基于LI-RADS分类标准的超声造影技术对肝细胞癌诊断的可行性研究

肝脏 ›› 2020, Vol. 25 ›› Issue (8): 822-824.

基于LI-RADS分类标准的超声造影技术对肝细胞癌诊断的可行性研究

李明桧, 唐荣, 陈孙斌

571400 海南琼海市中医院超声科(李明桧,陈孙斌);海南省人民医院肝胆胰外科(唐荣)

收稿日期:2020-01-07 出版日期:2020-08-31 发布日期:2020-09-04
通讯作者: 唐荣,Email:tangrong105@163.com
基金资助:
湖南省重点研发项目(编号:2015SK20161)

Feasibility study of contrast-enhanced ultrasound LI-RADS in the diagnosis of primary hepatocellular carcinoma

LI Ming-hui¹ TANG Rong^2* CHEN Sun-bin¹

1. Department of Ultrasound, Qionghai Hospital of traditional Chinese Medicine, Hainan, 571400, China;
2. Department of Hepatobiliary and Pancreatic Surgery, Hainan Provincial People's Hospital, Hainan, 570311, China

Received:2020-01-07 Online:2020-08-31 Published:2020-09-04
Contact: TANG Rong, Email: tangrong105@163.com

摘要/Abstract

摘要： 目的基于肝脏影像报告和数据管理系统(LI-RADS)分类标准的超声造影(CEUS)技术对肝细胞癌诊断的可行性。方法连续收集2016年6月至2019年6月期间我科收治入院肝细胞癌高危患者。疾病诊断符合2015年版原发性肝癌规范化病理诊断指南。超声造影剂为SonoVue(Bracco公司,意大利)。采用2017年版CEUS LI-RADS分类标准。本次研究以病理结果作为诊断金标准,LI-RADS 1类(LR-1)及LI-RADS 2类(LR-2)为阴性结果,LI-RADS 3类(LR-3)、LI-RADS 4类(LR-4)及LI-RADS 5类(LR-5)为阳性结果。绘制ROC曲线,计算诊断指标。结果纳入患者74例,男性52例,女性22例,平均年龄(54.2±11.4)岁。共检出病灶86个,病灶直径0.6至9.2 cm,平均直径(2.6±1.4)cm。病理结果包括原发性肝细胞癌(72个),胆管细胞癌(3个),局灶性结节增生(6个),肝血管瘤(3个)及炎性病变(2个)。CEUS LI-RADS分类中LR-1 4个,LR-2 5个,LR-3 16个,LR-4 25个,LR-5 36个。ROC曲线下面积为0.86(0.80~0.91),基于LI-RADS分类标准的CEUS技术对原发性肝细胞癌诊断指标如下:准确度94.2%(81/86),敏感度100%(72/72),特异度64.3%(9/14),阳性预测值93.5%(72/77),阴性预测值100%(9/9)。当不考虑LR-3分类时,调整后的诊断指标如下:准确度97.1%(68/70),敏感度100%(59/59),特异度81.8%(9/11),阳性预测值96.7%(59/61),阴性预测值100%(9/9)。结论基于LI-RADS分类标准的超声造影检查能够对原发性肝细胞癌作出较好的诊断效能,具有临床可行性。

关键词: 肝细胞癌, 肝脏影像报告和数据管理系统, 超声造影

Abstract: Objective To study the feasibility of contrast-enhanced ultrasound (CEUS) liver imaging reporting and data system (LI-RADS) in the diagnosis of primary hepatocellular carcinoma. Methods Clinical data of high-risk patients with primary hepatocellular carcinoma admitted to our department from June 2016 to June 2019 were collected. The diagnosis of the disease was in accordance with the 2015 edition of practice guidelines for pathological diagnosis of primary liver cancer. The ultrasound contrast agent is SonoVue (Bracco Company, Italy). The 2017 edition of CEUS LI-RADS was adopted. In this study, pathological results were used as the diagnostic gold standard. LI-RADS class 1 (LR-1) and LI-RADS class 2 (LR-2) were defined as negative results, LI-RADS 3 (LR-3), LI-RADS 4 (LR-4) and LI-RADS 5 (LR-5) as positive ones. The diagnostic value was analyzed by receiver operator characteristic (ROC) curve. Results There were 74 patients enrolled in the study, including 52 males and 22 females, with an average age of (54.2 ± 11.4) years. A total of 86 lesions were detected. The diameter of the lesions ranged from 0.6 to 9.2 cm, with an average of (2.6 ± 1.4) cm. The pathological results included primary hepatocellular carcinoma (72), cholangiocarcinoma (3), focal nodular hyperplasia (6), hepatic hemangioma (3) and inflammatory lesions (2). Based on CEUS LI-RADS, there were 4 cases of LR-1, 5 cases of LR-2, 16 cases of LR-3, 25 cases of LR-4 and 36 cases of LR-5. The area under the ROC curve was 0.86 (95% confidence interval: 0.80-0.91). The diagnostic indexes of CEUS LI-RADS for primary hepatocellular carcinoma were as follows: the accuracy of 94.2% (81/86), the sensitivity of 100% (72/72), the specificity of 64.3% (9/14), the positive predictive value of 91.1% (72/79), and the negative predictive value of 100% (9/9). When LR-3 was not taken into account, the adjusted diagnostic indexes were as follows: the accuracy of 97.1% (68/70), the sensitivity of 100% (59/59), the specificity of 81.8% (9/11), the positive predictive value of 96.7% (59/61), and the negative predictive value of 100% (9/9). Conclusion CEUS LI-RADS performs well in the diagnosis of primary hepatocellular carcinoma, which has clinical feasibility.

Key words: Primary hepatocellular carcinoma, Liver imaging reporting and data system, Contrast-enhanced ultrasound

李明桧, 唐荣, 陈孙斌. 基于LI-RADS分类标准的超声造影技术对肝细胞癌诊断的可行性研究[J]. 肝脏, 2020, 25(8): 822-824.

LI Ming-hui TANG Rong CHEN Sun-bin. Feasibility study of contrast-enhanced ultrasound LI-RADS in the diagnosis of primary hepatocellular carcinoma[J]. Chinese Hepatolgy, 2020, 25(8): 822-824.

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