title: Repeatability of diagnostic features and scoring systems for hepatocellular carcinoma by using MR imaging.
abstract: OBJECTIVE
  To determine for expert and novice radiologists repeatability of major diagnostic features and scoring systems (ie, Liver Imaging Reporting and Data System [LI-RADS], Organ Procurement and Transplantation Network [OPTN], and American Association for the Study of Liver Diseases [AASLD]) for hepatocellular carcinoma (HCC) by using magnetic resonance (MR) imaging.
  
  
  METHODS
  Institutional review board approval was obtained and patient consent was waived for this HIPAA-compliant, retrospective study. The LI-RADS discussed in this article refers to version 2013.1. Ten blinded readers reviewed 100 liver MR imaging studies that demonstrated observations preliminarily assigned LI-RADS scores of LR1-LR5. Diameter and major HCC features (arterial hyperenhancement, washout appearance, pseudocapsule) were recorded for each observation. LI-RADS, OPTN, and AASLD scores were assigned. Interreader agreement was assessed by using intraclass correlation coefficients and κ statistics. Scoring rates were compared by using McNemar test.
  
  
  RESULTS
  Overall interreader agreement was substantial for arterial hyperenhancement (0.67 [95% confidence interval {CI}: 0.65, 0.69]), moderate for washout appearance (0.48 [95%CI: 0.46, 0.50]), moderate for pseudocapsule (0.52 [95% CI: 050, 0.54]), fair for LI-RADS (0.35 [95% CI: 0.34, 0.37]), fair for AASLD (0.39 [95% CI: 0.37, 0.42]), and moderate for OPTN (0.53 [95% CI: 0.51, 0.56]). Agreement for measured diameter was almost perfect (range, 0.95-0.97). There was substantial agreement for most scores consistent with HCC. Experts agreed significantly more than did novices and were significantly more likely than were novices to assign a diagnosis of HCC (P < .001).
  
  
  CONCLUSIONS
  Two of three major features for HCC (washout appearance and pseudocapsule) have only moderate interreader agreement. Experts and novices who assigned scores consistent with HCC had substantial but not perfect agreement. Expert agreement is substantial for OPTN, but moderate for LI-RADS and AASLD. Novices were less consistent and less likely to diagnose HCC than were experts.
authors.affiliation: From the Department of Radiology, University of Michigan Health System, 1500 E Medical Center Dr, Ann Arbor, MI 48109.
authors.forename: Matthew S
authors.initials: MS
authors.lastname: Davenport
authors.forename: Shokoufeh
authors.initials: S
authors.lastname: Khalatbari
authors.forename: Peter S C
authors.initials: PS
authors.lastname: Liu
authors.forename: Katherine E
authors.initials: KE
authors.lastname: Maturen
authors.forename: Ravi K
authors.initials: RK
authors.lastname: Kaza
authors.forename: Ashish P
authors.initials: AP
authors.lastname: Wasnik
authors.forename: Mahmoud M
authors.initials: MM
authors.lastname: Al-Hawary
authors.forename: Daniel I
authors.initials: DI
authors.lastname: Glazer
authors.forename: Erica B
authors.initials: EB
authors.lastname: Stein
authors.forename: Jeet
authors.initials: J
authors.lastname: Patel
authors.forename: Deepak K
authors.initials: DK
authors.lastname: Somashekar
authors.forename: Benjamin L
authors.initials: BL
authors.lastname: Viglianti
authors.forename: Hero K
authors.initials: HK
authors.lastname: Hussain
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis* / Q000473:pathology; D002983:Clinical Competence; D003287:Contrast Media; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000473:pathology; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008536:Meglumine / Q000031:analogs & derivatives; D008875:Middle Aged; D009942:Organometallic Compounds; D015203:Reproducibility of Results; D012189:Retrospective Studies
chemical_list: D003287:Contrast Media; D009942:Organometallic Compounds; C064572:gadobenic acid; D008536:Meglumine