Figure 3:

MRI scans show (A) reader disagreement and (B) reader agreement. (A) Gadoxetic acid–enhanced MRI scans in a 56-year-old male patient with cirrhosis secondary to hepatitis C. From left to right: contrast-unenhanced (Pre), arterial phase (AP), portal venous phase (PVP), and hepatobiliary phase (HBP) images. This 21-mm hepatobiliary phase hypointense observation (arrow) was characterized on the clinical read as having nonrim arterial phase hyperenhancement and washout appearance and was categorized as Liver Imaging Reporting and Data System (LI-RADS) category LR-5 (definitely hepatocellular carcinoma [HCC]). The first research reader characterized it as having a targetoid appearance and categorized it as LR-M (probably or definitely malignant, not specific for HCC). The second research reader characterized it as having no major features and paralleling the blood pool and categorized it as LR-2 (probably benign). It was subsequently resected and found to be a well-differentiated HCC. (B) Extracellular contrast–enhanced MRI scans in a 61-year-old female patient with cirrhosis secondary to hepatitis C. From left to right: contrast-unenhanced, arterial phase, portal venous phase, and delayed-phase (DP) images. This 31-mm observation (arrow) in the caudate lobe was characterized on the clinical read as having arterial phase hyperenhancement, washout appearance, and capsule appearance, and was categorized as LI-RADS category LR-5 (definitely HCC). Both research readers also categorized this observation as LR-5. The patient died of intracranial hemorrhage a few months later.