title: Classifying CT/MR findings in patients with suspicion of hepatocellular carcinoma: Comparison of liver imaging reporting and data system and criteria-free Likert scale reporting models.
abstract: OBJECTIVE
  To compare the Liver Imaging Reporting and Data System (LI-RADS) and a criteria-free Likert scale (LS) reporting models for classifying computed tomography/magnetic resonance imaging (CT/MR) findings of suspicious hepatocellular carcinoma (HCC).
  
  
  METHODS
  Imaging data of 281 hepatic nodules in 203 patients were retrospectively included. Imaging characteristics including diameter, arterial hyperenhancement, washout, and capsule were reviewed independently by two groups of readers using LI-RADS and LS (range, score 1-5). LS is primarily based on the overall impression of image findings without using fixed criteria. Interreader agreement (IRA), intraclass agreement (ICA), and diagnostic performance were determined by Fleiss, Cohen's kappa (κ), and logistic regression, respectively.
  
  
  RESULTS
  There were 167 contrast-enhanced CT (CECT) versus 114 MR data. Overall, IRA was moderate (κ = 0.47, 0.52); IRA was moderate-to-good for arterial hyperenhancement, washout, and capsule (κ = 0.56-0.69); excellent for diameter and tumor embolus (κ = 0.99). Overall, ICA between LI-RADS and LS was moderate (κ = 0.44-0.50); ICA was good for scores 1-2 (κ = 0.71-0.90), moderate for scores 3 and 5 (κ = 0.41-0.52), but very poor for score 4 (κ = 0.11-0.19). LI-RADS produced significantly lower accuracy (78.6% vs. 87.2%) and sensitivity (72.1% vs. 92.8%), higher specificity (97.3% vs. 71.2%) and positive likelihood ratio (+LR: 26.32 vs. 3.23) in diagnosis of HCC. CECT produced relatively low IRA, ICA, and diagnostic ability against MR.
  
  
  CONCLUSIONS
  There were substantial variations in liver observations between LI-RADS and LS. Further study is needed to investigate ICA between CECT and MR.
authors.affiliation: Department of Radiology, the First Affiliated Hospital with Nanjing Medical University, Nanjing, P.R. China.
authors.forename: Yu-Dong
authors.initials: YD
authors.lastname: Zhang
authors.affiliation: Department of Radiology, the First Affiliated Hospital with Nanjing Medical University, Nanjing, P.R. China.
authors.forename: Fei-Peng
authors.initials: FP
authors.lastname: Zhu
authors.affiliation: Department of Radiology, the First Affiliated Hospital with Nanjing Medical University, Nanjing, P.R. China.
authors.forename: Xun
authors.initials: X
authors.lastname: Xu
authors.affiliation: Department of Radiology, the First Affiliated Hospital with Nanjing Medical University, Nanjing, P.R. China.
authors.forename: Qing
authors.initials: Q
authors.lastname: Wang
authors.affiliation: Department of Radiology, the First Affiliated Hospital with Nanjing Medical University, Nanjing, P.R. China.
authors.forename: Chen-Jiang
authors.initials: CJ
authors.lastname: Wu
authors.affiliation: Department of Radiology, the First Affiliated Hospital with Nanjing Medical University, Nanjing, P.R. China.
authors.forename: Xi-Sheng
authors.initials: XS
authors.lastname: Liu
authors.affiliation: Department of Radiology, the First Affiliated Hospital with Nanjing Medical University, Nanjing, P.R. China.
authors.forename: Hai-Bin
authors.initials: HB
authors.lastname: Shi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008099:Liver / Q000000981:diagnostic imaging / Q000473:pathology; D008113:Liver Neoplasms / Q000175:diagnosis*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D011873:Radiology Information Systems; D015203:Reproducibility of Results; D012107:Research Design; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed
keywords: HCC; LI-RADS; Likert scale; interreader agreement; intraclass agreement