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Background <p>Abbreviated MRI (AMRI) protocols may offer an alternative to ultrasound for hepatocellular carcinoma (HCC) surveillance in high-risk patients, but standardized assessment and interreader agreement are essential for clinical implementation. As surveillance programs expand, these examinations will increasingly be interpreted by early-to-mid career radiologists, making it critical to evaluate agreement within this workforce segment.</p> Purpose <p>To evaluate interreader agreement for image quality assessment, observation detection, and proposed AMRI-LI-RADS classification in non-contrast (NC) AMRI for HCC surveillance among early-to-mid career radiologists, and to assess the influence of experience within this cohort on interpretation patterns.</p> Methods <p>In this retrospective analysis of 614 NC-AMRI examinations (HASTE and DWI sequences), four early-to-mid career radiologists (2, 4.5, 5.5, and 5.5 years of post-training experience in abdominal MRI) independently evaluated image quality (5-point scale), presence of observations (≥ 10mm), and proposed AMRI-LI-RADS classification (benign, equivocal, or malignant). Agreement was assessed using percentage agreement and prevalence-adjusted bias-adjusted kappa (PABAK) for image quality, and Cohen's kappa for observation detection and proposed AMRI-LI-RADS classification. Friedman test, Cochran's Q test, and Bhapkar test for marginal homogeneity were used to evaluate differences across experience levels, with subsequent pairwise comparisons and regression analyses to quantify experience-related effects.</p> Results <p>Most examinations received excellent image quality ratings across all readers (HASTE: 73.3%-97.1%; DWI: 66.3%-93.7%). Interreader agreement was substantial for dichotomized image quality (PABAK: 0.807-0.995), observation detection (kappa: 0.742-0.993), and proposed AMRI-LI-RADS classification (kappa: 0.641-0.915). Reader experience significantly influenced assessments , with less experienced readers assigning higher quality scores and detecting more observations. There was no significant influence of reader experience on AMRI-LIRADS classification.</p> Conclusion <p>NC-AMRI demonstrates high interreader agreement for image quality assessment, observation detection, and proposed AMRI-LI-RADS classification among early-to-mid career radiologists, supporting reproducibility of NC-AMRI interpretation. However, significant reader-dependent differences in quality ratings and observation detection indicate systematic variations in reader thresholds, highlighting the importance of standardized interpretation criteria and reader calibration when implementing NC-AMRI surveillance programs.</p>

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Interreader agreement for image quality, observation detection, and proposed AMRI-LI-RADS classification in non-contrast abbreviated MRI for hepatocellular carcinoma surveillance among early-to-mid career radiologists

  • 期刊论文

  • 发表日期：

    2026年6月30日

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  • Pankaj Gupta,
  • Raghuraman Soundararajan,
  • Abhinandan Kumar,
  • Tarvinder Singh,
  • Shubham Saini,
  • Joseph Johnson,
  • Ajay Gulati,
  • Naveen Kalra,
  • Madhumita Premkumar,
  • Sunil Taneja,
  • Vishal Sharma,
  • Ajay Duseja

摘要

Background

Abbreviated MRI (AMRI) protocols may offer an alternative to ultrasound for hepatocellular carcinoma (HCC) surveillance in high-risk patients, but standardized assessment and interreader agreement are essential for clinical implementation. As surveillance programs expand, these examinations will increasingly be interpreted by early-to-mid career radiologists, making it critical to evaluate agreement within this workforce segment.

Purpose

To evaluate interreader agreement for image quality assessment, observation detection, and proposed AMRI-LI-RADS classification in non-contrast (NC) AMRI for HCC surveillance among early-to-mid career radiologists, and to assess the influence of experience within this cohort on interpretation patterns.

Methods

In this retrospective analysis of 614 NC-AMRI examinations (HASTE and DWI sequences), four early-to-mid career radiologists (2, 4.5, 5.5, and 5.5 years of post-training experience in abdominal MRI) independently evaluated image quality (5-point scale), presence of observations (≥ 10mm), and proposed AMRI-LI-RADS classification (benign, equivocal, or malignant). Agreement was assessed using percentage agreement and prevalence-adjusted bias-adjusted kappa (PABAK) for image quality, and Cohen's kappa for observation detection and proposed AMRI-LI-RADS classification. Friedman test, Cochran's Q test, and Bhapkar test for marginal homogeneity were used to evaluate differences across experience levels, with subsequent pairwise comparisons and regression analyses to quantify experience-related effects.

Results

Most examinations received excellent image quality ratings across all readers (HASTE: 73.3%-97.1%; DWI: 66.3%-93.7%). Interreader agreement was substantial for dichotomized image quality (PABAK: 0.807-0.995), observation detection (kappa: 0.742-0.993), and proposed AMRI-LI-RADS classification (kappa: 0.641-0.915). Reader experience significantly influenced assessments , with less experienced readers assigning higher quality scores and detecting more observations. There was no significant influence of reader experience on AMRI-LIRADS classification.

Conclusion

NC-AMRI demonstrates high interreader agreement for image quality assessment, observation detection, and proposed AMRI-LI-RADS classification among early-to-mid career radiologists, supporting reproducibility of NC-AMRI interpretation. However, significant reader-dependent differences in quality ratings and observation detection indicate systematic variations in reader thresholds, highlighting the importance of standardized interpretation criteria and reader calibration when implementing NC-AMRI surveillance programs.