超声造影LI-RADS分类标准对肝细胞癌的诊断价值

张家玲; 葛晖; 武文娟

doi:10.16766/j.cnki.issn.1674-4152.001929

超声造影LI-RADS分类标准对肝细胞癌的诊断价值

doi: 10.16766/j.cnki.issn.1674-4152.001929

1.
蚌埠医学院附属蚌埠市第三人民医院超声科，安徽蚌埠 233000
2.
蚌埠医学院生化与分子生物学教研室，安徽蚌埠 233000

基金项目:

安徽省教育厅自然科学资助项目 kj2017A234

详细信息

通讯作者:
葛晖, E-mail: 0552gh@163.com

中图分类号: R735.7 R730.41
计量
- 文章访问数: 305
- HTML全文浏览量: 97
- PDF下载量: 3
- 被引次数: 0
出版历程
- 收稿日期: 2020-08-25
- 网络出版日期: 2022-02-16

Diagnostic value of contrast-enhanced LI-RADS classification criteria in hepatocellular carcinoma

1.
Department of Medical Ultrasound, the Third People's Hospital of Bengbu, Affiliated to Bengbu Medical College, Bengbu, Anhui 233000, China

摘要

摘要: 目的探讨超声造影肝脏影像报告与数据系统(liver imaging reporting and data system，LI-RADS)对肝细胞癌(hepatocellular carcinoma，HCC)的诊断效能，评估其在HCC诊断中的应用价值。方法选取2018年9月—2020年6月于蚌埠市第三人民医院就诊的具有HCC高危因素患者150例共163个肝脏局灶性病变的超声造影资料，由4名具有5年以上肝脏超声造影经验的医师按照超声造影常规法标准和LI-RADS分类法标准分为2组，分别对163个病灶进行诊断。以病理结果为金标准，计算敏感性、特异性、阳性预测值、阴性预测值、诊断符合率，绘制ROC曲线比较2组的诊断效能。结果 163个病灶经病理证实HCC为122个，非HCC恶性病变16个，良性病变25个。常规法诊断HCC符合率为87.1%(142/163)，曲线下面积(AUC)为85.7%。LI-RADS分类法中LR-5类诊断HCC特异性最高(95.1%)但敏感性偏低(72.1%)，若将LR-4+LR-5类诊断为HCC，其敏感性(98.4%，120/122)、特异性(82.9%，34/41)、诊断符合率(94.5%，154/163)及AUC(90.6%)均高于常规法。分类法诊断准确性优于常规法，二者差异具有统计学意义(χ²=4.654, P=0.031)。结论超声造影LI-RADS分类标准可以提高HCC诊断符合率，具有较高的诊断价值。
- 肝细胞癌 /
- 超声造影 /
- 肝脏影像报告与数据系统(LI-RADS)
Abstract: Objective The aim of this study was to explore the diagnostic efficacy of the Contrast-enhanced ultrasound liver image report and data system (LI-RADS) for hepatocellular carcinoma (HCC) and evaluate its application value in HCC. Methods The ultrasound contrast data of 163 focal liver lesions in 150 patients with high risk factors for HCC who were treated at the Third People's Hospital of Bengbu from September 2018 to June 2020 were selected, and four physicians with more than 5 years of experience in contrast-enhanced liver ultrasound were divided into two groups according to the standard of conventional contrast-enhanced ultrasound and the LI-RADS classification standard of contrast-enhanced ultrasound to diagnose 163 lesions. Using pathological results as the gold standard, we calculated the sensitivity, specificity, positive and negative predictive value, and diagnostic coincidence rate, and draw ROC curve to compare the diagnostic efficacy of the two groups. Results One hundred and sixty-three lesions were confirmed pathologically for 122 HCC, 16 for non-HCC malignant lesions, and 25 for benign lesions. The coincidence rate of conventional diagnosis of HCC was 87.1% (142/163), and the area under the curve (AUC) was 85.7%. In the LI-RADS classification, LR-5 has the highest specificity (95.1%) but low sensitivity (72.1%) in the diagnosis of HCC. If LR-4+LR-5 were diagnosed as HCC, its sensitivity (98.4%, 120/122), specificity (82.9%, 34/41), diagnostic coincidence rate (94.5%, 154/163) and AUC (90.6%) were all higher than the conventional methods. The diagnostic accuracy of classification method is better than that of conventional method, and the difference between the two groups were statistically significant (χ² =4.654, P=0.031). Conclusion The LI-RADS classification standard of contrast-enhanced ultrasound can improve the diagnostic coincidence rate of HCC and has high diagnostic value.
- Hepatocellular carcinoma /
- Contrast enhanced ultrasound /
- Liver imaging report and data system

