| 摘要: |
| 目的 探讨超声造影肝脏影像报告与数据系统（LI-RADS）在慢性肝病患者肝局灶性病变恶性风险评估中的应用价值。方法 回顾性分析2018年1月至2020年10月在上海交通大学医学院附属瑞金医院行肝脏超声造影检查的具有肝细胞癌（HCC）高危因素的151例肝局灶性病变患者的197枚结节的临床和影像学资料，根据美国放射学院（ACR）LI-RADS（2017版）标准对结节进行超声造影LI-RADS分级。目标病灶的诊断均经组织病理或CT/MRI增强检查并随访确定。利用诊断试验公式计算超声造影LI-RADS分类标准诊断肝脏恶性病灶的灵敏度、特异度、阳性预测值、阴性预测值和准确度。结果 197枚结节中恶性病灶126枚、良性病灶71枚。超声造影LI-RADS诊断LR-1类结节12枚、LR-2类24枚、LR-3类39枚、LR-4类14枚、LR-5类90枚、LR-M类18枚。以LR-5类为HCC诊断标准时，其诊断HCC的灵敏度、特异度、阳性预测值、阴性预测值、准确度分别为77.57%（83/107）、92.22%（83/90）、92.22%（83/90）、77.57%（83/107）、84.26%（166/197）；以LR-4+5类为HCC诊断标准时，其诊断HCC的灵敏度、特异度、阳性预测值、阴性预测值、准确度分别为86.92%（93/107）、87.78%（79/90）、89.42%（93/104）、84.95%（79/93）、87.31%（172/197）；2个标准的诊断价值差异无统计学意义（P＞0.05）。LR-M类诊断肝脏非HCC恶性病灶的灵敏度、特异度、阳性预测值、阴性预测值、准确度分别为73.68%（14/19）、97.75%（174/178）、77.78%（14/18）、97.21%（174/179）及95.43%（188/197）。结论 超声造影LI-RADS为肝脏超声造影的标准化评估提供了参考标准，对HCC具有较好的诊断效能，对肝脏非HCC恶性病灶也有较高的诊断特异度和准确度。 |
| 关键词: 超声检查 超声造影 肝脏影像报告与数据系统 肝细胞癌 肝肿瘤 |
| DOI：10.16781/j.CN31-2187/R.20210754 |
| 投稿时间：2021-08-03 |
| 基金项目: |
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| Role of contrast-enhanced ultrasound LI-RADS in assessing malignancy risk of focal liver lesions in chronic liver disease patients |
| XIA Shu-jun1△,ZHENG Li-li2△,ZHAN Wei-wei1,REN Xin-ping1,2* |
(1. Department of Ultrasound, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China;
2. Department of Ultrasound, Wuxi Branch of Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Wuxi 214028, Jiangsu, China
△Co-first authors.
* Corresponding author) |
| Abstract: |
| Objective To evaluate the role of contrast-enhanced ultrasound (CEUS) liver imaging reporting and data system (LI-RADS) in the malignant risk assessment of focal liver lesions in patients with chronic liver disease.Methods The clinical and imaging data of 197 nodules in 151 patients with focal liver lesions with high-risk factors of hepatocellular carcinoma (HCC) who underwent liver CEUS in Ruijin Hospital, Shanghai Jiao Tong University School of Medicine from Jan. 2018 to Oct. 2020 were analyzed retrospectively. The nodules were graded by CEUS LI-RADS according to the American College of Radiology (ACR) LI-RADS (2017). The diagnosis of target lesions was confirmed by histopathology or contrast-enhanced computed tomography/magnetic resonance imaging combined with follow-up. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of CEUS LI-RADS classification standard in the diagnosis of liver malignant lesions were calculated by diagnostic test formula.Results Among the 197 lesions, 126 were malignant and 71 were benign. CEUS LI-RADS showed that there were 12 lesions for LR-1, 24 lesions for LR-2, 39 lesions for LR-3, 14 lesions for LR-4, 90 lesions for LR-5, and 18 lesions for LR-M. When LR-5 was recognized as HCC, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 77.57% (83/107), 92.22% (83/90), 92.22% (83/90), 77.57% (83/107), and 84.26% (166/197), respectively; when LR-4+5 was recognized as HCC, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 86.92% (93/107), 87.78% (79/90), 89.42% (93/104), 84.95% (79/93), and 87.31% (172/197), respectively; there was no significant difference in the diagnostic value between the 2 criteria (P > 0.05). In addition, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy of LR-M in diagnosing non-HCC malignant lesions were 73.68% (14/19), 97.75% (174/178), 77.78% (14/18), 97.21% (174/179), and 95. 43% (188/197), respectively.Conclusion CEUS LI-RADS provides a standardized evaluation for focal liver lesions in patients with chronic liver diseases. It shows good diagnostic efficiency for HCC and high diagnostic specificity and accuracy for non-HCC malignant lesions. |
| Key words: ultrasonography contrast-enhanced ultrasonography liver imaging reporting and data system hepatocellular carcinoma liver neoplasms |
