超声造影肝脏影像报告与数据系统在LR--3、LR-4、LR-5类病灶中的应用价值

肝脏 ›› 2020, Vol. 25 ›› Issue (8): 816-818.

超声造影肝脏影像报告与数据系统在LR--3、LR-4、LR-5类病灶中的应用价值

杨大才, 吴宏, 朱廷玲

402160 重庆市永川区中医院超声科(杨大才,朱廷玲);巴南区第二人民医院超声科(吴宏)

收稿日期:2020-04-21 出版日期:2020-08-31 发布日期:2020-09-04
通讯作者: 朱廷玲,Email:420175435@qq.com
基金资助:
重庆市科技计划项目(cstc2015shmszx120060)

The application value of liver imaging-reporting and data system (LI-RADS) of contrast-enhanced ultrasound in LR-3, LR-4 and LR-5 lesions

YANG Da-cai¹, WU Hong², ZHU Ting-ling¹

1. Department of Ultrasound, Yongchuan Hospital of Traditional Chinese Medicine, Chongqing 402160, China;
2. Department of ultrasound, the second people's Hospital of Banan District, Chongqing 400054, China

Received:2020-04-21 Online:2020-08-31 Published:2020-09-04
Contact: ZHU Ting-ling, Email: 420175435@qq.com

摘要/Abstract

摘要： 目的探讨超声造影肝脏影像报告与数据系统(CEUS LI-RADS)在LR-3、LR-4、LR-5类HCC病灶中的应用价值。方法收集2013年1月至2019年1月具有肝细胞癌(HCC)高危风险的肝脏局灶性病变患者122例。以病理结果为诊断金标准,评价CEUS LI-RADS分类的诊断表现。结果患者共有146个病灶,经病理证实HCC 120个(82.2%),肝脏良性病变26个(17.8%)。LR-1 5个、LR-2 3个,均为良性,LR-3 16个、LR-4 32个和LR-5 90个。以LR-1、LR-2类病灶为阴性结果,LR-3、LR-4和LR-5类病灶为阳性结果,LR-3+LR-4+LR-5诊断HCC敏感度、特异度和准确度分别为95.8%、30.8%和84.2%;不考虑LR-3类病灶,LR-4+LR-5诊断HCC敏感度、特异度和准确度分别为100%、53.3%和94.6%;不考虑LR-3、LR-4类病灶,LR-5诊断HCC敏感度、特异度和准确度分别为100%、80.0%和98.0%。LR-3+LR-4+LR-5(30.8%)诊断特异度显著低于LR-4+LR-5(53.3%)和LR-5(80.0%);同时LR-4+LR-5(53.3%)诊断特异度显著低于LR-5(80.0%);LR-3+LR-4+LR-5(84.2%)诊断准确度显著低于LR-4+LR-5(94.6%)和LR-5(98.0%);而LR-3+LR-4+LR-5、LR-4+LR-5和LR-5诊断敏感度无明显差异(P>0.05)。结论 CEUS LI-RADS分类标准对LR--3、LR-4、LR-5类HCC病灶具有较高的诊断准确度,特别是LR-5类病灶。

关键词: 超声造影, 肝细胞癌, 肝脏影像学报告与数据系统

Abstract: Objective To explore the application value of liver imaging-reporting and data system (LI-RADS) of contrast-enhanced ultrasound (CEUS) in LR-3, LR-4 and LR-5 lesions. Methods From January 2013 to January 2019, 122 patients including 87 males and 35 females with liver focal lesions at risk of hepatocellular carcinoma (HCC) were collected, with an average age of 53.1±8.4 years. The diagnostic performance of CEUS LI-RADS classification was evaluated, with liver pathology as the diagnostic gold standard. The comparison of measurement data (x+s) were performed with t test, and the comparison of counting data (%) were analyzed with chi-square test. Results There were 146 lesions in these patients, of which 120 (82.2%) were pathologically confirmed HCC and 26 (17.8%) were benign liver lesions. 5 were classified as LR-1, 3 were LR-2, all were benign;16 were classified as LR-3, 32 were LR-4 and 90 were LR-5. The LR-1, LR-2 lesions were considered as negative, whereas the LR-3, LR-4 and LR-5 lesions were positive. The sensitivity, specificity and accuracy of LR-3+LR-4+LR-5 in the diagnosis of HCC were 95.8%, 30.8% and 84.2%. Regardless of LR-3 lesions, the sensitivity, specificity and accuracy of LR-4+LR-5 in the diagnosis of HCC were 100%, 53.3% and 94.6%,. Regardless of LR-3 and LR-4 lesions, the sensitivity, specificity and accuracy of LR-5 in the diagnosis of HCC were 100%, 80.0% and 98.0%. The specificity of LR-3+LR-4+LR-5 (30.8%) in the diagnosis of HCC was significantly lower than that of LR-4+LR-5 (53.3%, P<0.05) and LR-5 (80.0%, P<0.05). Meanwhile, the specificity of LR-4+LR-5 (53.3%) was significantly lower than LR-5 (80.0%, P<0.05). The diagnostic accuracy of LR-3+LR-4+LR-5 (84.2%) was significantly lower than that of LR-4+LR-5 (94.6%, P<0.05) and LR-5 (98.0%, P<0.05). However, there was no significant difference in the diagnostic sensitivity between LR-3+LR-4+LR-5, LR-4+LR-5 and LR-5 (P>0.05). Conclusion CEUS LI-RADS classification standard has high diagnostic accuracy for LR-3, LR-4, LR-5 HCC lesions, especially for LR-5 lesions.

