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A Multicenter Assessment of Interreader Reliability of LI-RADS Version 2018 for MRI and CT
Cheng William Hong1, Victoria Chernyak1, Jin-Young Choi1
1From the Department of Radiology and Biomedical Imaging, University of California San Francisco, 513 Parnassus Ave, S255, Box 0628, San Francisco, CA 94143 (C.W.H., M.A.O.); Liver Imaging Group, Department of Radiology, University of California, San Diego, San Diego, Calif (C.W.H., C.P., T.D., D.T.M., K.J.F., C.B.S.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (V.C., N.H.); Department of Radiology, Yonsei University, Seoul, South Korea (J.Y.C.); Department of Radiology, University of California Irvine, Orange, Calif (S.L., R.K.); Computational and Applied Statistics Laboratory, University of California San Diego, San Diego, Calif (T.W., A.G.); Department of Radiology, New York University, New York, NY (J.B.); Department of Radiology, University of Florida, Jacksonville, Fla (C.L.); Department of Radiology, University of Kentucky, Lexington, Ky (J.T.L., J.W.O.); Department of Radiology, Fundación Santa Fe de Bogotá, Bogotá, Colombia (D.A.A.); Department of Radiology, University of Michigan, Ann Arbor, Mich (M.M.L., M.S.D., W.M.); Department of Radiology, Allegheny Health Network, Pittsburgh, Pa (A.R.); Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (S.C.L.); Department of Radiology, New York-Presbyterian/Weill Cornell Medical Center, New York, NY (A.S.K., E.M.H.); Departments of Radiology and Medicine, Duke University Medical Center, New York, NY (M.R.B.); Section of Radiology, Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University Hospital Paolo Giaccone, Palermo, Italy (G.B.); Department of Radiology, University of California Los Angeles, Los Angeles, Calif (M.L.D.); Department of Radiology, Radiation Oncology and Nuclear Medicine, Université de Montréal, Montréal, Canada (A.T., M.C.); Department of Radiology, Oregon Health & Science University, Portland, Ore (A.F.); CEDRUL-Centro de Diagnóstico por Imagem, João Pessoa, Brazil (E.A.C.); Department of Radiology, University of California Davis, Sacramento, Calif (M.T.C., J.P.M.); Radiology Limited, Tucson, Ariz (B.K.); Department of Abdominal Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E., V.R.S., K.B.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); University of São Paulo/Hospital Sírio-Libanês, São Paulo, Brazil (N.H.); Department of Radiology, University of Kansas, Kansas City, Kan (S.B., R.A.); Sir H. N. Reliance Foundation Hospital and Research Centre, Mumbai, India (K.G.); Department of Radiology, California Pacific Medical Center, San Francisco, Calif (C.R.K.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.K.); The 3rd Affiliated Hospital, Sun Yat-sen University, Guangzhou, China (J.W.); Inland Imaging, Spokane, Wash (I.C.); Sutter Medical Group, Sacramento, Calif (B.B.); Austin Health, Melbourne, Australia (M.G.); Department of Radiology, University of Washington, Seattle, Wash (G.M.C.).
Abstract:
Background Various limitations have impacted research evaluating reader agreement for Liver Imaging Reporting and Data System (LI-RADS). Purpose To assess reader agreement of LI-RADS in an international multicenter multireader setting using scrollable images. Materials and Methods This retrospective study used deidentified clinical multiphase CT and MRI and reports with at least one untreated observation from six institutions and three countries; only qualifying examinations were submitted. Examination dates were October 2017 to August 2018 at the coordinating center. One untreated observation per examination was randomly selected using observation identifiers, and its clinically assigned features were extracted from the report. The corresponding LI-RADS version 2018 category was computed as a rescored clinical read. Each examination was randomly assigned to two of 43 research readers who independently scored the observation. Agreement for an ordinal modified four-category LI-RADS scale (LR-1, definitely benign; LR-2, probably benign; LR-3, intermediate probability of malignancy; LR-4, probably hepatocellular carcinoma [HCC]; LR-5, definitely HCC; LR-M, probably malignant but not HCC specific; and LR-TIV, tumor in vein) was computed using intraclass correlation coefficients (ICCs). Agreement was also computed for dichotomized malignancy (LR-4, LR-5, LR-M, and LR-TIV), LR-5, and LR-M. Agreement was compared between research-versus-research reads and research-versus-clinical reads. Results The study population consisted of 484 patients (mean age, 62 years ± 10 [SD]; 156 women; 93 CT examinations, 391 MRI examinations). ICCs for ordinal LI-RADS, dichotomized malignancy, LR-5, and LR-M were 0.68 (95% CI: 0.61, 0.73), 0.63 (95% CI: 0.55, 0.70), 0.58 (95% CI: 0.50, 0.66), and 0.46 (95% CI: 0.31, 0.61) respectively. Research-versus-research reader agreement was higher than research-versus-clinical agreement for modified four-category LI-RADS (ICC, 0.68 vs 0.62, respectively; P = .03) and for dichotomized malignancy (ICC, 0.63 vs 0.53, respectively; P = .005), but not for LR-5 (P = .14) or LR-M (P = .94). Conclusion There was moderate agreement for LI-RADS version 2018 overall. For some comparisons, research-versus-research reader agreement was higher than research-versus-clinical reader agreement, indicating differences between the clinical and research environments that warrant further study. © RSNA, 2023 Supplemental material is available for this article. See also the editorials by Johnson and Galgano and Smith in this issue.
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