Liver, Abdomen, Oncology, CT, Diagnostic procedure, Observer performance, Cancer, Neoplasia
I. Garg, S. Thompson, E. Ehman, S. P. Sheedy, A. Khandelwal, C. A. Bookwalter, T. Mounajjed, S. K. Venkatesh; Rochester, Mn/US
Methods and materials
This is an institutional review board (IRB) approved,
HIPPA-compliant retrospective study with waiver of informed consent.
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
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.
42 patients (66.7% male; mean age 63.3 years)
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.
Arterial phase hyperenhancement (APHE)
Portal venous phase washout (PVWO)
Delayed phase washout (DPWO)
Presence of capsule
Features of cirrhosis- surface nodularity,
Signs of portal hypertension- splenomegaly,
The final imaging features were determined by majority.
A fifth (blinded) reader reviewed cases lacking majority.
Data were analyzed using JMP 11.0 (SAS,
NC) and Prism 5.0 (GraphPad Software,
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.