Systematic training of LI-RADS CT v2018 improves interobserver agreements and performances in LR categorization for focal liver lesions.

AIM: To retrospectively explored whether systematic training in the use of Liver Imaging Reporting and Data System (LI-RADS) v2018 on computed tomography (CT) can improve the interobserver agreements and performances in LR categorization for focal liver lesions (FLLs) among different radiologists. MATERIALS AND METHODS: A total of 18 visiting radiologists and the liver multiphase CT images of 70 hepatic observations in 63 patients at high risk of HCC were included in this study. The LI-RADS v2018 training procedure included three thematic lectures, with an interval of 1 month. After each seminar, the radiologists had 1 month to adopt the algorithm into their daily work. The interobserver agreements and performances in LR categorization for FLLs among the radiologists before and after training were compared. RESULTS: After training, the interobserver agreements in classifying the LR categories for all radiologists were significantly increased for most LR categories (P < 0.001), except for LR-1 (P = 0.053). After systematic training, the areas under the curve (AUCs) for LR categorization performance for all participants were significantly increased for most LR categories (P < 0.001), except for LR-1 (P = 0.062). CONCLUSION: Systematic training in the use of the LI-RADS can improve the interobserver agreements and performances in LR categorization for FLLs among radiologists with different levels of experience.

Preoperatively predicting early response of HCC to TACE using clinical indicators and MRI features.

BACKGROUND: We aimed to evaluate the value of using preoperative magnetic resonance imaging (MRI) features and clinical indicators to predict the early response of hepatocellular carcinoma (HCC) to transcatheter arterial chemoembolization (TACE). We also aimed to establish a preoperative prediction model. METHODS: We retrospectively reviewed data of 111 patients with HCC who underwent magnetic resonance imaging (MRI) before the first TACE and underwent MRI or computed tomography between 30 and 60 days after TACE. We used the modified response evaluation criteria in solid tumors for evaluating the TACE response. We used univariate and multivariate logistic regression analyses to identify independent predictors based on MRI features and clinical indicators. Moreover, receiver operating characteristic (ROC) curve analyses were performed to assess the diagnostic performance of the prediction model and each independent predictor. RESULTS: Among the 111 included patients, 85 were men (76.6%). Patient age was 31-86 years (average age, 61.08 ± 11.50 years). After the first treatment session, 56/111 (50.5%) patients showed an objective response (complete response + partial response), whereas the remaining showed non-response (stable disease + local progressive disease). In the univariate analysis, we identified irregular margins, number of nodules, and satellite nodules as predictors of early objective response. However, in the multivariate logistic regression analysis, irregular margins, number of nodules and pretreatment platelet were identified as the independent predictors of early objective response. A combined prediction model was then established, which factored in irregular margins, the number of nodules, and the pretreatment platelet count. This model showed good diagnostic performance (area under the ROC curve = 0.755), with the sensitivity, specificity, positive predictive value, and negative predictive value being 78.6%, 69.1%, 72.1%, and 76.0%, respectively. CONCLUSIONS: Irregular margins, the number of nodules and the pretreatment platelet count are independent predictors of the early response of HCC to TACE. Our clinical combined model can provide a superior predictive power to a single indicator.

Systematic Training of Liver Imaging Reporting and Data System Magnetic Resonance Imaging v2018 can Improve the Diagnosis of Hepatocellular Carcinoma for Different Radiologists.

BACKGROUND AND AIMS: Liver imaging reporting and data system (LI-RADS) provides standardized lexicon and categorization for diagnosing hepatocellular carcinoma (HCC). However, there is limited knowledge about the effect of LI-RADS training. We prospectively explored whether the systematic training of LI-RADS v2018 on magnetic resonance imaging (MRI) can effectively improve the diagnostic performances of different radiologists for HCC. METHODS: A total of 20 visiting radiologists and the multiparametric MRI of 70 hepatic observations in 61 patients with high risk of HCC were included in this study. The LI-RADS v2018 training procedure included three times of thematic lectures (each lasting for 2.5 h) given by a professor specialized in imaging diagnosis of liver, with an interval of a month. After each seminar, the radiologists had a month to adopt the algorithm into their daily work. The diagnostic performances and interobserver agreements of these radiologists adopting the algorithm for HCC diagnosis before and after training were compared. RESULTS: A total of 20 radiologists (male/female, 12/8; with an average age of 36.75±4.99 years) were enrolled. After training, the interobserver agreements for the LI-RADS category for all radiologists (p=0.005) were increased. The sensitivity, specificity, positive predictive value, negative predictive value, and coincidence rate of all radiologists for HCC diagnosis before and after training were 43% vs. 54%, 86% vs. 88%, 74% vs. 81%, 62% vs. 67%, and 65% vs. 71%, respectively. The diagnostic performances of all radiologists (p<0.001) showed improvement after training. CONCLUSIONS: The systematic training of LI-RADS can effectively improve the diagnostic performances of radiologists with different experiences for HCC.

