Repeatability of Diagnostic Features and Scoring Systems for Hepatocellular Carcinoma by Using MR Imaging

This article evaluated the inter-rater reliability of assessing characteristics of liver lesions and overall staging of hepatocellular carcinomas using various staging systems (OTPN, AASLD, and LI-RADS).

10 blinded readers reviewed 100 liver MRI cases assessing lesions for HCC criteria (arterial hyper-enhancement, washout, and pseudocapsule). Readers were also asked to assign an OTPN, AASLD and LI-RADS score (ver. 2013.1) based on their findings.

5 abdominal imaging staff at an OPTN approved liver transplant center (6-11 years of experience) and 5 “novice” radiology residents were selected to be a part of the study. 10 cases were used for training but not included as part of the study results.

High Kappa scores were achieved for the finding of arterial hyper-enhancement (0.67). Moderate scores for wash-out and the presence of a pseudocapsule (0.48 and 0.52 respectively).

As for staging moderate agreement was noted for OPTN staging (0.53) and fair agreement for LI-RADS and AASLD (0.35 and 0.39).

Overall agreement amongst experts was significantly higher in comparison to that of novice residents (P<.001). Interestingly (yet not surprising) agreement between experts for LI-RADS and AASLD was fair to moderate (0.43 and 0.46) in comparison to OPTN (0.64).


PICO Analysis:

Population: Radiologists
Intervention: The effect of experience for interpretation and accurate staging of hepatocellular carcinomas.
Comparison: “experts” versus “novice” residents
Outcome: There is higher consistency and accuracy amongst experts reading liver MRI. There is moderate agreement amongst “experts” for relatively complex classification systems (LI-RADS and AASLD) in comparison to high agreement for OPTN




Advancement in Knowledge:

1. Experience plays a role in the interpretation of Liver MRI
2. There is only moderate agreement amongst “experts” in staging hepatocellular carcinoma using LI-RADS and AASLD.



Reference:
Pubmed Full Text

Advanced-stage Hodgkin Lymphoma: US/Chest Radiography for Detection of Relapse in Patients in First Complete Remission—A Randomized Trial of Routine Surveillance Imaging Procedures

This intriguing study looks at alternatives to PET/CT and CT for followup of Hodgkin lymphoma. The study prospectively enrolled 300 patients into either F18 PET/CT or US + CXR at specified intervals. The US/CXR arm had higher specificity than PET/CT (96% vs 86%), and both arms had similar sensitivity (97.5% vs 100%).
This is an intriguing approach to reduce radiation dose (14.5 mSv per PET/CT vs 0.1 mSv per CXR) in this population who have a high baseline risk of second malignancy (as documented in this study, ~5% 5yr risk of secondary malignancy with no difference between the two arms). Further benefit is the reduced cost of the US/CXR approach, which in Italy was estimated at €1071 per PET/CT vs €103 per US/CXR. There were also lower secondary costs and fewer invasive procedures (eg mediastinoscopy) in the US/CXR arm.
The main limitation is the technical feasibility of performing US screening, in the study this was all done by one 'expert' radiologist, and its extension to other practices may be challenging but is worth considering.

PICO Analysis:
Population: advanced stage Hodgkin Lymphoma
Intervention: US + CXR f/u post initial tx
Comparison: PET/CT f/u post initial tx
Outcome: Sensitivity & specificity for relapse, time to recurrence and cost

Reference: Pubmed Full Text

Thyroid Cancers Incidentally Detected at Imaging in a 10-year Period: How Many Cancers Would Be Missed with Use of the Recommendations from the Society of Radiologists in Ultrasound?

A large retrospective review of 2090 patients with thyroidectomy and comparison with the ultrasound findings. This confirms a low proportion of false negative results when the SRU guidelines are applied to thyroid ultrasounds. Furthermore the 'missed' cancers tended to be of lower grade than those that met the SRU guidelines.

PICO Analysis:
Population: 2090 patients with full or hemi-thyroidectomy
Intervention: thyroid ultrasound by SRU guidelines
Comparison: pathology
Outcome: False negative rate

Reference: Pubmed Full Text
Link: SRU Conference Statement (Radiology, 2005)