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. 2025 Aug 14;25(1):99.
doi: 10.1186/s40644-025-00922-9.

LI-RADS: concordance between energy-integrating computed tomography, photon-counting detector computed tomography and magnetic resonance imaging

Lukas Müller  1   2 , Tobias Jorg  3 , Fabian Stoehr  3 , Jan-Peter Grunz  4   5 , Dirk Graafen  3 , Moritz C Halfmann  3 , Henner Huflage  5 , Friedrich Foerster  6 , Jens Mittler  7 , Daniel Pinto Dos Santos  3 , Tobias Bäuerle  3 , Roman Kloeckner #  8 , Tilman Emrich #  3
Affiliations

LI-RADS: concordance between energy-integrating computed tomography, photon-counting detector computed tomography and magnetic resonance imaging

Lukas Müller et al. Cancer Imaging. .

Abstract

Background: Photon-counting detector CT (PCD-CT) offers technical advantages over energy-integrating detector CT (EID-CT) for liver imaging. However, it is unclear whether these translate into clinical improvements regarding the classification of suspicious liver lesions using the Liver Imaging Reporting and Data System (LI-RADS). This study compared the intra- and intermodal agreement of EID-CT and PCD-CT with Magnetic resonance imaging (MRI) for liver lesion classification.

Methods: This retrospective study included patients who underwent EID-CT or PCD-CT and MRI within 30 days between 02/2023 and 01/2024. Three board-certified radiologists assessed LI-RADS classification and presence of LI-RADS major features. Fleiss' Kappa and intraclass correlation coefficients (ICC) were used to evaluate rater agreement.

Results: Sixty-eight lesions in 26 patients (mean age 65.0 ± 14.2 years, 19 [73.1%] male) were analyzed. Intramodal inter-rater agreement for LI-RADS classification was 0.88 (0.62-0.88) for EID-CT, 0.90 (0.83-0.94) for PCD-CT, and 0.87 (0.81-0.91) for MRI. Agreement in PCD-CT was substantial for all LI-RADS major features, whereas in EID-CT only for washout. Intermodal agreement between CT and MRI ranged from 0.67 to 0.72. Final intermodal LI-RADS classification agreement was higher for PCD-CT (0.72-0.85) than EID-CT (0.52-0.64).

Conclusions: PCD-CT demonstrated higher intermodal and intramodal agreement for LI-RADS classification and major features than EID-CT. Additionally, PCD-CT shows significantly higher intramodal and inter-rater agreement for LI-RADS classification and greater concordance with MRI compared to EID-CT, reaching substantial to almost perfect agreement. These results suggest a potential benefit of PCD-CT in the management and treatment decision-making of HCC.

Keywords: Accuracy; Hepatocellular Carcinoma; Liver Imaging Reporting & Data System; Magnetic Resonance Imaging; Photon-Counting Computed Tomography.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The study was also approved by the ethics committee of the Medical Association of Rhineland Palatinate, Mainz, Germany (Permit number 2022–16359). The requirement of obtaining informed consent was waived due to the retrospective design of the study. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Sequential reading of CT and MRI scans across two sessions
Fig. 2
Fig. 2
Examples of the different major features of the LI-RADS classification. Top row: Photon-counting detector computed tomography (PCD-CT) (A) and magnetic resonance imaging (MRI) (B), hepatic arterial phase; the lesion shows strong contrast enhancement compared to the surrounding liver parenchyma (non-rim arterial phase hyperenhancement, APHE) (arrow). Bottom row: PCD-CT (C) and MRI (D), delayed phase; the lesion shows a reduction in enhancement relative to the surrounding background liver (non-peripheral “washout”) (*). Note the smooth border around the largest parts of the observation (enhancing “capsule” (arrowhead))
Fig. 3
Fig. 3
Sankey diagram demonstrating the number of reclassifications from CT to MRI
Fig. 4
Fig. 4
Comparison of reclassification rates from CT to MRI for EID-CT vs PCD-CT
See this image and copyright information in PMC

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