How reader perception of capsule affects interpretation of washout in hypervascular liver nodules in patients at risk for hepatocellular carcinoma

Sofue, Keitaro; Sirlin, Claude B.; Allen, Brian C.; Nelson, Rendon C.; Berg, Carl L.; Bashir, Mustafa R.

doi:10.1002/jmri.25094

Cited by 36 publications

(37 citation statements)

References 39 publications

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“…Their results revealed that while quantitative assessment of washout showed better sensitivity than qualitative assessment, this improvement is obtained at the expense of a higher number of false-positive findings (74). A recent retrospective study by Sofue et al showed that a lesion-to-liver signal intensity ratio of 0.88 at MR imaging correlated most strongly with readers' visual interpretation of washout (68).…”

Section: Washout Appearancementioning

confidence: 91%

“…A recent article has shown that, in some cases, the presence of a capsule creates the visual perception of washout, even when a mass is not hypointense to background liver (68). Because this was an unrecognized phenomenon until recently, some prior studies may have failed to distinguish washout appearance from the optical illusion of washout created by an enhancing capsule.…”

Section: Threshold Growthmentioning

confidence: 95%

“…These in turn have been attributed to diminished portal venous blood supply, high tumoral cellularity with associated small extracellular volume (15,16,72), and expanded extracellular space of the surrounding fibrotic liver. Additionally, the concomitant presence of capsule appearance may produce an optical illusion of "washout" not confirmed by objective measurement of signal intensity (68). Finally, intrinsic hypoattenuation or hypointensity before contrast agent injection may contribute to the perception of "washout."…”

Section: Washout Appearancementioning

confidence: 99%

“…Finally, intrinsic hypoattenuation or hypointensity before contrast agent injection may contribute to the perception of "washout." Based on current knowledge, washout appearance should be considered absent if its perception is due entirely to optical illusion from the enhancing capsule (68). On the other hand, washout appearance should be considered present even (Fig 4).…”

Section: Washout Appearancementioning

confidence: 99%

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Evidence Supporting LI-RADS Major Features for CT- and MR Imaging–based Diagnosis of Hepatocellular Carcinoma: A Systematic Review

et al. 2018

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The Liver Imaging Reporting and Data System (LI-RADS) standardizes the interpretation, reporting, and data collection for imaging examinations in patients at risk for hepatocellular carcinoma (HCC). It assigns category codes reflecting relative probability of HCC to imaging-detected liver observations based on major and ancillary imaging features. LI-RADS also includes imaging features suggesting malignancy other than HCC. Supported and endorsed by the American College of Radiology (ACR), the system has been developed by a committee of radiologists, hepatologists, pathologists, surgeons, lexicon experts, and ACR staff, with input from the American Association for the Study of Liver Diseases and the Organ Procurement Transplantation Network/United Network for Organ Sharing. Development of LI-RADS has been based on literature review, expert opinion, rounds of testing and iteration, and feedback from users. This article summarizes and assesses the quality of evidence supporting each LI-RADS major feature for diagnosis of HCC, as well as of the LI-RADS imaging features suggesting malignancy other than HCC. Based on the evidence, recommendations are provided for or against their continued inclusion in LI-RADS.q RSNA, 2017 Online supplemental material is available for this article.An Tang REVIEW: LI-RADS Major Features for Hepatocellular Carcinoma DiagnosisTang et al selection of five major features was based on expert opinion, the literature review was performed to ensure that imaging-based diagnostic criteria were able to achieve near-100% specificity for the noninvasive diagnosis of HCC. This review focused on the evidence supporting the inclusion of imaging features and did not attempt to gather evidence on the composition of the LI-RADS diagnostic algorithm and probability of HCC for different combinations of criteria (other than the hallmark combination of APHE and washout appearance) in the LI-RADS diagnostic table.Each subgroup was charged with developing key research questions and then critically reviewing the literature to answer research questions thematically related to its assigned topic. Search StrategyThe PICO (patient population, intervention, comparison, and outcome) format frequently used in structured reviews does not lend itself well to studies of diagnostic performance. Rather than using PICO-style questions to guide the searches, therefore, the subgroups formulated free-form questions in advance with feedback from the other subgroups. A total of 10 questions were formulated under the framework and with the understanding that their answers would inform recommendations for removing or continuing to include the corresponding LI-RADS features. After the questions were formulated, each subgroup searched the PubMed develop a standardized Liver Imaging Reporting and Data System (LI-RADS) for interpretation, reporting, and data collection of imaging studies in patients at risk for developing HCC (1). The committee was composed mainly of diagnostic radiologists, but also hepatologists, surgeons, patho...