Key words: Contrast-enhanced ultrasonography, Hepatocellular carcinoma, Liver imaging-reporting and data system

杨大才, 吴宏, 朱廷玲. 超声造影肝脏影像报告与数据系统在LR--3、LR-4、LR-5类病灶中的应用价值[J]. 肝脏, 2020, 25(8): 816-818.

YANG Da-cai, WU Hong, ZHU Ting-ling. The application value of liver imaging-reporting and data system (LI-RADS) of contrast-enhanced ultrasound in LR-3, LR-4 and LR-5 lesions[J]. Chinese Hepatolgy, 2020, 25(8): 816-818.

参考文献

[1] 李川, 覃琰, 陈康, 等. 年轻肝细胞癌患者的临床病理特征及预后分析. 中华普通外科杂志, 2019, 34:928-931.
[2] 熊琨, 朱莉萍, 陆勇, 等. 我国肝细胞癌手术切除与热消融疗效和安全性比较的网络荟萃分析. 中华肝胆外科杂志, 2019, 25:823-827.
[3] Burak KW, Sherman M. Hepatocellular carcinoma: consensus, controversies and future directions. a report from the Canadian Association for the study of the liver hepatocellular carcinoma meeting. Can J Gastroenterol Hepatol, 2015, 29:178-84.
[4] Schellhaas B, Hammon M, Strobel D, et al. Interobserver and intermodality agreement of standardized algorithms for non-invasive diagnosis of hepatocellular carcinoma in high-risk patients: CEUS-LI-RADS versus MRI-LI-RADS. Eur Radiol, 2018, 28:4254-4264.
[5] Elsayes KM, Kielar AZ, Elmohr MM, et al. White paper of the Society of Abdominal Radiology hepatocellular carcinoma diagnosis disease-focused panel on LI-RADS v2018 for CT and MRI. Abdom Radiol (NY), 2018, 43:2625-2642.
[6] Ludwig DR, Fraum TJ, Cannella R, et al. Expanding the Liver Imaging Reporting and Data System (LI-RADS) v2018 diagnostic population: performance and reliability of LI-RADS for distinguishing hepatocellular carcinoma (HCC) from non-HCC primary liver carcinoma in patients who do not meet strict LI-RADS high-risk criteria. HPB (Oxford), 2019, 21:1697-1706.
[7] Basha MAA, AlAzzazy MZ, Ahmed AF, et al. Does a combined CT and MRI protocol enhance the diagnostic efficacy of LI-RADS in the categorization of hepatic observations? A prospective comparative study. Eur Radiol, 2018, 28:2592-2603.
[8] 尹珊珊, 姜彬彬, 崔秋丽, 等. 超声造影LI-RADS分类标准对混合型肝癌诊断价值的初步探讨. 中国超声医学杂志, 2019, 35:239-243.
[9] Zhang T, Huang ZX, Wei Y, et al. Hepatocellular carcinoma: Can LI-RADS v2017 with gadoxetic-acid enhancement magnetic resonance and diffusion-weighted imaging improve diagnostic accuracy?. World J Gastroenterol, 2019, 25:622-631.
[10] Choi HH, Perez MG, Millet JD, et al. Association of advanced hepatic fibrosis and sonographic visualization score: a dual-center study using ACR US LI-RADS. Abdom Radiol (NY), 2019, 44:1415-1422.
[11] Wang JY, Feng SY, Yi AJ, et al. Comparison of contrast-Enhanced ultrasound versus contrast-enhanced magnetic resonance imaging for the diagnosis of focal liver lesions using the liver imaging reporting and data system. Ultrasound Med Biol, 2020, 46:1216-1223.
[12] Tan Z, Teoh WC, Wong KM, et al. Analysis of comparative performance of CEUS and CECT/MR LI-RADS classification: Can CEUS dichotomize LI-RADS indeterminate lesions on CT or MRI?. Clin Imaging, 2020, 62:63-68.
[13] 吴晓贝, 罗鸿昌, 李开艳, 等. 超声造影LI-RADS分类在肝细胞癌诊断中的应用价值. 中华超声影像学杂志, 2018, 27: 936-941.
[14] Kono Y, Lyshchik A, Cosgrove D, et al. Contrast enhanced ultrasound (CEUS) liver imaging reporting and data system (LI-RADS): the official version by the American College of Radiology (ACR). Ultraschall Med, 2017, 38:85-86.
[15] Terzi E, Iavarone M, Pompili M, et al. Contrast ultrasound LI RADS LR-5 identifies hepatocellular carcinoma in cirrhosis in a multicenter restropective study of 1 006 nodules. J Hepatol, 2018,68:485-492.