基于CT和MRI检查肝脏成像报告和数据系统评判肝结节性质临床应用

摘要/Abstract

摘要： 目的旨在应用肝脏影像报告及数据系统(LI-RADS)评分系统,探讨CT和MRI在疑似肝细胞癌(HCC)患者肝结节性质诊断中的价值分析。方法收集2016年6月—2019年12月期间疑似HCC患者80例(男58例、女22例),年龄(55.4±9.0)岁。制作ROC曲线,由最高约登指数确定出CT、MRI诊断截断点。计量资料($\bar{x}$±s)表示,采用t检验;计数资料(%)表示,采用卡方检验。结果经手术(n=64)、经皮CT引导下穿刺活检(n=16)确诊病灶108个,其中HCC 71个,良性病变37个(肝血管瘤9个、局灶性结节增生11个、错构瘤4个、炎性病变13个)。CT、MRI检查≥LR-2、≥LR-3、≥LR-4及LR-5病灶时约登指数分别为0、0.190、0.354及0.096;0、0.042、0.381及0.150,提示当诊断≥LR-4病灶时CT、MRI表现最优。定义LR-4为CT、MRI诊断截断点,CT(40.8%)诊断≥LR-4病灶敏感度明显低于MRI(73.2%,P<0.05);CT(59.2%)诊断≥LR-4病灶特异度明显低于MRI(70.4%,P<0.05);CT(94.6%)诊断≥LR-4病灶准确度明显高于MRI(64.9%,P<0.05);而CT、MRI AUC值无明显差异(P>0.05)。结论 CT、MRI对基于LI-RADS分类标准的HCC病灶诊断表现存在差异。与CT相比,MRI在动脉期高强化、门脉期或延迟期低强化及包膜表现等病灶表现中具有明显优势,总体来说MRI诊断表现优于CT。

关键词: 肝细胞癌, 肝脏影像报告及数据系统, CT, MRI

Abstract: Objective To investigate the value of computed tomography (CT) and magnetic resonance imaging (MRI) in the diagnosis of liver nodules in patients with suspected hepatocellular carcinoma (HCC) by using liver imaging report and data system (LI-RADS). Methods From June 2016 to December 2019, 80 patients with suspected HCC (58 males and 22 females) with an average age of (55.4 ± 9.0) years were enrolled. The Youden’s index was calculated in receiver operating characteristic (ROC) curve to determine the diagnostic cutoff points of CT and MRI. The measurement data (x ± s) were analyzed by t-test, and the counting data (%) were analyzed by chi-square test. Results There were 71 HCC lesions and 37 benign lesions (9 hepatic hemangiomas, 11 focal nodular hyperplasia, 4 hamartomas and 13 inflammatory lesions) diagnosed by operation (n = 64) and CT-guided percutaneous biopsy (n = 16). The Youden's index of CT for LI-RADS (LR) 2-5, LR 3-5, LR 4-5 and LR-5 lesions were 0, 0.190, 0.354 and 0.096, respectively. The Youden's index of MRI for LR 2-5, LR 3-5, LR 4-5 and LR-5 lesions were 0, 0.042, 0.381 and 0.150, respectively. It was suggested that both CT and MRI have best diagnostic efficacy for LR 4-5 lesions. CT had lower sensitivity, higher specificity and lower accuracy than MRI (40.8% vs.73.2%, 94.6% vs. 64.9%, 59.2% vs. 70.4%, P< 0.05). There was no significant difference in the area under ROC curve between CT and MRI. Conclusion There were differences between CT and MRI in the diagnosis of suspected HCC lesions based on LI-RADS classification. Compared with CT, MRI has obvious advantages in the suspected HCC lesion diagnosis. Generally speaking, the diagnostic value of MRI is higher than that of CT.

Key words: Hepatocellular carcinoma, Liver imaging reporting and data system, Computed tomography, Magnetic resonance imaging

马臻雏, 蒋兆杰. 基于CT和MRI检查肝脏成像报告和数据系统评判肝结节性质临床应用[J]. 肝脏, 2020, 25(10): 1062-1064.

MA Zhen-chu, JIANG Zhao-jie. Clinical application of liver imaging reporting and data system for CT and MRI to evaluate liver nodules[J]. Chinese Hepatolgy, 2020, 25(10): 1062-1064.

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