Interobserver agreement of semi-automated and manual measurements of functional MRI metrics of treatment response in hepatocellular carcinoma

David Bonekamp; Susanne Bonekamp; Vivek Gowdra Halappa; Jean-Francois H Geschwind; John Eng; Celia Pamela Corona-Villalobos; Timothy M Pawlik; Ihab R Kamel

doi:10.1016/j.ejrad.2013.11.016

Interobserver agreement of semi-automated and manual measurements of functional MRI metrics of treatment response in hepatocellular carcinoma

Eur J Radiol. 2014 Mar;83(3):487-96. doi: 10.1016/j.ejrad.2013.11.016. Epub 2013 Dec 3.

Authors

David Bonekamp¹, Susanne Bonekamp¹, Vivek Gowdra Halappa¹, Jean-Francois H Geschwind¹, John Eng¹, Celia Pamela Corona-Villalobos¹, Timothy M Pawlik², Ihab R Kamel³

Affiliations

¹ The Johns Hopkins School of Medicine, Department of Radiology, Baltimore, MD, United States.
² The Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University School of Medicine, Baltimore, MD, United States; The Johns Hopkins School of Medicine, Department of Surgery, Oncology, Baltimore, MD, United States.
³ The Johns Hopkins School of Medicine, Department of Radiology, Baltimore, MD, United States. Electronic address: ikamel@jhmi.edu.

Abstract

Purpose: To assess the interobserver agreement in 50 patients with hepatocellular carcinoma (HCC) before and 1 month after intra-arterial therapy (IAT) using two semi-automated methods and a manual approach for the following functional, volumetric and morphologic parameters: (1) apparent diffusion coefficient (ADC), (2) arterial phase enhancement (AE), (3) portal venous phase enhancement (VE), (4) tumor volume, and assessment according to (5) the Response Evaluation Criteria in Solid Tumors (RECIST), and (6) the European Association for the Study of the Liver (EASL).

Materials and methods: This HIPAA-compliant retrospective study had institutional review board approval. The requirement for patient informed consent was waived. Tumor ADC, AE, VE, volume, RECIST, and EASL in 50 index lesions was measured by three observers. Interobserver reproducibility was evaluated using intraclass correlation coefficients (ICC). P<0.05 was considered to indicate a significant difference.

Results: Semi-automated volumetric measurements of functional parameters (ADC, AE, and VE) before and after IAT as well as change in tumor ADC, AE, or VE had better interobserver agreement (ICC=0.830-0.974) compared with manual ROI-based axial measurements (ICC=0.157-0.799). Semi-automated measurements of tumor volume and size in the axial plane before and after IAT had better interobserver agreement (ICC=0.854-0.996) compared with manual size measurements (ICC=0.543-0.596), and interobserver agreement for change in tumor RECIST size was also higher using semi-automated measurements (ICC=0.655) compared with manual measurements (ICC=0.169). EASL measurements of tumor enhancement in the axial plane before and after IAT ((ICC=0.758-0.809), and changes in EASL after IAT (ICC=0.653) had good interobserver agreement.

Conclusion: Semi-automated measurements of functional changes assessed by ADC and VE based on whole-lesion segmentation demonstrated better reproducibility than ROI-based axial measurements, or RECIST or EASL measurements.

Keywords: Cancer treatment response; Functional magnetic resonance imaging; Observer agreement; Reproducibility; Response assessment.

Publication types

Randomized Controlled Trial

MeSH terms

Algorithms
Carcinoma, Hepatocellular / pathology*
Carcinoma, Hepatocellular / therapy*
Chemoembolization, Therapeutic*
Female
Humans
Image Enhancement / methods
Image Interpretation, Computer-Assisted / methods*
Imaging, Three-Dimensional / methods
Liver Neoplasms / pathology*
Liver Neoplasms / therapy*
Magnetic Resonance Imaging / methods*
Male
Observer Variation
Pattern Recognition, Automated / methods
Reproducibility of Results
Retrospective Studies
Sensitivity and Specificity
Treatment Outcome
Tumor Burden

Grants and funding

P30 CA006973/CA/NCI NIH HHS/United States