Prevalence and clinical significance of discordant LI-RADS® observations on multiphase contrast-enhanced MRI in patients with cirrhosis

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Abstract

Purpose: To determine the prevalence and clinical significance of discordant LI-RADS® (Liver Imaging Reporting and Data System) liver observations on multiphase contrast-enhanced (MCE) magnetic resonance imaging (MRI) in patients with cirrhosis. Methods: This cross-sectional study included 93 cirrhosis patients who underwent 1.5 or 3 T MCE MRI for evaluation of hepatocellular carcinoma (HCC). Two abdominal radiologists independently reviewed T1-, T2-, diffusion-weighted unenhanced images as well as MCE T1-weighted fat-suppressed images and reported liver observations using LI-RADS®. Concordance were recorded for detection (co-detected by both radiologists or not), size category (< 10; 10–19; ≥ 20 mm), and LI-RADS® category assignment as reportable (LR-3/4/5/M) and actionable (LR-4/5/M). The overall concordance (i.e., concordant in detection, size, and LR-category) was calculated with 95% confidence interval [CI], and separately for detection, size, and LR-category. Clinical significance of discordance was assessed as impact on follow-up imaging, referral for biopsy, liver transplant eligibility, or treatment modality. Results: Reportable and actionable observations were overall concordant between two radiologists only in 32.3% [24.6, 41.0] and 40.1% [29.5, 51.5] of cases, respectively. Poor overall concordance was related to detection concordance of 52.0% [44.3, 59.5] and 62.5% [52.3, 71.8], as well as LR-category concordance of 73.7% [61.6, 83.1] and 70.9% [57.3, 81.6], for reportable and actionable observations, respectively. Discordant LI-RADS® observations would have impacted clinical management in 30 subjects (43.5%), most (66.7%) of whom were due to discordant detection. Conclusion: Discordant MRI LI-RADS® observations are common in patients with cirrhosis and may have potential implications for patient management.

Original languageEnglish (US)
JournalAbdominal Radiology
DOIs
StatePublished - Jan 1 2019

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Information Systems
Fibrosis
Magnetic Resonance Imaging
Liver
Hepatocellular Carcinoma
Referral and Consultation
Cross-Sectional Studies
Fats
Confidence Intervals
Transplants
Biopsy
Radiologists

Keywords

  • Concordance
  • Discordance
  • Hepatocellular carcinoma
  • Liver imaging and reporting and data system (LI-RADS)

ASJC Scopus subject areas

  • Radiological and Ultrasound Technology
  • Radiology Nuclear Medicine and imaging
  • Gastroenterology
  • Urology

Cite this

@article{79d4dc06fe72497e981a0c56b012979b,
title = "Prevalence and clinical significance of discordant LI-RADS{\circledR} observations on multiphase contrast-enhanced MRI in patients with cirrhosis",
abstract = "Purpose: To determine the prevalence and clinical significance of discordant LI-RADS{\circledR} (Liver Imaging Reporting and Data System) liver observations on multiphase contrast-enhanced (MCE) magnetic resonance imaging (MRI) in patients with cirrhosis. Methods: This cross-sectional study included 93 cirrhosis patients who underwent 1.5 or 3 T MCE MRI for evaluation of hepatocellular carcinoma (HCC). Two abdominal radiologists independently reviewed T1-, T2-, diffusion-weighted unenhanced images as well as MCE T1-weighted fat-suppressed images and reported liver observations using LI-RADS{\circledR}. Concordance were recorded for detection (co-detected by both radiologists or not), size category (< 10; 10–19; ≥ 20 mm), and LI-RADS{\circledR} category assignment as reportable (LR-3/4/5/M) and actionable (LR-4/5/M). The overall concordance (i.e., concordant in detection, size, and LR-category) was calculated with 95{\%} confidence interval [CI], and separately for detection, size, and LR-category. Clinical significance of discordance was assessed as impact on follow-up imaging, referral for biopsy, liver transplant eligibility, or treatment modality. Results: Reportable and actionable observations were overall concordant between two radiologists only in 32.3{\%} [24.6, 41.0] and 40.1{\%} [29.5, 51.5] of cases, respectively. Poor overall concordance was related to detection concordance of 52.0{\%} [44.3, 59.5] and 62.5{\%} [52.3, 71.8], as well as LR-category concordance of 73.7{\%} [61.6, 83.1] and 70.9{\%} [57.3, 81.6], for reportable and actionable observations, respectively. Discordant LI-RADS{\circledR} observations would have impacted clinical management in 30 subjects (43.5{\%}), most (66.7{\%}) of whom were due to discordant detection. Conclusion: Discordant MRI LI-RADS{\circledR} observations are common in patients with cirrhosis and may have potential implications for patient management.",
keywords = "Concordance, Discordance, Hepatocellular carcinoma, Liver imaging and reporting and data system (LI-RADS)",
author = "Takeshi Yokoo and Amit Singal and {Diaz De Leon III}, Alberto and Lakshmi Ananthakrishnan and Fetzer, {David T} and Ivan Pedrosa and Gaurav Khatri",
year = "2019",
month = "1",
day = "1",
doi = "10.1007/s00261-019-02133-w",
language = "English (US)",
journal = "Abdominal Radiology",
issn = "2366-004X",
publisher = "Springer New York",

