Keywords:
Liver, Abdomen, Oncology, CT, Diagnostic procedure, Observer performance, Cancer, Neoplasia
Authors:
I. Garg, S. Thompson, E. Ehman, S. P. Sheedy, A. Khandelwal, C. A. Bookwalter, T. Mounajjed, S. K. Venkatesh; Rochester, Mn/US
DOI:
10.1594/ecr2018/C-1742
Methods and materials
This is an institutional review board (IRB) approved,
HIPPA-compliant retrospective study with waiver of informed consent.
Patient selection:
We reviewed our institutional pathology and imaging database between January 2006 and December 2016 for patients with HCC and hepatic steatosis.
Fig. 1: Flow chart showing selection of patients with HCC in NAFLD
Inclusion criteria:
-
HCC confirmed on pathology.
-
Hepatic steatosis confirmed on pathology or at MRI (hepatic fat signal fraction >5%) performed within 6 months of HCC confirmation
-
Triphasic CT obtained within 6 months of pathologic confirmation.
Exclusion criteria:
Study population:
42 patients (66.7% male; mean age 63.3 years)
Data acquisition:
Patient demographics,
laboratory values,
and clinical management information were noted from electronic medical records.
CT Imaging Review:
All the CT images were independently reviewed on PACS Workstation (Centricity,
GE Healthcare) by four board-certified radiologists who were blinded to clinical and pathological findings other than the presence of HCC.
-
Location
-
Size
-
Arterial phase hyperenhancement (APHE)
-
Portal venous phase washout (PVWO)
-
Delayed phase washout (DPWO)
-
Presence of capsule
-
Features of cirrhosis- surface nodularity,
volumetric changes
-
Signs of portal hypertension- splenomegaly,
varices
The final imaging features were determined by majority.
A fifth (blinded) reader reviewed cases lacking majority.
Statistical Analysis:
Data were analyzed using JMP 11.0 (SAS,
Cary,
NC) and Prism 5.0 (GraphPad Software,
Inc,
La Jolla,
CA).
Descriptive statistics were generated. Inter-rater agreement was determined by prevalence-adjusted bias-adjusted Cohen’s kappa12.
Agreement between cirrhotic liver morphology by CT and cirrhosis at pathology was determined by prevalence-adjusted Cohen’s kappa5 P < .05 was considered statistically significant.