Ultrasound Liver Imaging Reporting and Data System (US LI-RADS) Visualization Score: a reliability analysis on inter-reader agreement

Thodsawit Tiyarattanachai; Kristen N Bird; Edward C Lo; Aladin T Mariano; Amanzo A Ho; Craig W Ferguson; Ranjit S Chima; Terry S Desser; Linda Nayeli Morimoto; Aya Kamaya

doi:10.1007/s00261-021-03067-y

Ultrasound Liver Imaging Reporting and Data System (US LI-RADS) Visualization Score: a reliability analysis on inter-reader agreement

Abdom Radiol (NY). 2021 Nov;46(11):5134-5141. doi: 10.1007/s00261-021-03067-y. Epub 2021 Jul 6.

Authors

Affiliations

¹ Faculty of Medicine, Chulalongkorn University, 1873 Rama 4 Rd., Pathum Wan, Bangkok, 10330, Thailand.
² Department of Radiology, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, 94305, USA.
³ Body and Chest Divisions, Department of Radiology, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, 94305, USA.
⁴ Department of Radiology, Stanford University School of Medicine, 300 Pasteur Drive, Room S048A, Stanford, CA, 94305, USA.
⁵ Department of Radiology, Stanford University School of Medicine, 300 Pasteur Drive, Room H-1307, Stanford, CA, 94305, USA.
⁶ Department of Radiology, Stanford University School of Medicine, 300 Pasteur Drive, Room H-1307, Stanford, CA, 94305, USA. kamaya@stanford.edu.

PMID: 34228197
DOI: 10.1007/s00261-021-03067-y

Abstract

Background & aim: The American College of Radiology Ultrasound Liver Imaging Reporting and Data System (ACR US LI-RADS) Visualization Score conveys the expected level of sensitivity of screening and surveillance ultrasound exams in patients at risk for hepatocellular carcinoma (HCC). We sought to determine inter-reader agreement of the Visualization Score which is currently unknown.

Methods: Consecutive 6998 ultrasound HCC screening and surveillance studies in 3115 patients from 2017 to 2020 were retrospectively retrieved. Of these, 6154 (87.9%) studies were Visualization A (No or minimal limitations), 709 (10.1%) were Visualization B (Moderate limitations), and 135 (1.9%) were Visualization C (Severe limitations). Randomly sampled 90 studies, with 30 studies in each Visualization category, were included for analysis. Nine radiologists (3 senior attendings, 3 junior attendings and 3 body imaging fellows) blinded to the original categorization independently reviewed each study and assigned a Visualization Score. Intraclass correlation coefficient (ICC) was used to quantify inter-reader agreement.

Results: ICC among all 9 radiologists was 0.70 (95% CI 0.63-0.77). ICCs among senior attendings, junior attendings and body imaging fellows were 0.68 (CI 0.58-0.76), 0.72 (CI 0.62-0.80) and 0.76 (CI 0.68-0.83), respectively. Subgroup analysis by liver parenchyma was further performed. ICC was highest in the patient group with normal liver parenchyma (0.69, CI 0.56-0.81), followed by steatosis (0.66, CI 0.54-0.79) and cirrhosis (0.58, CI 0.43-0.73), respectively.

Conclusions: US LI-RADS Visualization Score is a reliable tool with good inter-reader agreement that can be used to indicate the expected level of sensitivity of a screening and surveillance ultrasound examination for detecting focal liver observations.

Keywords: Hepatocellular carcinoma; Inter-reader agreement; Screening and surveillance; Ultrasound LI-RADS; Visualization Score.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Carcinoma, Hepatocellular* / diagnostic imaging
Contrast Media
Humans
Liver Neoplasms* / diagnostic imaging
Magnetic Resonance Imaging
Reproducibility of Results
Retrospective Studies

Substances

Contrast Media