Does Training in LI-RADS Version 2018 Improve Readers' Agreement with the Expert Consensus and Inter-reader Agreement in MRI Interpretation?

BACKGROUND: The Liver Imaging Reporting and Data System (LI-RADS) was established for noninvasive diagnosis for hepatocellular carcinoma (HCC). However, whether training can improve readers' agreement with the expert consensus and inter-reader agreement for final categories is still unclear. PURPOSE: To explore training effectiveness on readers' agreement with the expert consensus and inter-reader agreement. STUDY TYPE: Prospective. SUBJECTS: Seventy lesions in 61 patients at risk of HCC undergoing liver MRI; 20 visiting scholars. FIELD STRENGTH/SEQUENCE: 1.5 T or 3 T, Dual-echo T1 WI, Fast spin-echo T2 WI, SE-EPI DWI, and Dynamic multiphase fast gradient-echo T1 WI. ASSESSMENT: Seventy lesions assigned LI-RADS categories of LR1-LR5, LR-M, and LR-TIV by three radiologists in consensus were randomly selected, with 10 cases for each category. The consensus opinion was the standard reference. The third radiologist delivered the training. Twenty readers reviewed images independently and assigned each an LI-RADS category both before and after the training. STATISTICAL TESTS: Accuracy, sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, negative likelihood ratio, receiver operating characteristic (ROC) analysis, simple and weighted kappa statistics, and Fleiss kappa statistics. RESULTS: Before and after training: readers' AUC (areas under ROC) for LR-1-LR-5, LR-M, and LR-TIV were 0.898 vs. 0.913, 0.711 vs. 0.876, 0.747 vs. 0.860, 0.724 vs. 0.815, 0.844 vs. 0.895, 0.688 vs. 0.873, and 0.720 vs. 0.948, respectively, and all improved significantly (P < 0.05), except LR-1(P = 0.25). Inter-reader agreement between readers for LR-1-LR-5, LR-M, LR-TIV were 0.725 vs. 0.751, 0.325 vs. 0.607, 0.330 vs. 0.559, 0.284 vs. 0.488, 0.447 vs. 0.648, 0.229 vs. 0.589, and 0.362 vs. 0.852, respectively, and all increased significantly (P < 0.05). For training effectiveness on both AUC and inter-reader agreement, LR-TIV, LR-M, and LR-2 improved most, and LR-1 made the least. DATA CONCLUSION: This study shows LI-RADS training could improve reader agreement with the expert consensus and inter-reader agreement for final categories. LEVEL OF EVIDENCE: 2 TECHNICAL EFFICACY STAGE: 2.

Diagnostic performance of MR for hepatocellular carcinoma based on LI-RADS v2018, compared with v2017.

BACKGROUND: The Liver Imaging Reporting and Data System (LI-RADS) is widely adopted for noninvasive diagnosis of hepatocellular carcinoma (HCC). It's updated to version 2018 recently, with some major changes compared with v2017. However, the diagnostic performance of LI-RADS v2018 and its difference with v2017 are yet to be validated. PURPOSE: To compare the diagnostic performances of LI-RADS on MR for diagnosing HCC between v2017 and v2018. STUDY TYPE: Retrospective. SUBJECTS: In all, 181 patients with 217 hepatic observations (146 HCCs, 16 non-HCC malignancies and 55 benign lesions) with liver MRI and pathological or follow-up imaging diagnoses. FIELD STRENGTH/SEQUENCE: 1.5 T or 3 T MRI. Dual-echo T1 WI, T2 WI, diffusion-weighted imaging, and a liver acquisition with volume acceleration. Assessment Images were independently interpreted by three radiologists, and then in consensus for observations with different LR categories, according to LI-RADS v2017 and v2018, separately. STATISTICAL TESTS: Sensitivity, specificity, accuracy, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (+LR), and Youden index. RESULTS: When adopting LR-5 as a predictor of HCC, the sensitivity (80.8% vs. 71.2%), NPV (69.6% vs. 60.7%), and accuracy (83.9% vs. 77.9%) were all increased for LI-RADS v2018 compared with v2017, with a greater Youden index (0.709 vs. 0.627). However, the diagnostic performances of MRI for diagnosing HCC were not changed while adopting LR-4/5 as a predictor. The threshold growths of 76% (19/25) observations in v2017 were revised to subthreshold growth in v2018, and 16 LR-4 observations in v2017 were changed to LR-5 based on v2018. DATA CONCLUSION: The diagnostic performance of LI-RADS v2018 for diagnosing HCC is superior to v2017, with a greater sensitivity, NPV, and accuracy. The revisions in v2018 mainly affect the categorization when adopting LR-5 as a predictor of HCC. LEVEL OF EVIDENCE: 4 Technical Efficacy Stage: 2 J. Magn. Reson. Imaging 2019;50:746-755.

