Inter-reader reliability of contrast-enhanced ultrasound Liver Imaging Reporting and Data System: a meta-analysis

• Published in: Abdominal imaging 2021-10, Vol.46 (10), p.4671-4681
• Main Authors: Kang, Ji Hun, Choi, Sang Hyun, Lee, Ji Sung, Kim, Dong Wook, Jang, Jong Keon
• Format: Article
• Language: English
• Subjects: Classification; Confidence intervals; Gastroenterology; Hepatobiliary; Hepatocellular carcinoma; Hepatology; Heterogeneity; Homogeneity; Imaging; Lesions; Liver; Liver cancer; Malignancy; Mathematical analysis; Medicine; Medicine & Public Health; Meta-analysis; Radiology; Regression analysis; Regression models; Reliability analysis; Reproducibility; Statistical analysis; Ultrasonic imaging; Ultrasound
• ISSN: 2366-004X; 2366-0058
• DOI: 10.1007/s00261-021-03169-7

Purpose To systematically determine the inter-reader reliability of the contrast-enhanced ultrasound (CEUS) Liver Imaging Reporting and Data System (LI-RADS), with emphasis on its major features for hepatocellular carcinoma (HCC) and LR-M (LI-RADS category M) features for non-HCC malignancy. Methods MEDLINE, EMBASE, and Cochrane databases were searched from January 2016 to March 2021 to identify original articles reporting the inter-reader reliability of CEUS LI-RADS. Meta-analytic pooled kappa values ( κ ) were calculated for major features [nonrim arterial-phase hyperenhancement (APHE), mild and late washout], LR-M features (rim APHE, early washout), and LI-RADS categorization using the DerSimonian-Laird random-effects model. Meta-regression analysis was performed to explore any causes of study heterogeneity. Results Twelve studies with a total of 2862 lesions were included. The meta-analytic pooled κ of nonrim APHE, mild and late washout, rim APHE, early washout, and LI-RADS categorization were 0.73 [95% confidence interval (CI), 0.67 − 0.79], 0.69 (95% CI, 0.54–0.84), 0.54 (95% CI, 0.37–0.71), 0.62 (95% CI, 0.45–0.79), and 0.75 (95% CI, 0.64–0.87), respectively. Compared with the major features, LR-M features had a lower meta-analytic pooled κ . Substantial study heterogeneity was noted in the LI-RADS categorization, and lesion size ( p  = 0.03) and the homogeneity in reader experience ( p  = 0.03) were significantly associated with study heterogeneity. Conclusions CEUS LI-RADS showed substantial inter-reader reliability for major features and LI-RADS categorization, but relatively lower reliability was found for LR-M features. In our opinion, the definitions of imaging features require further refinement to improve the inter-reader reliability of CEUS LI-RADS. Graphic abstract