Intraobserver and Interobserver Agreement in the Evaluation of Tumor Vascularization With Computed Tomography Perfusion in Cirrhotic Patients With Hepatocellular Carcinoma

Objectives: To evaluate intrareader and inter-reader agreement in CT perfusion (Pert) measurements in cirrhotic patients with hepatocellular carcinoma (HCC) lesions. Methods: Sixteen patients with HCC (9 untreated, 5 recurrence/residual disease after transarterial chemoembolization, and 2 after radiofrequency ablation treatment) underwent standard CT examination and a Perf study; a quantitative map of arterial and portal Perf by means of a color scale was generated. With dedicated Perf software, the following parameters were calculated on untreated and treated HCC lesions and on cirrhotic parenchyma: hepatic Perf, tissue blood volume, hepatic perfusion index, arterial perfusion, and time to peak. Intraobserver and interobserver agreements were assessed for 2 readers with Bland-Altman plots, intraclass correlation coefficients (ICCs), coefficients of variation, and repeatability. Results: In HCC lesions, agreement analysis demonstrated higher infra agreement values in comparison with interagreement (range of ICC values, 0.26-0.59 between readers and 0.67-0.94 between readings). Lower inter agreement was found for treated HCC lesions in comparison with untreated lesions (range of ICC values, respectively, 0.12-0.54 and 0.31-0.89). Conclusions: For all Perf parameters intra-agreement was higher than interagreement, even though a relatively wide range of 95% limits of agreement was found in both cases.