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Radiologists’ Performance in the Diagnosis of Liver Tumors with Central Scars by Using Specific CT Criteria¹

¹ From the Departments of Radiology (A.B., M.P.F., J.V.F., J.M.L., J.S.W., D.R.A., G.C., O.A., E.B.) and Biostatistics (W.L.), University of Pittsburgh Medical Center, 200 Lothrop St, Pittsburgh, PA 15213; and Department of Radiology, Spedali Civili Brescia, Italy (L.G.). Received April 17, 2001; revision requested June 5; revision received September 17; accepted October 10. Address correspondence to M.P.F. (e-mail: federle@pitt.edu).

PURPOSE: To determine the performance of radiologists with differing levels of expertise in the diagnosis of the most common types of liver tumors with central scars (ie, focal nodular hyperplasia [FNH], fibrolamellar hepatocellular carcinoma [HCC], and large hepatic hemangioma) by using specific computed tomographic (CT) findings.

MATERIALS AND METHODS: Review of medical records at the University of Pittsburgh Medical Center identified patients with a total of 64 liver tumors that had central scars—including 29 cases of FNH, 20 fibrolamellar HCCs, and 15 large (>3.5 cm in diameter) hemangiomas—and with CT scans available for review. Retrospective review of these scans was performed individually by six radiologists who were blinded to the diagnosis, including two faculty abdominal radiologists, one abdominal imaging fellow, and three radiology residents. Individual performance was evaluated by means of receiver operating characteristic analysis, and interobserver agreement was measured by using the Cronbach . Individual CT findings that may allow differentiation of tumor types were identified with the Kruskal-Wallis test.

RESULTS: CT allowed good to excellent interobserver agreement in the diagnosis of tumor type and in recognition of differential findings among the three types. The individual accuracy of diagnosis was very good, with the average area under the receiver operating characteristic curve ranging from 0.81 to 0.90. Although the faculty radiologists performed the best, the differences in performance between the subgroups of readers and the levels of confidence in diagnosis were not statistically significant. The diagnosis of fibrolamellar HCC was the most accurate and had the highest sensitivity, followed by FNH and large hemangioma. Clinical and CT findings that were found to be statistically significant in differentiating tumor types were patient age and sex, tumor size larger than 10 cm, width of tumor scars, invasion of vessels, nodular centripetal enhancement, marked hyperattenuation on arterial phase images, lymphadenopathy, heterogeneity, extrahepatic metastases, surface lobulation, calcification, and isoattenuation with liver tissue on portal venous phase images.

CONCLUSION: CT allows accurate differentiation of the most common types of liver tumors with central scars, including FNH, fibrolamellar HCC, and large hemangioma.

© RSNA, 2002

Index terms: Diagnostic radiology, observer performance • Liver, focal nodular hyperplasia, 761.3198 • Liver, hemangioma, 761.3194 • Liver neoplasms, CT, 761.12111, 761.12114 • Liver neoplasms, diagnosis, 761.3194, 761.3198, 761.323

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