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Abstract #1079

Inter-observer Agreement for the Diagnosis of LI-RADS 3 and 4 Lesions on Gadoxetate MRI and Outcome Assessment

Murat Yuce1, Sara Lewis2, Augusto Villanueva3, and Bachir Taouli2,4
1BioMedical Engineering and Imaging Institute, Icahn School of Medicine Mount Sinai, New York, NY, United States, 2Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States, 3Mount Sinai Liver Cancer Program (Division of Liver Diseases), Icahn School of Medicine at Mount Sinai, New York, NY, United States, 4BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Synopsis

Keywords: Liver, Liver

Motivation: Despite standardization by LI-RADS v2018, inter-observer variability persists in diagnosing liver lesions, especially for indeterminate lesions (LR-3 and 4), impacting patient outcomes.

Goal(s): Assess inter-observer agreement in diagnosing LR-3 and 4 lesions on gadoxetate-enhanced MRI, describe lesion outcomes, and identify malignancy-predictive imaging features.

Approach: A retrospective single-center study (n=111) analyzed inter-observer agreement, outcomes, and malignancy-predicting imaging features of LR-3 and 4 lesions.

Results: Inter-observer agreement was poor for LR-3 (kappa 0.27) and fair for LR-4 (kappa 0.43). Malignancy developed in 29% of LR-3 and 60% of LR-4 lesions; LR-4 lesions progressed to HCC faster (median 18 vs. 31 months, p=0.01).

Impact: The study highlights the need for improved standardization and radiologist’s training in applying LI-RADS criteria to enhance diagnostic accuracy.

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