Inter-reader reliability of CT Liver Imaging Reporting and Data System according to imaging analysis methodology: a systematic review and meta-analysis

• Published in: European radiology 2021-09, Vol.31 (9), p.6856-6867
• Main Authors: Kang, Ji Hun, Choi, Sang Hyun, Lee, Ji Sung, Kim, Kyung Won, Kim, So Yeon, Lee, Seung Soo, Byun, Jae Ho
• Format: Article
• Language: English
• Subjects: Computed tomography; Correlation coefficient; Correlation coefficients; Diagnostic Radiology; Epidemiology; Gastrointestinal; Imaging; Internal Medicine; Interventional Radiology; Lesions; Liver; Liver cancer; Mathematical analysis; Medical schools; Medicine; Medicine & Public Health; Meta-analysis; Methodology; Neuroradiology; Radiology; Reliability analysis; Reproducibility; Statistical analysis; Subgroups; Systematic review; Ultrasound
• ISSN: 0938-7994; 1432-1084
• DOI: 10.1007/s00330-021-07815-y

Objectives To establish inter-reader reliability of CT Liver Imaging Reporting and Data System (LI-RADS) and explore factors that affect it. Methods MEDLINE and EMBASE databases were searched from January 2014 to March 2020 to identify original articles reporting the inter-reader reliability of CT LI-RADS. The imaging analysis methodology of each study was identified, and pooled intraclass correlation coefficient (ICC) or kappa values (κ) were calculated for lesion size, major features (arterial-phase hyperenhancement [APHE], nonperipheral washout [WO], and enhancing capsule [EC]), and LI-RADS categorization (LR) using random-effects models. Subgroup analyses of pooled κ were performed for the number of readers, average reader experience, differences in reader experience, and LI-RADS version. Results In the 12 included studies, the pooled ICC or κ of lesion size, APHE, WO, EC, and LR were 0.99 (0.96−1.00), 0.69 (0.58–0.81), 0.67 (0.53–0.82), 0.65 (0.54–0.76), and 0.70 (0.59–0.82), respectively. The experience and number of readers varied: studies using readers with ≥ 10 years of experience showed significantly higher κ for LR (0.82 vs. 0.45, p = 0.01) than those with < 10 years of reader experience. Studies with multiple readers including inexperienced readers showed significantly lower κ for APHE (0.55 vs. 0.76, p = 0.04) and LR (0.45 vs. 0.79, p = 0.02) than those with all experienced readers. Conclusions CT LI-RADS showed substantial inter-reader reliability for major features and LR. Inter-reader reliability differed significantly according to average reader experience and differences in reader experience. Reported results for inter-reader reliability of CT LI-RADS should be understood with consideration of the imaging analysis methodology. Key Points • The CT Liver Imaging Reporting and Data System (LI-RADS) provides substantial inter-reader reliability for three major features and category assignment. • The imaging analysis methodology varied across studies. • The inter-reader reliability of CT LI-RADS differed significantly according to the average reader experience and the difference in reader experience.