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Multicenter Study
. 2025 Feb;44(2):349-357.
doi: 10.1002/jum.16608. Epub 2024 Oct 29.

Inter-Reader Agreement for Contrast-Enhanced Ultrasound Liver Imaging Reporting and Data System Major Features and Final Categorization: A Subanalysis From a Prospective Multicenter Study

Cristina M Kuon Yeng Escalante  1 , Tania Siu Xiao  1 , Yuko Kono  2 , Fabio Piscaglia  3   4 , Stephanie R Wilson  5 , Alexandra Medellin  5 , Shuchi K Rodgers  1   6 , Virginia Planz  7 , Aya Kamaya  8 , David T Fetzer  9 , Annalisa Berzigotti  10 , Paul S Sidhu  11   12 , Corinne E Wessner  1 , Kristen Bradigan  1 , John R Eisenbrey  1 , Flemming Forsberg  1 , Andrej Lyshchik  1 ; CEUS LI‐RADS Trial Group
Collaborators, Affiliations
Multicenter Study

Inter-Reader Agreement for Contrast-Enhanced Ultrasound Liver Imaging Reporting and Data System Major Features and Final Categorization: A Subanalysis From a Prospective Multicenter Study

Cristina M Kuon Yeng Escalante et al. J Ultrasound Med. 2025 Feb.

Abstract

Objectives: Contrast-enhanced ultrasound (CEUS) Liver Imaging Reporting and Data System (LI-RADS) is used to definitively diagnose hepatocellular carcinoma (HCC) in patients at risk. However, the user variability associated with CEUS LI-RADS has not been validated in North American and European patients. This study aims to evaluate the inter-reader agreements of CEUS LI-RADS features for, and final categorization of, HCC in patients at risk.

Methods: This retrospective multicenter clinical study used the database of a previous prospective multinational study, evaluating the accuracy of CEUS LI-RADS for HCC diagnosis in patients at risk. All cases were first evaluated by a site physician performing/supervising the CEUS examination. Randomly selected cases were re-evaluated by a blinded central reader. Final diagnosis was confirmed with the reference standard, which was a composite of imaging tests and histology. Cohen's kappa test was used to evaluate inter-reader agreement.

Results: This study included 150 liver nodules and 58.0% (87/150) were confirmed as HCC, 4.7% (7/150) non-HCC malignancies, 22.7% (34/150) had no confirmed final diagnosis, and 14.7% (22/150) were nonmalignant. Inter-reader agreements were substantial for CEUS LI-RADS categorization (κ = 0.61; 95% confidence interval [CI]: 0.51-0.71) and major features assessment (ranged κ = 0.64-0.78), LR-5 (κ = 0.65; 95% CI: 0.52-0.77), and LR-M (κ = 0.67; 95% CI: 0.44-0.90), while for LR-1 and LR-2 categorization was almost perfect (κ = 0.85; 95% CI: 0.65-1.00).

Conclusion: Our study reported a substantial inter-reader agreement for overall CEUS LI-RADS categorization, especially for LR-5 and LR-M, and major imaging features of HCC, further confirming CEUS LI-RADS as a valuable and reliable tool for diagnosis of HCC.

Keywords: CEUS; LI‐RADS; agreement; inter‐reader.

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References

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