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A multicenter assessment of interreader reliability of LI-RADS version 2018 for MRI and CT
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 multi-center, multireader setting using scrollable images.
Materials and Methods: This retrospective study used de-identified clinical multiphase
CT and MRI examinations and reports with at least one untreated observation from six
institutions and three countries; only qualifying examinations were submitted.
Examination dates were October 2017 – 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 v2018 category was computed as a re-scored 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-1/2, LR-3, LR-4, LR-5/M/tumor in vein) was computed using intra-class correlation
coefficients (ICC). Agreement was also computed for dichotomized malignancy (LR-4/LR5/LR-M/LR-tumor in vein), LR-5, and LR-M. Agreement was compared between researchversus-research reads and research-versus-clinical reads.
Results: 484 patients (mean age, 62 years ±10 [SD]; 156 women; 93 CT, 391 MRI) were
included. ICCs for ordinal LI-RADS, dichotomized malignancy, LR-5, and LR-M were 0.68
(95% CI: 0.62, 0.74), 0.63 (95% CI: 0.56, 0.71), 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, P = .03) and for dichotomized malignancy (ICC, 0.63 vs. 0.53, P = .005), but not
for LR-5 (P = .14) or LR-M (P = .94).
Conclusion: There was moderate agreement for Liver Imaging-Reporting and Data
System v2018 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
Changes of CD14 and CD1a expression in response to IL-4 and granulocyte-macrophage colony-stimulating factor are different in cord blood and adult blood monocytes
Neonates are relatively immature in their immune response; thus, to further clarify the differences of monocyte function and differentiation between neonates and adults, we investigated their CD14+CD4+ and CD14+CD16+ monocyte subpopulations, production of IL-1β and tumor necrosis factor-α induced by lipopolysaccharide, and their CD14 and CD1a phenotypic changes in response to IL-4 and granulocyte-macrophage colony-stimulating factor. Our results showed that 1) the expression of CD14 in cord blood monocytes was significantly lower than that in adult peripheral blood monocytes; 2) both the percentages of CD14+CD4+ cells and CD14+CD16+ cells among CD14+ monocytes were also significantly lower in cord blood; 3) after stimulation by lipopolysaccharide for 72 h, production of both IL-1β and tumor necrosis factor-α was lower in cord blood than that in adult peripheral blood; and 4) in response to IL-4 or GM-CSF, the phenotype development of CD14 and CD1a in cord blood and adult peripheral blood was different. Down-regulation of CD14 expression in response to IL-4 and GM-CSF was slower in cord blood monocytes than that in adult peripheral blood monocytes. After 9 d of culture in the presence of IL-4 and GM-CSF, the percentage of CD1a+ monocytes was significantly more increased in cord blood than that in adult peripheral blood. The reduced expression of CD14 and other mature phenotype markers such as CD16 and CD4 as well as the reduced IL-1β and tumor necrosis factor-α production may contribute to the impaired immune response of neonates. Slower down-regulation of CD14 by IL-4 and GM-CSF suggests that differential properties of cord blood monocytes in response to cellular stress signals take a longer time than those of adult peripheral blood monocytes.link_to_subscribed_fulltex