| 摘要: |
| 目的 探讨超声造影（CEUS）肝脏影像报告与数据系统2017版（LI-RADS v2017）对最大径≤3 cm的肝细胞癌（HCC）和肝脏其他恶性肿瘤（OM）的鉴别诊断价值。方法 回顾性分析2018年1月至2022年6月在上海交通大学医学院附属瑞金医院总院及无锡分院行CEUS检查、病灶最大径≤3 cm且经组织病理学证实为肝脏恶性肿瘤的126例患者（163个病灶）的临床和影像学资料。163个病灶中，HCC 133个，OM 30个。分析病灶的CEUS特征，根据美国放射学院CEUS LI-RADS v2017对病灶进行分类，以组织病理学结果为金标准计算各CEUS征象及分类标准对HCC和OM的鉴别诊断效能。结果 HCC组与OM组病灶动脉期增强特征、廓清时间和廓清程度差异均有统计学意义（均P＜0.001）。HCC组分类结果以LR-3（20个，15.04%）、LR-4（25个，18.80%）、LR-5（82个，61.65%）为主，OM组分类结果以LR-M（28个，93.33%）为主。CEUS征象中，延迟廓清诊断HCC的特异度和阳性预测值分别为93.33%（28/30）和98.06%（101/103），早期廓清诊断OM的灵敏度为93.33%（28/30）。CEUS LI-RADS v2017分类中，LR-5和LR-4/5诊断HCC的灵敏度分别为61.65%（82/133）和80.45%（107/133），特异度均为93.33%（28/30），阳性预测值分别为97.62%（82/84）和98.17%（107/109），LR-4/5诊断HCC的灵敏度高于LR-5（P＝0.001）；LR-M诊断OM的灵敏度和特异度分别为93.33%（28/30）和95.49%（127/133）。结论 CEUS LI-RADS v2017对最大径≤3 cm的HCC与OM有较好的鉴别诊断价值，但LR-5对HCC的诊断灵敏度较低，LR-4/5可提高对HCC的诊断灵敏度。 |
| 关键词: 肝肿瘤 肝细胞癌 恶性肿瘤 超声造影 肝脏影像报告与数据系统 |
| DOI：10.16781/j.CN31-2187/R.20230085 |
| 投稿时间：2023-02-27修订日期：2023-07-10 |
| 基金项目: |
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| Value of contrast-enhanced ultrasound liver imaging reporting and data system for differential diagnosis between hepatocellular carcinoma and other hepatic malignancies less than or equal to 3 cm |
| ZHENG Lili1△,LIN Yanyan2△,DU Yiyan1,ZHAN Weiwei2,REN Xinping1,2* |
(1. Department of Ultrasound, Wuxi Branch of Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Wuxi 214028, Jiangsu, China;
2. Department of Ultrasound, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
△Co-first authors.
* Corresponding author) |
| Abstract: |
| Objective To investigate the value of contrast-enhanced ultrasound (CEUS) liver imaging reporting and data system version 2017 (LI-RADS v2017) in the differential diagnosis between hepatocellular carcinoma (HCC) and other hepatic malignancies (OM) less than or equal to 3 cm. Methods The clinical and imaging data of 163 liver lesions less than or equal to 3 cm in 126 patients with pathologically-confirmed liver malignancy were retrospectively analyzed. The patient underwent CEUS from Jan. 2018 to Jun. 2022 in our hospital, including 133 with HCC and 30 with OM. Nodules were classified based on the CEUS features according to the CEUS LI-RADS v2017. The evaluation of CEUS characteristics and CEUS LI-RADS v2017 in differential diagnosis of HCC and OM were calculated based on pathological findings. Results There were significant differences in the characteristics of arterial phase enhancement, timing of washout onset and washout degree between the HCC group and the OM group (all P＜0.001). The HCC group was mainly LR-3 (20 lesions, 15.04%), LR-4 (25 lesions, 18.80%) and LR-5 (82 lesions, 61.65%), and the OM group was mainly LR-M (28 lesions, 93.33%). The specificity and positive predictive value of late washout for HCC were 93.33% (28/30) and 98.06% (101/103), respectively; and the sensitivity of early washout for OM was 93.33% (28/30). With LR-5 as the criterion to diagnose HCC, the sensitivity was 61.65% (82/133), the specificity was 93.33% (28/30), and the positive predictive value was 97.62% (82/84); with LR-4/5 as the criterion to diagnose HCC, the sensitivity was 80.45% (107/133), the specificity was 93.33% (28/30), and the positive predictive value was 98.17% (107/109), with the sensitivity of LR-4/5 being significantly higher than those of LR-5 (P＝0.001). With LR-M as the criterion to diagnose OM, the sensitivity was 93.33% (28/30) and the specificity was 95.49% (127/133). Conclusion The CEUS LI-RADS v2017 can effectively distinguish HCC from OM less than or equal to 3 cm. LR-5 has a low sensitivity for HCC, while LR-4/5 can improve the sensitivity for HCC. |
| Key words: liver neoplasms hepatocellular carcinoma malignant tumor contrast-enhanced ultrasound liver imaging reporting and data system |
