The role of three different contrast-enhanced, abbreviated MRI protocols as a screening tool of hepatocellular carcinoma in patients with chronic hepatitis C virus infection.

Purpose: Our study aims to assess the role and diagnostic performance of 3 different contrast-enhanced, abbreviated magnetic resonance imaging (MRI) protocols as a screening tool of hepatocellular carcinoma (HCC). Material and methods: Our retrospective study included 80 patients who were screened for HCC: 47 patients revealed 138 focal hepatic lesions. MRI examinations were performed including full CE-MRI protocols. The MRI was done on a 1.5 T machine. Then 3 different abbreviated contrast-enhanced MRI protocols were analysed separately. The standard dynamic contrast MRI and abbreviated protocols were evaluated following the LI-RADS 2018 lexicon diagnostic features. Results: A considerable overall kappa (k) agreement between the abbreviated 1, 2, and 3 protocols on LI-RADS classification was noted with k = 0.865. There was almost perfect agreement between all abbreviated protocols and full standard protocol on LI-RADS classification, with k = 0.890. As regards the k agreement on LI-RADS classification, there was a considerable highest agreement between the abbreviated 1 protocol and the full standard protocol, with k = 0.980. The abbreviated 1 and 2 protocols showed high diagnostic performance on LI-RADS classification of lesions, with 100% sensitivity, specificity, PPV, NPV, and accuracy, while the abbreviated 3 protocol showed a lesser but comparable sensitivity 96.9%, NPV 99.4, and accuracy 99.4%. Conclusions: Abbreviated contrast-enhanced MRI protocols can be used as a screening tool for the detection of HCC, with high sensitivity, specificity, PPV, NPV, and accuracy close to the full protocol. There was a considerable highest agreement between the abbreviated 1 protocol and the full standard protocol. Subsequently, this protocol can be used as a standard protocol for screening high-risk patients.

Liver imaging reporting and data system (LI-RADS) v2018: Reliability and agreement for assessing hepatocellular carcinoma locoregional treatment response.

PURPOSE: The purpose of this study was to determine the reliability and interobserver agreement of the liver imaging reporting and data system (LI-RADS) treatment response algorithm (LR-TR) v2018 using dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and the added value of diffusion-weighted imaging (DWI). MATERIALS AND METHODS: A total of 54 patients who underwent DCE-MRI and DWI after locoregional treatment of 81 hepatocellular carcinoma (HCC) lesions from September 2020 to July 2021 were included. There were 47 men and 7 women, with a mean age of 63.9 ± 9.2 (SD) years (age range: 23-77 years). Locoregional treatments included transarterial chemoembolization (TACE) (53/81; 65.4%), radiofrequency ablation (RFA) (25/81; 30.9%) and microwave ablation (MWA) (3/81; 3.7%). Two independent radiologists retrospectively evaluated DCE-MRI examinations obtained after locoregional treatment using LR-TR, and then three months later both radiologists reevaluated DCE-MRI examinations with DWI. Interobserver agreement was assessed using intraclass correlation coefficient (ICC) and Kappa test. Diagnostic performances were evaluated in term of sensitivity, specificity, and area under ROC curve (AUC) using a composite standard of reference that included results of histopathological examinations and follow-up findings. RESULTS: Using DCE-MRI alone, observer 1 had 83.9% sensitivity (26/31; 95% confidence interval [CI]: 66-95%), 88% specificity (44/50; 95% CI: 76-95%) and 86.4% accuracy (70/81; 95%CI: 77-93%), and observer 2 had 71% sensitivity (22/31; 95% CI: 52-86%), 92% specificity (46/50; 95% CI: 81-98%) and 83.9% accuracy (68/81; 95% CI: 74-91%). For the diagnosis of viable tumors using DCE-MRI with DWI, observer 1 and observer 2 had 87.1% (27/31; 95% CI: 70-96%) and 74.2% (23/31; 95% CI: 55-88%) sensitivity, respectively. The diagnostic performance of DCE-MRI with DWI yielded an AUC (0.875; 95% CI: 0.789-0.962) not different from that of DCE-MRI without DWI (0.859; 95% CI: 0.768-0.951) (P = 0.317). Interobserver agreement for arterial phase hyperenhancement, washout, enhancement similar to pretreatment and DWI findings in all treated HCCs was almost perfect (kappa = 0.815, 0.837, 0.826 and 0.81 respectively). Agreement between observers for LR-TR category was substantial (kappa = 0.795; 95% CI: 0.665-0.924). Interobserver agreement for size of viable HCC was excellent (ICC = 0.938; 95% CI: 0.904-0.960). CONCLUSION: LR-TR using DCE-MRI alone or DCE-MRI with DWI are both accurate for detecting viable HCC lesions after locoregional treatment, with no differences in diagnostic performance and excellent interobserver agreement.

Interrater reliability and agreement of the liver imaging reporting and data system (LI-RADS) v2018 for the evaluation of hepatic lesions.

Purpose: The liver imaging reporting and data system (LI-RADS) is a structured reporting system that categorizes hepatic observations according to major imaging features and lesion size, with an optional ancillary features contribution. This study aimed to evaluate inter-reader agreement of dynamic magnetic resonance imaging (MRI) using LI-RADS v2018 lexicon. Material and methods: Forty-nine patients with 69 hepatic observations were included in our study. The major and ancillary features of each hepatic observation were evaluated by 2 radiologists using LI-RADS v2018, and the interreader agreement was allocated. Results: The inter-reader agreement of major LI-RADS features was substantial; κ of non-rim arterial hyperenhancement, non-peripheral washout appearance, and enhancing capsule was 0.796, 0.799, and 0.772 (p < 0.001), respectively. The agreement of the final LI-RADS category was substantial with κ = 0.651 (p < 0.001), and weighted κ = 0.786 (p < 0.001). The inter-reader agreement of the ancillary features was substantial to almost perfect (k range from 0.718 to 1; p < 0.001). An almost perfect correlation was noted for the hepatic lesion size measurement with ICC = 0.977 (p < 0.001). Conclusions: The major and ancillary features of the LI-RADS v2018, as well as the final category and lesions size, have substantial to almost perfect inter-reader agreement.