# LI-RADS: concordance between energy-integrating computed tomography, photon-counting detector computed tomography and magnetic resonance imaging

## TL;DR

Photon-counting CT (PCD-CT) shows better agreement with MRI for liver lesion classification than traditional CT, suggesting improved accuracy for diagnosing liver cancer.

## Contribution

This study is the first to compare PCD-CT and EID-CT with MRI for LI-RADS classification of liver lesions.

## Key findings

- PCD-CT showed higher intermodal agreement with MRI compared to EID-CT for LI-RADS classification.
- Intramodal agreement for LI-RADS classification was substantial to almost perfect for PCD-CT and MRI.
- PCD-CT demonstrated better inter-rater agreement for LI-RADS major features than EID-CT.

## Abstract

Photon-counting detector CT (PCD-CT) offers technical advantages over energy-integrating detector CT (EID-CT) for liver imaging. However, it is unclear whether these translate into clinical improvements regarding the classification of suspicious liver lesions using the Liver Imaging Reporting and Data System (LI-RADS). This study compared the intra- and intermodal agreement of EID-CT and PCD-CT with Magnetic resonance imaging (MRI) for liver lesion classification.

This retrospective study included patients who underwent EID-CT or PCD-CT and MRI within 30 days between 02/2023 and 01/2024. Three board-certified radiologists assessed LI-RADS classification and presence of LI-RADS major features. Fleiss’ Kappa and intraclass correlation coefficients (ICC) were used to evaluate rater agreement.

Sixty-eight lesions in 26 patients (mean age 65.0 ± 14.2 years, 19 [73.1%] male) were analyzed. Intramodal inter-rater agreement for LI-RADS classification was 0.88 (0.62–0.88) for EID-CT, 0.90 (0.83–0.94) for PCD-CT, and 0.87 (0.81–0.91) for MRI. Agreement in PCD-CT was substantial for all LI-RADS major features, whereas in EID-CT only for washout. Intermodal agreement between CT and MRI ranged from 0.67 to 0.72. Final intermodal LI-RADS classification agreement was higher for PCD-CT (0.72–0.85) than EID-CT (0.52–0.64).

PCD-CT demonstrated higher intermodal and intramodal agreement for LI-RADS classification and major features than EID-CT. Additionally, PCD-CT shows significantly higher intramodal and inter-rater agreement for LI-RADS classification and greater concordance with MRI compared to EID-CT, reaching substantial to almost perfect agreement. These results suggest a potential benefit of PCD-CT in the management and treatment decision-making of HCC.

The online version contains supplementary material available at 10.1186/s40644-025-00922-9.