基于超声造影LI-RADS分类标准对甲胎蛋白阴性高危风险肝脏局灶性病变患者的评估

摘要/Abstract

摘要： 目的分析超声造影LI-RADS分类标准评估甲胎蛋白阴性高危风险肝脏局灶性病变的临床价值。方法纳入2018年1月至2022年1月收治的甲胎蛋白阴性高危风险肝脏局灶性病变患者120例,共计153个病灶。所有患者均行超声造影检查,基于LI-RADS对病灶进行分类,以病理检查结果为金标准,分析超声造影LI-RADS分类标准对甲胎蛋白阴性高危风险肝脏局灶性病变的评估价值。结果 153个病灶经组织病理学证实,肝细胞癌90个,其他肝脏恶性肿瘤19个,良性肝脏病变44个。肝细胞癌以动脉相高增强(78个)和延迟/轻度廓清(70个)为主;其他肝脏恶性肿瘤中呈动脉相高增强9个,呈环状增强8个,全部出现对比剂廓清,其中呈显著廓清8个,呈轻度廓清11个;良性肝脏病灶以动脉相等增强(18个)和延迟相无廓清(32个)为主。在LR-5分类标准下,153个病灶中有77个肝细胞癌,其中66个为真正肝细胞癌,阳性检出率为73.3%(66/90),与组织病理学检查一致性良好,Kappa值为0.792。在LR-4+5分类标准下,153个病灶中有83个肝细胞癌,其中80个为真正肝细胞癌,阳性检出率为88.9%(80/90),与组织病理学检查一致性较强,Kappa值为0.763。LR-4+5分类对甲胎蛋白阴性肝细胞癌的诊断灵敏度、特异度、准确度、阳性预测值、阴性预测值分别为88.9%、95.2%、91.5%、96.4%、85.7%,均高于LR-5分类标准的73.3%、82.5%、77.1%、85.7%、68.4%(P<0.05)。结论超声造影LI-RADS分类标准对甲胎蛋白阴性高危风险肝脏局灶性病变具有一定的评估价值,其中LR-4+5分类标准具有优异的诊断效能,值得在临床推广使用。

关键词: 甲胎蛋白阴性, 肝脏局灶性病变, 超声造影, LI-RADS分类

Abstract: Objective To analyze the clinical value of using contrast-enhanced ultrasound LI-RADS classification criteria to evaluate the high-risk of alpha fetoprotein (AFP) negative focal liver lesions. Methods Between January 2018 and January 2022, 120 patients with high risk of focal liver lesions with negative AFP were admitted to our hospital, with a total of 153 lesions. All patients underwent contrast-enhanced ultrasound examination, and the lesions were classified based on LI-RADS. The pathological examination results were used as the gold standard to analyze the evaluation value of LI-RADS classification criteria for liver focal lesions at high risk of negative AFP. Results 153 lesions were confirmed by histopathology, including 90 HCC, 19 other liver malignant tumors and 44 benign liver lesions. HCC is mainly characterized by arterial phase hyperenhancement (78 cases) and delayed/mild clearance (70 cases); Among other malignant liver tumors, 9 showed arterial phase hyper-enhancement and 8 showed circular enhancement, with contrast agent clearance of 100%, significant clearance of 8, and mild clearance of 11. Benign liver lesions were mainly characterized by equal arterial enhancement (18 cases) and delayed phase no clearance (32 cases). Under the LR-5 classification standard, there were 77 HCCs in 153 lesions, 66 of which were true HCCs, with a positive detection rate of 73.3% (66/90), which was in good agreement with histopathology, and the Kappa value was 0.792. Under the LR-4+5 classification standard, there were 83 HCCs in 153 lesions, 80 of which were true HCCs, with a positive detection rate of 88.9% (80/90), which was consistent with histopathology examination, and the Kappa value was 0.763. The diagnostic sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of LR-4+5 classification for AFP negative HCC were 88.9%, 95.2%, 91.5%, 96.4%, and 85.7%, respectively, which were higher than those of 73.3%, 82.5%, 77.1%, 85.7%, 68.4% of LR-5 classification standards (P<0.05). Conclusion The LI-RADS classification standard for contrast-enhanced ultrasound has certain evaluation value for high-risk liver focal lesions with negative AFP. Among them, the LR-4+5 classification standard has excellent diagnostic efficacy and is worth of vigorously promotion and usage in clinical practice.

Key words: Negative alpha fetoprotein, Focal liver lesions, Contrast-enhanced ultrasound, LI-RADS classification

马宇, 赖仕峰, 洪莉. 基于超声造影LI-RADS分类标准对甲胎蛋白阴性高危风险肝脏局灶性病变患者的评估[J]. 肝脏, 2025, 30(4): 446-448.

Ma Yu, Lai Shi-feng, Hong Li. An evaluation of high-risk patients with focal liver lesions and negative AFP based on LI-RADS classification criteria of contrast-enhanced ultrasound[J]. Chinese Hepatolgy, 2025, 30(4): 446-448.

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