Interreader and inter-test agreement in assessing treatment response following transarterial embolization for hepatocellular carcinoma

• Published in: European radiology 2015-09, Vol.25 (9), p.2779-2788
• Main Authors: Donati, Olivio F., Do, Richard Kinh Gian, Hötker, Andreas M., Katz, Seth S., Zheng, Junting, Moskowitz, Chaya S., Beattie, Christopher, Brown, Karen T.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Agreements; Carcinoma, Hepatocellular - diagnostic imaging; Carcinoma, Hepatocellular - therapy; Chemoembolization, Therapeutic; Clinical medicine; Diagnostic Radiology; Embolization; Female; Hepatobiliary-Pancreas; Humans; Imaging; Internal Medicine; Interventional Radiology; Liver - diagnostic imaging; Liver cancer; Liver Neoplasms - diagnostic imaging; Liver Neoplasms - therapy; Male; Medicine; Medicine & Public Health; Middle Aged; Neuroradiology; Observer Variation; Radiology; Reproducibility of Results; Retrospective Studies; Tomography, X-Ray Computed; Treatment Outcome; Ultrasound
• ISSN: 0938-7994; 1432-1084
• DOI: 10.1007/s00330-015-3677-4

Purpose To evaluate interreader and inter-test agreement in applying size- and necrosis-based response assessment criteria after transarterial embolization (TAE) for hepatocellular carcinoma (HCC), applying two different methods of European Association for the Study of the Liver (EASL) criteria. Methods Seventy-four patients (median age, 67 years) from a prospectively accrued study population were included in this retrospective study. Four radiologists independently evaluated CT data at 2–3 (1st follow-up, FU) and 10–12 (2nd FU) weeks after TAE and assessed treatment response using size-based (WHO, RECIST) and necrosis-based (mRECIST, EASL) criteria. Enhancing tissue was bidimensionally measured (EASL meas ) and also visually estimated (EASL est ). Interreader and inter-test agreements were assessed using intraclass correlation coefficient (ICC) and κ statistics. Results Interreader agreement for all response assessment methods ranged from moderate to substantial (κ = 0.578–0.700) at 1st FU and was substantial (κ = 0.716–0.780) at 2nd FU. Inter-test agreement was substantial between WHO and RECIST (κ = 0.610–0.799, 1st FU; κ = 0.655–0.782, 2nd FU) and excellent between EASL meas and EASL est (κ = 0.899–0.918, 1st FU; κ = 0.843–0.877, 2nd FU). Conclusion Size- and necrosis-based criteria both show moderate to excellent interreader agreement in evaluating treatment response after TAE for HCC. Inter-test agreement regarding EASL meas and EASL est was excellent, suggesting that either may be used. Key points • Applying EASL criteria, visual estimation and bidimensional measurements show comparable interreader agreement. • EASL meas and EASL est show substantial interreader agreement for treatment response in HCC. • Agreement was excellent for EASL meas and EASL est after TAE of HCC. • Visual estimation of enhancement is adequate to assess treatment response of HCC.