Impact of a Structured Report Template on the Quality of CT and MRI Reports for Hepatocellular Carcinoma Diagnosis

Transcription

1 Impact of a Structured Report Template on the Quality of CT and MRI Reports for Hepatocellular Carcinoma Diagnosis Jeremy Ganeles 1, Tulay Ekinci 1, Milana Flusberg 1, Viktoriya Paroder 1, Mariya Kobi 1, Shlomit Goldberg-Stein 1, Victoria Chernyak 1 1 Montefiore Medical Center, Bronx, NY 1 The authors have no financial disclosures

2 Introduction LI-RADS developed in 2011 and updated in 2014 to standardize an algorithm and lexicon for interpretation and reporting of CT/MRIs in patients at risk for HCC Diagnostic algorithm based on defined major and ancillary imaging features, but no specific recommendations provided on how to report these features Structured reports has been shown to demonstrate greater clarity and comprehensive content when compared to free-text reports Similarly shown to be preferred by both referring clinicians and radiologist

3 Purpose To assess the impact of implementing a Liver Imaging Reporting and Data System (LI-RADS) structured reporting template on the quality of MRI reports for hepatocellular carcinoma

4 Methods: Background Structured LIRADS introduced at Montefiore in 4/2015; accompanied by LI- RADS training Template includes Observation identifier Location (Couinaud segment) Pick lists for all LI-RADS major features: Arterial Phase Hyperenhancement (APHE): yes/no Washout (WO): yes/no Capsule : yes/no Diameter Threshold Growth (TG): yes/no/n/a > Final LI-RADS category

5 LIRADS Template

6 Methods Retrospective IRB approved study Included reports of CTs and MRIs from 9/2014 to 2/2016 Free-text reports Structured LI-RADS reports Included only "Probable" and "Definite" HCC lesions (i.e. LR- 4 and LR-5) or equivalent descriptors in free-text reports Presence or absence of each or the following was recorded for each observation: LI-RADS category Couinaud segment Major LI-RADS HCC features: APHE WO Diameter Threshold growth Capsule At least one image number provided

7 Methods Free-text reports were compared with structured template report for whether presence or absence of each of the assessed variables was unequivocally reported Logistic regression models with binary outcomes of unequivocal reporting of each of the variables were constructed

8 Results Template (n=181) Free-text (n=125) p Value Age (years; mean and standard deviation) 63.0 (8.1) 63.6 (7.9) Sex (n, % male) 131 (72.4) 85 (68.0) Cause of liver disease (n, %) Hepatitis C Cirrhosis, NOS Hepatitis B Alcoholic cirrhosis Primary biliary cirrhosis Hepatitis C and B 99 (54.7) 65 (35.9) 9 (5.0) 5 (2.8) 0 (0.0) 3 (1.7) 87 (69.6) 26 (20.8) 3 (2.4) 7 (5.6) 2 (1.6) 0 (0.0) Modality (n, % MR) 164 (90.6) 100 (80.0) Description of lesion Definite HCC Probable HCC HCC Compatible with HCC Consistent with HCC Likely HCC Typical of HCC Suspicious for HCC Concerning for HCC 74 (40.9) 97 (53.6) 2 (1.1) 1 (0.6) 2 (1.1) 2 (1.1) 2 (1.1) 0 (0) 1 (0.6) 0 (0) 3 (2.4) 11 (8.8) 11 (8.8) 51 (40.8) 5 (4.0) 21 (16.8) 16 (12.8) 7 (5.6) <0.001

9 Results Variable Template (n=181) Free-text (n=125) p Value LI-RADS category 178 (98.3) 23 (18.4) <0.001 Couinaud segment 181 (100) 102 (81.6) <0.001 Diameter 181 (100) 118 (94.4) Presence/absence of TG 140 (77.4) 14 (11.2) <0.001 unequivocally reported Presence/absence of APHE 177 (97.8) 101 (80.8) <0.001 unequivocally reported Presence/absence of WO 178 (98.3) 93 (74.4) <0.001 unequivocally reported Presence/absence of capsule 176 (97.2) 24 (19.2) <0.001 unequivocally reported At least image number reported 181 (100) 81 (64.8) <0.001 Reported as n (%)

10 Results Outcome variable Odds Ratio 95% CI p Value LI-RADS category reported <0.001 Presence/absence of TG unequivocally <0.001 reported Presence/absence of APHE unequivocally reported <0.001 Presence/absence of WO unequivocally <0.001 reported Presence/absence of capsule unequivocally reported <0.001 Adjusted for modality and cause of liver disease; free-text group as the reference

11 Discussion Structured reporting demonstrated more comprehensive and consistent reporting of the major HCC features and LI-RADS category Serves as a useful checklist for assessing liver lesions in at-risk patients Documentation of major HCC features is mandated by OPTN (Organ Procurement and Transplantation Network) for transplant candidates All imaging is re-interpreted by radiologists in transplant centers Adds cost and time More likely to use a scoring system and characterize a lesion as definite HCC at transplant center Substantial differences shown in MRI interpretations between transplant center and outside institution reads Implementation of structured reporting may help reduce discrepancies in HCC diagnosis between readers with varying experience and comfort, as well as increase the rate of reporting of all OPTN-required elements, thereby eliminating the need for re-interpretation.

12 Discussion Limitations: Study limited to Definite or Probable HCC End user satisfaction was not assessed Impact on patient management/outcome was not assesed Accuracy of reports not reviewed Conclusion Use of structured LI-RADS template results in more comprehensive and consistent reporting of major features of HCC and LI-RADS category compared with free-text.