Inter-Reader Agreement for Contrast-Enhanced Ultrasound Liver Imaging Reporting and Data System Major Features and Final Categorization: A Subanalysis From a Prospective Multicenter Study

• Published in: Journal of ultrasound in medicine 2025-02, Vol.44 (2), p.349-357
• Main Authors: Kuon Yeng Escalante, Cristina M, Siu Xiao, Tania, Kono, Yuko, Piscaglia, Fabio, Wilson, Stephanie R, Medellin, Alexandra, Rodgers, Shuchi K, Planz, Virginia, Kamaya, Aya, Fetzer, David T, Berzigotti, Annalisa, Sidhu, Paul S, Wessner, Corinne E, Bradigan, Kristen, Eisenbrey, John R, Forsberg, Flemming, Lyshchik, Andrej
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Carcinoma, Hepatocellular - diagnostic imaging; Contrast Media; Data Systems; Female; Humans; Image Enhancement - methods; Liver - diagnostic imaging; Liver Neoplasms - diagnostic imaging; Male; Middle Aged; Observer Variation; Original; Prospective Studies; Radiology Information Systems - statistics & numerical data; Reproducibility of Results; Retrospective Studies; Ultrasonography - methods
• ISSN: 0278-4297; 1550-9613; 1550-9613
• DOI: 10.1002/jum.16608

Contrast-enhanced ultrasound (CEUS) Liver Imaging Reporting and Data System (LI-RADS) is used to definitively diagnose hepatocellular carcinoma (HCC) in patients at risk. However, the user variability associated with CEUS LI-RADS has not been validated in North American and European patients. This study aims to evaluate the inter-reader agreements of CEUS LI-RADS features for, and final categorization of, HCC in patients at risk. This retrospective multicenter clinical study used the database of a previous prospective multinational study, evaluating the accuracy of CEUS LI-RADS for HCC diagnosis in patients at risk. All cases were first evaluated by a site physician performing/supervising the CEUS examination. Randomly selected cases were re-evaluated by a blinded central reader. Final diagnosis was confirmed with the reference standard, which was a composite of imaging tests and histology. Cohen's kappa test was used to evaluate inter-reader agreement. This study included 150 liver nodules and 58.0% (87/150) were confirmed as HCC, 4.7% (7/150) non-HCC malignancies, 22.7% (34/150) had no confirmed final diagnosis, and 14.7% (22/150) were nonmalignant. Inter-reader agreements were substantial for CEUS LI-RADS categorization (κ = 0.61; 95% confidence interval [CI]: 0.51-0.71) and major features assessment (ranged κ = 0.64-0.78), LR-5 (κ = 0.65; 95% CI: 0.52-0.77), and LR-M (κ = 0.67; 95% CI: 0.44-0.90), while for LR-1 and LR-2 categorization was almost perfect (κ = 0.85; 95% CI: 0.65-1.00). Our study reported a substantial inter-reader agreement for overall CEUS LI-RADS categorization, especially for LR-5 and LR-M, and major imaging features of HCC, further confirming CEUS LI-RADS as a valuable and reliable tool for diagnosis of HCC.