Abstract
OBJECTIVES: This study aimed to assess the performance of the LI-RADS tumor response algorithm in analyzing inter-reader agreement in patients with hepatocellular carcinoma (HCC) treated with Microwave Ablation (MWA) and Transarterial Embolization (TAE) and the relationship between inter-reader agreement and Neutrophils to Lymphocytes ratio dynamic variations at different time points to explore how inflammation influences tumor response and its interpretation on imaging. METHODS: A retrospective analysis was conducted on 78 HCC patients treated with MWA or TAE. Two independent radiologists evaluated pre- and post-treatment imaging and assigned categories according to the LR-TRA. Inter-reader agreement was assessed with a focus on subgroup analysis considering the different locoregional treatments. NLR values, measured at baseline (T0), 72 h (T1), and 30 days post-procedure (T2), were compared with patients with concordant and discordant LR-TRA assessments. This analysis aimed to identify any association between NLR dynamics and inter-reader agreement on treatment response. RESULTS: The inter-reader agreement in the LR-TRA application was "substantial" in the cases of MWA treatment evaluation (κ = 0.65), and "moderate" in the cases of TAE treatment evaluation (κ = 0.51). The differences in inter-reader agreement were found to be expressions of different levels of NLR mean values in the different time frames evaluated. Three days after treatment, NLR increased significantly in TAE groups. At 30 days, NLR had returned close to baseline levels but with NLR persisting higher in the TAE group. There was a statistically significant difference in NLR between the "mismatch" group (those with discrepant LR-TRA readings) and the "match" group at 3 days (p = 0.004) and late evaluation (30+ days). CONCLUSIONS: This study has shown that NLR levels can predict inter-reader discrepancies in LR-TRA assessment and may be translated into different levels of difficult imaging interpretation. Combining LR-TRA and NLR is promising for a more comprehensive assessment of tumor response and inflammatory dynamics.