}

TY - JOUR

T1 - Prevalence and clinical significance of discordant LI-RADS® observations on multiphase contrast-enhanced MRI in patients with cirrhosis

AU - Yokoo, Takeshi

AU - Singal, Amit

AU - Diaz De Leon III, Alberto

AU - Ananthakrishnan, Lakshmi

AU - Fetzer, David T

AU - Pedrosa, Ivan

AU - Khatri, Gaurav

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Purpose: To determine the prevalence and clinical significance of discordant LI-RADS® (Liver Imaging Reporting and Data System) liver observations on multiphase contrast-enhanced (MCE) magnetic resonance imaging (MRI) in patients with cirrhosis. Methods: This cross-sectional study included 93 cirrhosis patients who underwent 1.5 or 3 T MCE MRI for evaluation of hepatocellular carcinoma (HCC). Two abdominal radiologists independently reviewed T1-, T2-, diffusion-weighted unenhanced images as well as MCE T1-weighted fat-suppressed images and reported liver observations using LI-RADS®. Concordance were recorded for detection (co-detected by both radiologists or not), size category (< 10; 10–19; ≥ 20 mm), and LI-RADS® category assignment as reportable (LR-3/4/5/M) and actionable (LR-4/5/M). The overall concordance (i.e., concordant in detection, size, and LR-category) was calculated with 95% confidence interval [CI], and separately for detection, size, and LR-category. Clinical significance of discordance was assessed as impact on follow-up imaging, referral for biopsy, liver transplant eligibility, or treatment modality. Results: Reportable and actionable observations were overall concordant between two radiologists only in 32.3% [24.6, 41.0] and 40.1% [29.5, 51.5] of cases, respectively. Poor overall concordance was related to detection concordance of 52.0% [44.3, 59.5] and 62.5% [52.3, 71.8], as well as LR-category concordance of 73.7% [61.6, 83.1] and 70.9% [57.3, 81.6], for reportable and actionable observations, respectively. Discordant LI-RADS® observations would have impacted clinical management in 30 subjects (43.5%), most (66.7%) of whom were due to discordant detection. Conclusion: Discordant MRI LI-RADS® observations are common in patients with cirrhosis and may have potential implications for patient management.

AB - Purpose: To determine the prevalence and clinical significance of discordant LI-RADS® (Liver Imaging Reporting and Data System) liver observations on multiphase contrast-enhanced (MCE) magnetic resonance imaging (MRI) in patients with cirrhosis. Methods: This cross-sectional study included 93 cirrhosis patients who underwent 1.5 or 3 T MCE MRI for evaluation of hepatocellular carcinoma (HCC). Two abdominal radiologists independently reviewed T1-, T2-, diffusion-weighted unenhanced images as well as MCE T1-weighted fat-suppressed images and reported liver observations using LI-RADS®. Concordance were recorded for detection (co-detected by both radiologists or not), size category (< 10; 10–19; ≥ 20 mm), and LI-RADS® category assignment as reportable (LR-3/4/5/M) and actionable (LR-4/5/M). The overall concordance (i.e., concordant in detection, size, and LR-category) was calculated with 95% confidence interval [CI], and separately for detection, size, and LR-category. Clinical significance of discordance was assessed as impact on follow-up imaging, referral for biopsy, liver transplant eligibility, or treatment modality. Results: Reportable and actionable observations were overall concordant between two radiologists only in 32.3% [24.6, 41.0] and 40.1% [29.5, 51.5] of cases, respectively. Poor overall concordance was related to detection concordance of 52.0% [44.3, 59.5] and 62.5% [52.3, 71.8], as well as LR-category concordance of 73.7% [61.6, 83.1] and 70.9% [57.3, 81.6], for reportable and actionable observations, respectively. Discordant LI-RADS® observations would have impacted clinical management in 30 subjects (43.5%), most (66.7%) of whom were due to discordant detection. Conclusion: Discordant MRI LI-RADS® observations are common in patients with cirrhosis and may have potential implications for patient management.

KW - Concordance

KW - Discordance

KW - Hepatocellular carcinoma

KW - Liver imaging and reporting and data system (LI-RADS)

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U2 - 10.1007/s00261-019-02133-w

DO - 10.1007/s00261-019-02133-w

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C2 - 31342103

AN - SCOPUS:85069660259

JO - Abdominal Radiology

JF - Abdominal Radiology

SN - 2366-004X

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