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Garg et al. Hepatoma Res 2019;5:39 Hepatoma Research
DOI: 10.20517/2394-5079.2019.009

Original Article Open Access

CT of hepatocellular carcinoma in non-alcoholic
fatty liver disease: imaging characteristics and inter-

rater agreement

Ishan Garg , Scott M. Thompson , Shannon P. Sheedy , Taofic Mounajjed , Ashish Khandelwal , Eric C.
2
1,#
1
1
1,#
Ehman , Candice A. Bookwalter , Sudhakar K. Venkatesh 1
1
1
1 Department of Radiology, Mayo Clinic College of Medicine, Rochester, MN 55905, USA.
2 Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Rochester, MN 55905, USA.
# Co-equal first authors.
st
Correspondence to: Dr. Sudhakar K. Venkatesh, Department of Radiology, Mayo Clinic College of Medicine, 200 1 St SW,
Rochester, MN 55905, USA. E-mail: venkatesh.sudhakar@mayo.edu
How to cite this article: Garg I, Thompson SM, Sheedy SP, Mounajjed T, Khandelwal A, Ehman EC, Bookwalter CA, Venkatesh
SK. CT of hepatocellular carcinoma in non-alcoholic fatty liver disease: imaging characteristics and inter-rater agreement.
Hepatoma Res 2019;5:39. http://dx.doi.org/10.20517/2394-5079.2019.009
Received: 16 Aug 2019 First Decision: 29 Sep 2019 Revised: 7 Oct 2019 Accepted: 10 Oct 2019 Published: 17 Oct 2019

Science Editor: Dalbir Sandhu Copy Editor: Cai-Hong Wang Production Editor: Jing Yu
Received: First Decision: Revised: Accepted: Published:

Science Editor: Copy Editor: Production Editor: Jing Yu
Abstract
Aim: To determine the computed tomography (CT) features of non-alcoholic fatty liver disease (NAFLD) associated
hepatocellular carcinoma (HCC).

Methods: In this institutional review board approved study, we reviewed 38 patients with NAFLD (68.4% male; mean
age 63 years) with histology confirmed HCC and triphasic liver CT. CT images were independently reviewed by four
readers blinded to clinical and pathology data. The reviewers assessed HCC for arterial phase hyper enhancement
(APHE), portal venous phase washout (PVWO), delayed phase washout (DPWO), and enhancing capsule. Features
of cirrhotic morphology and portal hypertension (PH) were also evaluated. The final CT features were determined
by majority and a fifth reader reviewed cases lacking majority. Inter-rater agreement was determined by prevalence-
adjusted kappa.

Results: Mean HCC size was 3.6 ± 2.8 cm (range, 1.1-16.0 cm). The HCCs showed APHE in 92.1%, PVWO in 55.3%,
DPWO in 81.6%, and enhancing capsule in 44.7%. Cirrhotic morphology was present in 65.8% and PH in 63.2%.
Inter-rater agreement was moderate to almost perfect for APHE (0.74-1.0), cirrhosis (0.79-0.89), and PH (0.79-
0.95), weak to perfect for DPWO (0.47-0.95) and poor for PVWO (0-0.42).

© The Author(s) 2019. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use,
sharing, adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as long
as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license,
and indicate if changes were made.

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