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Section: Washout Appearancementioning

confidence: 91%

Section: Threshold Growthmentioning

confidence: 95%

Section: Washout Appearancementioning

confidence: 99%

Section: Washout Appearancementioning

confidence: 99%

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Evidence Supporting LI-RADS Major Features for CT- and MR Imaging–based Diagnosis of Hepatocellular Carcinoma: A Systematic Review

et al. 2018

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“…Six prior studies have assessed reader agreement regarding LI-RADS categories (11,19,20) or major features of HCC (11,(19)(20)(21)(22). Unlike these studies, which all included readers from the same institution, ours is further enhanced by (a) multicenter international cross-sectional reader pool, including community practice, academic, and mixed practice environments; (b) derivation of the cases from eight different sites; (c) the largest number of readers tested to date; (d) no training module aside from the LI-RADS materials available online; (e) mixture of all LI-RADS 10% of total cases.…”

Section: Agreement On Major Featuresmentioning

confidence: 99%

Interreader Reliability of LI-RADS Version 2014 Algorithm and Imaging Features for Diagnosis of Hepatocellular Carcinoma: A Large International Multireader Study

Fowler¹,

Tang²,

Santillan³

et al. 2018

Radiology

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Supported by a research scholarship from the Fonds de Recherche du Québec-Santé and Fondation de l'association des radiologistes du Québec (FRQS-ARQ #26993).q RSNA, 2017 Purpose:To determine in a large multicenter multireader setting the interreader reliability of Liver Imaging Reporting and Data System (LI-RADS) version 2014 categories, the major imaging features seen with computed tomography (CT) and magnetic resonance (MR) imaging, and the potential effect of reader demographics on agreement with a preselected nonconsecutive image set. Materials and Methods:Institutional review board approval was obtained, and patient consent was waived for this retrospective study. Ten image sets, comprising 38-40 unique studies (equal number of CT and MR imaging studies, uniformly distributed LI-RADS categories), were randomly allocated to readers. Images were acquired in unenhanced and standard contrast material-enhanced phases, with observation diameter and growth data provided. Readers completed a demographic survey, assigned LI-RADS version 2014 categories, and assessed major features. Intraclass correlation coefficient (ICC) assessed with mixed-model regression analyses was the metric for interreader reliability of assigning categories and major features. Results: Conclusion:ICC is good for final LI-RADS categorization and high for major feature characterization, with minimal reader demographic effect. Of note, our results using selected image sets from nonconsecutive examinations are not necessarily comparable with those of prior studies that used consecutive examination series.q RSNA, 2017

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Prospective Intraindividual Comparison of Magnetic Resonance Imaging With Gadoxetic Acid and Extracellular Contrast for Diagnosis of Hepatocellular Carcinomas Using the Liver Imaging Reporting and Data System

Min

Kim

et al. 2018

Hepatology

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We intraindividually compared the efficacy of magnetic resonance imaging (MRI) with extracellular contrast agents (ECA-MRI) and MRI with hepatobiliary agents (HBA-MRI) for the diagnosis of hepatocellular carcinoma (HCC) using the Liver Imaging Reporting and Data System (LI-RADS). Between November 2016 and November 2017, we enrolled 91 patients with chronic liver disease who underwent both ECA-MRI and HBA-MRI within a 1-month interval for a first detected hepatic nodule on ultrasound. In total, 117 observations (95 HCCs, 19 benign lesions, and 3 other malignancies; median size, 18 mm) were identified with surgical resection. Two observers assessed two MRIs based on LI-RADS v2017, with consensus by a third observer. We then compared the diagnostic performance of LR-5 according to LI-RADS and modified LI-RADS. ECA-MRI had higher sensitivity (77.9% versus 66.3%) and accuracy (82.1% versus 72.6%) than HBA-MRI in the LR-5 category (P < 0.001). When applying either modified washout on the portal venous phase (PVP)/transitional phase (TP) of HBA-MRI or isointensity with a capsule during the PVP/delayed phase of ECA-MRI (illusional washout), 13 HCCs on HBA-MRI and 11 HCCs on ECA-MRI were correctly classified as HCC, while achieving 100% specificity. One cholangiocarcinoma was accurately classified only with HBA-MRI due to its targetoid appearance in the TP and hepatobiliary phase. Conclusion: ECA-MRI showed better sensitivity and accuracy than HBA-MRI for the diagnosis of HCC with LI-RADS. We achieved better diagnostic performance when applying a modified washout on PVP/TP HBA-MRI and an illusional washout on ECA-MRI than we did with conventional criteria.

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How reader perception of capsule affects interpretation of washout in hypervascular liver nodules in patients at risk for hepatocellular carcinoma

Abstract: Reader perception of capsule affects interpretation of washout. This effect can influence nodule categorization using imaging-based diagnostic systems. J. Magn. Reson. Imaging 2016;43:1337-1345.

Cited by 36 publications

References 39 publications

Evidence Supporting LI-RADS Major Features for CT- and MR Imaging–based Diagnosis of Hepatocellular Carcinoma: A Systematic Review

Evidence Supporting LI-RADS Major Features for CT- and MR Imaging–based Diagnosis of Hepatocellular Carcinoma: A Systematic Review

Interreader Reliability of LI-RADS Version 2014 Algorithm and Imaging Features for Diagnosis of Hepatocellular Carcinoma: A Large International Multireader Study

Prospective Intraindividual Comparison of Magnetic Resonance Imaging With Gadoxetic Acid and Extracellular Contrast for Diagnosis of Hepatocellular Carcinomas Using the Liver Imaging Reporting and Data System

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