3.0 T conventional hip MR and hip MR arthrography for the acetabular labral tears confirmed by arthroscopy.

OBJECTIVE: To evaluate the value of hip MR for diagnosing acetabular labrum tears, and to further compare the diagnostic performances of conventional MR with MR arthrography in acetabular labrum tears. METHODS: 90 patients undergoing both hip MR examination and subsequent hip arthroscopy were retrospectively evaluated. Of these patients, 34 accepted both conventional MR and MR arthrography; while the other 56 only underwent conventional MR examination. All hip MR images were independently reviewed by two radiologists, and further compared with the results of hip arthroscopy. RESULTS: 59 of 90 patients were confirmed with acetabular labral tears by hip arthroscopy and 31 without tears. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of conventional MR for evaluating the acetabular labral tears were 61.0%, 77.4%, 83.7% and 51.1% (radiologist A), and 66.1%, 74.2%, 82.9% and 53.4% (radiologist B), respectively, with good consistency between the two observers (K=0.645). The sensitivity, specificity, PPV and NPV of MR arthrography for assessing the acetabular labral tears were 90.5%, 84.6%, 90.5% and 84.6% (radiologist A), and 95.2%, 84.6%, 90.9% and 91.7% (radiologist B), respectively, with excellent good consistency between the two observers (K=0.810). The sensitivity and NPV of MR arthrography for diagnosing the acetabular labral tears were significantly higher than those of conventional MR (both P<0.05). CONCLUSION: Hip MR arthrography is a reliable evaluation modality for diagnosing the acetabular labral tears, and its diagnostic performance is superior to that of conventional MR at 3.0 T.

The added value of ABER position for the detection and classification of anteroinferior labroligamentous lesions in MR arthrography of the shoulder.

PURPOSE: The purpose of this study is to compare MR arthrography in abduction and external rotation (ABER) position with conventional MR arthrography in neutral position for the detection and further classification of anteroinferior labroligamentous lesions. MATERIALS AND METHODS: Two hundred and twenty-nine cases of shoulder MR arthrography with subsequent arthroscopy were retrospectively evaluated. All MR arthrograms in ABER position and neutral position were independently assessed by two radiologists who were blinded to the arthroscopic findings. Sensitivities and specificities of both positions for detection and further categorization of anteroinferior labroligamentous lesions were calculated and compared using paired McNemar test. K values were calculated to quantify the level of interobserver agreement. RESULTS: At arthroscopy, 24 Bankart lesions, 59 ALPSA lesions, 39 Perthes lesions, 8 GLAD lesions, 4 ALIPSA lesions, 31 nonclassifiable lesions and 60 intact anteroinferior complexes were found. The sensitivity of MR arthrography in ABER position for detecting anteroinferior labroligamentous lesions was significantly higher than that of in neutral position (92.7-94.5% versus 81.8-83%, P<0.05). For the detection rate of the mentioned 6 subtypes of lesions, only the Perthes lesions had significant improvement in ABER position when compared with conventional MR arthrography (observer 1, 61.5-87.2%, P=0.006; observer 2, 69.2-92.3%, P=0.004). MR arthrography in ABER position was more effective in identifying of Perthes lesions (66.7-74.4% versus 35.9-40%, P<0.05) while the conventional MR arthrography was more effective in accurate diagnose of ALPSA lesions (74.6-78.0% versus 54.2-55.9%, P<0.05). No statistically significant difference of the diagnostic accuracy was found between the two positions for Bankart lesions, GLAD lesions, and ALIPSA lesions. CONCLUSION: MR arthrography in ABER position has more added value on detection of Perthes lesions in evaluation of anteroinferior labroligamentous complex tear.

An anatomical study of normal meniscal roots with isotropic 3D MRI at 3T.

OBJECTIVES: To clarify the morphological features of normal meniscal roots on magnetic resonance (MR) imaging with an isotropic 3D proton density-weighted (PDW) sequence. MATERIALS: 3D PDW MR was performed in sixty-two patients at 3T before knee arthroscopy. MR images of 34 normal medial menisci and 33 intact lateral menisci confirmed by arthroscopy were retrospectively evaluated. MR signals, insertion sites, dimensions and courses of four meniscal roots were recorded. RESULTS: The anterior root of medial meniscus (ARMM) was typically hypointense, while the posterior root of medial meniscus (PRMM) and the anterior root of lateral meniscus (ARLM) were prone to be hyperintense or showing a comblike signal, and the posterior root of lateral meniscus (PRLM) was usually hypointense or comblike on PDW MR images. ARMM and PRLM had more complex and diverse insertion patterns than ARLM and PRMM. There were significant statistical differences of the lengths, widths, heights and course angles among four meniscal roots (all P<0.001). CONCLUSIONS: The signal intensity of each meniscal root can be hypointense, hyperintense, or comblike on 3D PDW MR images. ARMM and PRLM have more complex and diverse insertion patterns than ARLM and PRMM. The dimensions and courses of four meniscal roots all differ.