodium in patients with chronic liver disease and its implications for liver imaging reporting and data system (LI‐RADS). J Magn Reson Imaging. 2019 May;49(5):1236-52.

    Article  Google Scholar 

  12. Saranathan M, Rettmann DW, Hargreaves BA, Clarke SE, Vasanawala SS. Differential subsampling with cartesian ordering (DISCO): A high spatio‐temporal resolution dixon imaging sequence for multiphasic contrast enhanced abdominal imaging. J Magn Reson Imaging. 2012 Jun;35(6):1484-92.

    Article  Google Scholar 

  13. Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977 Mar 1:159-74.

    Article  Google Scholar 

  14. Fowler KJ, Potretzke TA, Hope TA, Costa EA, Wilson SR. LI-RADS M (LR-M): definite or probable malignancy, not specific for hepatocellular carcinoma. Abdom Radiol. 2018 Jan 1;43(1):149-57.

    Article  Google Scholar 

  15. van Lunenburg JT, Tripathi V, Chan VS, et al. Sequence and Observer Variability in Gadoxectic Acid-Enhanced MRI Lesion Measurements in Hepatocellular Carcinoma. Acad Radiol. 2019 Jul 17.

  16. Chernyak V, Flusberg M, Law A, Kobi M, Paroder V, Rozenblit AM. Liver Imaging Reporting and Data System: discordance between computed tomography and gadoxetate-enhanced magnetic resonance imaging for detection of hepatocellular carcinoma major features. J Comput Assist Tomogr. 2018 Jan 1;42(1):155-61.

    Article  Google Scholar 

  17. Schellhaas B, Hammon M, Strobel D, et al. 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. Eur Radiol. 2018 Oct 1;28(10):4254-64.

    Article  Google Scholar 

  18. Ehman EC, Behr SC, Umetsu SE, et al. Rate of observation and inter-observer agreement for LI-RADS major features at CT and MRI in 184 pathology proven hepatocellular carcinomas. Abdom Radiol. 2016 May 1;41(5):963-9.

    Article  Google Scholar 

  19. Davenport MS, Khalatbari S, Liu PS, et al. Repeatability of diagnostic features and scoring systems for hepatocellular carcinoma by using MR imaging. Radiology. 2014 Feb 18;272(1):132-42.

    Article  Google Scholar 

  20. Wald C, Russo MW, Heimbach JK, Hussain HK, Pomfret EA, Bruix J. New OPTN/UNOS policy for liver transplant allocation: standardization of liver imaging, diagnosis, classification, and reporting of hepatocellular carcinoma. Radiology. 2013 Feb;266(2):376-82.

    Article  Google Scholar 

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Funding

The authors state that this work has not received any funding.

Author information

Author notes

  1. Guilherme M. Cunha and Heejin Kwon have contributed equally to this work and are first co-authors.

Authors and Affiliations

  1. Liver Imaging Group, Department of Radiology, Altman Clinical Translational Research Institute, 9452 Medical Center Drive, Lower Level 501, La Jolla, CA, 92037, USA

    Guilherme M. Cunha, Heejin Kwon, Tanya Wolfson, Claude B. Sirlin & Kathryn J. Fowler

  2. Dong-A University Hospital, 26 Daesingongwon-ro Seo-Gu, Busan, 602-812, South Korea

    Heejin Kwon

  3. Computational and Applied Statistics Laboratory, San Diego Supercomputer Center, University of California San Diego, La Jolla, CA, 92037, USA

    Tanya Wolfson & Anthony C. Gamst

  4. Yonsei University College of Medicine, Severance Hospital, 50-1 Yonsei-ro, Sinchon-dong, Seodaemun-gu, Seoul, South Korea

    Yong Eun Chung

  5. Department of Radiology, Hallym University Sacred Heart Hospital, 22 Gwanpyeong-ro 170beon-gil, Pyeongan-dong, Dongan-gu, Anyang, Gyeonggi-do, South Korea

    Min-Jeong Kim

  6. Kyung Hee University Hospital at Gangdong, 892 Dongnam-ro, Sangil-dong, Gangdong-gu, Seoul, South Korea

    Sang Won Kim

Authors
  1. Guilherme M. Cunha
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  2. Heejin Kwon
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  3. Tanya Wolfson
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  4. Anthony C. Gamst
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  5. Yong Eun Chung
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  6. Min-Jeong Kim
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  7. Sang Won Kim
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  8. Claude B. Sirlin
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  9. Kathryn J. Fowler
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Corresponding author

Correspondence to Guilherme M. Cunha.

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Conflict of interest

All authors listed have no financial interests or relationships to disclose with regard to the subject matter of this manuscript.

Ethical approval

The institutional ethics review board approved this cross-sectional, single-center, retrospective study and waived the informed consent requirement. Data were collected and handled in accordance with the Health Insurance Portability and Accountability Act.

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Cite this article

Cunha, G.M., Kwon, H., Wolfson, T. et al. Examining LI-RADS recommendations: should observation size only be measured on non-arterial phases?. Abdom Radiol 45, 3144–3154 (2020). https://doi.org/10.1007/s00261-020-02490-x

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  • DOI: https://doi.org/10.1007/s00261-020-02490-x

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