J Liver Cancer.  2024 Sep;24(2):192-205. 10.17998/jlc.2024.04.05.

Inter-reader agreement for CT/MRI LI-RADS category M imaging features: a systematic review and meta-analysis

• Kim DH
• Choi SH

• KMID: 2559466
• DOI: http://doi.org/10.17998/jlc.2024.04.05

Abstract

Backgrounds/Aims
To systematically evaluate inter-reader agreement in the assessment of individual liver imaging reporting and data system (LI-RADS) category M (LR-M) imaging features in computed tomography/magnetic resonance imaging (CT/MRI) LIRADS v2018, and to explore the causes of poor agreement in LR-M assignment.
Methods
Original studies reporting inter-reader agreement for LR-M features on multiphasic CT or MRI were identified using the MEDLINE, EMBASE, and Cochrane databases. The pooled kappa coefficient (κ) was calculated using the DerSimonian-Laird random-effects model. Heterogeneity was assessed using Cochran’s Q test and I² statistics. Subgroup meta-regression analyses were conducted to explore the study heterogeneity.
Results
In total, 24 eligible studies with 5,163 hepatic observations were included. The pooled κ values were 0.72 (95% confidence interval [CI], 0.65-0.78) for rim arterial phase hyperenhancement, 0.52 (95% CI, 0.39-0.65) for peripheral washout, 0.60 (95% CI, 0.50-0.70) for delayed central enhancement, 0.68 (95% CI, 0.57-0.78) for targetoid restriction, 0.74 (95% CI, 0.65-0.83) for targetoid transitional phase/hepatobiliary phase appearance, 0.64 (95% CI, 0.49-0.78) for infiltrative appearance, 0.49 (95% CI, 0.30-0.68) for marked diffusion restriction, and 0.61 (95% CI, 0.48-0.73) for necrosis or severe ischemia. Substantial study heterogeneity was observed for all LR-M features (Cochran’s Q test, P<0.01; I²≥89.2%). Studies with a mean observation size of <3 cm, those performed using 1.5-T MRI, and those with multiple image readers, were significantly associated with poor agreement of LR-M features.
Conclusions
The agreement for peripheral washout and marked diffusion restriction was limited. The LI-RADS should focus on improving the agreement of LR-M features.

Keyword

Carcinoma, hepatocellular; Radiology; Reproducibility of results; Meta-analysis; Systematic review

Figure

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  Figure 1. PRISMA flow diagram of the article selection process. PRISMA, Preferred Reporting Items for Systematic reviews and Meta- Analyses.

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  Figure 2. Forest plot of inter-reader agreement for rim arterial phase hyperenhancement (A), peripheral washout (B), delayed central enhancement (C), targetoid restriction (D), targetoid transitional phase/hepatobiliary phase appearance (E), infiltrative appearance (F), marked diffusion restriction (G), and necrosis or severe ischemia (H).

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  Figure 3. Distribution of the number of studies by kappa category for each imaging feature. APHE, arterial phase hyperenhancement; DCE, delayed central enhancement; TP, transitional phase; HBP, hepatobiliary phase.

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Reference

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