A.A. Esposito

D. Raciti

E. Casiraghi

L.V. Forzenigo

M. Manini

V. Buscarino

English

AIR Universita degli studi di Milano

Characterisation of liver nodules in patients with chronic
liver disease by MRI: comparison between the LI-RADS
v2014 and the Likert scale
Poster No.: C-2579
Congress: ECR 2017
Type: Scientific Exhibit
Authors: V. Buscarino, A. Esposito, D. Raciti, E. Casiraghi, L. V. Forzenigo,
M. Manini; Milan/IT
Keywords: Liver, Oncology, Abdomen, MR, Decision analysis, Cancer,
Cirrhosis, Tissue characterisation
DOI: 10.1594/ecr2017/C-2579
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Page 1 of 9
Aims and objectives
The usage of imaging techniques, such as CT or MRI, can detect small liver nodules.
An accurate diagnosis is extremely important to improve patient management and avoid
more invasive examinations as FNB samples [1]. In order to standardise the reporting LI-
RADS (Liver Imaging Reporting and Data System) [2] has been adopted by many clinical
practices since March 2011. It categorises nodules with a score from 1 to 5 by using
fixed criteria [2]. A different scale of diagnostic interpretation, adopted in many fields of
research, is the Likert. It is a psychometric scale and consists in setting up a number of
items (1 to 5 or 1 to 7) that evaluate and describe the attitude of the liver nodule towards
the HCC [3, 4] by using diagnostic guidelines but not fixed criteria. Our purpose in this
study was to compare the performance in the evaluation of liver nodules in high-risk
patients within two groups of readers, one using LI-RADS v.2014 and the other using
the 5-level Likert scale.
Page 2 of 9
Methods and materials
We reviewed patients with cirrhosis, with no history of previous HCC, who underwent
a MR examination between February 2006 and March 2012 for the presence of new
nodules. We identified 39 patients (15 males and 14 females) found with a total of
44 lesions. Images were analysed independently by four radiologists (two couples)
with different expertise in liver MRI: one group was made by 1-month (IradioLIR) and
10-year (EradioLIR) experienced radiologists, while the other pair was made by 3-
month (IradioLik) and 20-year (EradioLik) experienced radiologists. The first couple
used the LI-RADS v.2014, the second one adopted the Likert scale (scores 1-5). The
reference standard used was, in some instances, histopathological evaluation (72.7%
of lesions) and, in others, a 4-year MRI follow-up (27.3% of lesions). Statistical analysis
was performed and accuracy, sensitivity, specificity, PPV, NPV, ROC curves and inter-
observer agreement were calculated.
Page 3 of 9
Results
We evaluated 44 liver lesions: 26 HCC and 18 non-HCC. As for the LI-RADS v.2014,
when the two radiologists gave different scores, the score difference was never higher
than 1. Overall, the 77.27% of all the lesions achieved the same score. The k coefficient
between the two evaluators of LI-RADS scale was 0.89, while the estimated Pearson
correlation coefficient equaled 0.90. As far as the Likert scale is concerned, the inter-
reader agreement was much lower, and some nodules were classified with a 3-point
score difference. Overall, the 50% of all lesions were classified with equal scores. In
this case the k coefficient and the Pearson correlation coefficient were k=0.69 and
Pearson=0.63, respectively. Moreover, the readers of the LI-RADS scale obtained
the following results: ACC=0.80, SENS=0.72, SPEC=0.93, PPV=0.93, NPV=0.70,
AUC=0.85. As for the Likert, the results were: ACC=0.79, SENS=0.73, SPEC=0.87,
PPV=0.89, NPV=0.70, AUC=0.83. By applying the z-test to check a statistically significant
difference between the performance achieved by readers, the results have shown that
there is no a statistically significant difference between the two scales.
Page 4 of 9
Images for this section:
Fig. 1: ROC curve for each evaluator
© Postgraduation School in Radiodiagnostics, Università degli Studi di Milano - Milan/IT
Page 5 of 9
Fig. 2: LIRADS table: Performance values for each observer score. *NaN: Not a Number.
© Postgraduation School in Radiodiagnostics, Università degli Studi di Milano - Milan/IT
Page 6 of 9
Fig. 3: Likert table: Performance values for each observer score. *NaN: Not a Number.
© Postgraduation School in Radiodiagnostics, Università degli Studi di Milano - Milan/IT
Page 7 of 9
Conclusion
According to our results, both LI-RADS v.2014 and Likert scale show a good performance
in the evaluation of liver nodules and detection of HCC. Nevertheless, a strong agreement
has been shown between the LI-RADS evaluators and a moderate agreement between
the Likert scale evaluators. These values were also confirmed by the Pearson correlation
coefficient and suggest that the use of the LI-RADS provides a minor inter-reader
difference compared to the Likert scale [5]. These assumptions prove that a further
development and a wide diffusion of LI-RADS could be considered a primary purpose in
order to reduce the inter-reader variability.
Page 8 of 9
References
1. Forner A, Vilana R, Ayuso C et al. (2008) Diagnosis of Hepatic Nodules 20 mm or
Smaller in Cirrhosis: Prospective Validation of the Noninvasive Diagnostic Criteria for
Hepatocellular Carcinoma; Hepatology. 2008 Jan;47(1):97-104. Erratum in: Hepatology.
2008 Feb;47(2):769. doi: 10.1002/hep.21966.
2. Cruite I, Tang A, Sirlin CB (2013) Imaging-Based Diagnostic Systems for
Hepatocellular Carcinoma; AJR Am J Roentgenol. 2013 Jul;201(1):41-55. doi: 10.2214/
AJR.13.10570
3. Likert R. (1932) A technique for the measurement of attitudes; ArchPsychol
1932;22(140):1-55.
4. Villers A, Puech P, Mouton D, Leroy X, Ballereau C, Lemaitre L. (2006) Dynamic
contrast enhanced, pelvic phased array magnetic resonance imaging of localized
prostate cancer for predicting tumor volume: correlation with radical prostatectomy
findings; J Urol 2006;176 (6 pt 1):2432-2437 doi: 10.1016/j.juro.2006.08.007
5. Barth BK, Donati OF, Fischer MA et al. (2016) Reliability, Validity, and Reader
Acceptance of LI-RADS-An In-depth Analysis; Acad Radiol. 2016 Sep;23(9):1145-53.
doi: 10.1016/j.acra.2016.03.014
Page 9 of 9


Characterisation of liver nodules in patients with chronic liver disease by MRI: comparison between the LI-RADS v2014 and the Likert scale

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Characterisation of liver nodules in patients with chronic liver disease by MRI: comparison between the LI-RADS v2014 and the Likert scale

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