HTML全文

图 1 LI-RADS分类LR-4类超声及CEUS图

注：箭头示肝右叶低回声结节，大小约11 mm×10 mm。A：动脉期呈高增强；B：门脉期呈等增强；C：延迟期呈等增强，未见廓清。病理结果为高分化HCC。

下载: 全尺寸图片幻灯片

图 2 LI-RADS分类LR-5类超声及CEUS图

注：箭头示肝右叶低回声结节，大小约29 mm×22 mm。A：动脉期呈高增强；B：门脉期呈等增强；C：延迟期轻度廓清。病理结果为高分化HCC。

下载: 全尺寸图片幻灯片

图 3 CEUS常规法与LI-RADS分类法诊断HCC的ROC曲线图

注：绿色线表示CEUS常规法ROC曲线下面积为85.7%；蓝色线表示将LR-4+LR-5类归为HCC阳性，分类法ROC曲线下面积为90.6%。

下载: 全尺寸图片幻灯片

表 1 CEUS常规诊断法结果(个)

CEUS常规诊断法	病理结果			合计
CEUS常规诊断法	HCC	非HCC恶性	良性结节	合计
HCC	108	6	1	115
非HCC恶性	0	10	2	12
良性结节	14	0	22	36
合计	122	16	25	163

下载: 导出CSV

表 2 CEUS LI-RADS分类法诊断结果(个)

分类	病灶数	病理结果			阳性预测值(%)
分类	病灶数	HCC	非HCC恶性	良性结节	阳性预测值(%)
LR-3	16	2	0	14	12.5
LR-4	37	32	0	5	86.5
LR-5	90	88	0	2	97.8
LR-M	20	0	16	4	/
合计	163	122	16	25	/
注：“/”代表“无”。

下载: 导出CSV

表 3 2种诊断标准对HCC诊断准确性比较(个)

CEUS常诊断法	CEUS LI-RADS		合计
CEUS常诊断法	阳性	阴性	合计
阳性	108	7	115
阴性	19	29	48
合计	127	36	163

下载: 导出CSV

参考文献(18)

[1]	安澜, 曾红梅, 郑荣寿, 等. 2015年中国肝癌流行情况分析[J]. 中华肿瘤杂志, 2019, 41(10): 721-727.
[2]	《原发性肝癌诊疗规范(2019年版)》编写专家委员会. 原发性肝癌诊疗规范(2019年版)[J]. 临床肝胆病杂志, 2020, 36(2): 277-292. doi: 10.3969/j.issn.1001-5256.2020.02.007
[3]	卓涛, 陈海燕, 李坚, 等. 早期肝癌患者在临床诊断期间使用肝脏超声造影诊断其病灶位置和转移中的应用效果[J]. 中国超声医学杂志, 2020, 36(6): 528-531. doi: 10.3969/j.issn.1002-0101.2020.06.014
[4]	杨丹, 李锐. 美国放射学院超声造影LI-RADS指南(2016版)[J]. 临床超声医学杂志, 2017, 19(10): 712-718. doi: 10.3969/j.issn.1008-6978.2017.10.027
[5]	王延杰, 严昆, 高旭东, 等. 超声及超声造影诊断HCC的局限性[J]. 中国超声医学杂志, 2020, 36(6): 520-524. doi: 10.3969/j.issn.1002-0101.2020.06.012
[6]	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)[J]. Ultraschall Med, 2017, 38(1): 85-86. doi: 10.1055/s-0042-124369
[7]	齐宝文, 吕娟, 张利. 血清学指标联合超声造影时间-强度曲线对肝脏肿瘤良恶性的鉴别诊断价值[J]. 中国医药, 2019, 14(10): 1527-1530. doi: 10.3760/j.issn.1673-4777.2019.10.021
[8]	杨丹, 李锐, 郭燕丽, 等. 肝细胞癌分化程度、病灶大小及肝病背景对超声造影廓清过程的影响[J]. 中华医学超声杂志(电子版), 2016, 13(4): 286-292. doi: 10.3877/cma.j.issn.1672-6448.2016.04.011
[9]	HEIMBACH J K, KULIK L M, FINN R S, et al. AASLD guidelines for the treatment of hepatocellular carcinoma[J]. Hepatology (Baltimore, Md. ), 2018, 67(1): 358-380. doi: 10.1002/hep.29086
[10]	PETER R G, ALEJANDRO F, JOSEP M L, et al. EASL clinical practice guidelines: management of hepatocellular carcinoma[J]. J Hepatol, 2018, 69(1): 182-236. doi: 10.1016/j.jhep.2018.03.019
[11]	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]. J Hepatol, 2018, 68(3): 485-492. doi: 10.1016/j.jhep.2017.11.007
[12]	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[J]. 中华超声影像学杂志, 2018, 27(11): 936-941. doi: 10.3760/cma.j.issn.1004-4477.2018.11.004
[13]	ELSAYES K M, FOWLER K J, CHERNYAK V, et al. User and system pitfalls in liver imaging with LI-RADS. [J]. J Magn Reson Imaging, 2019, 50(6): 1673-1686. doi: 10.1002/jmri.26839
[14]	吴亚丽, 李丹, 毛雯. 超声检查在肝硬化背景下肝细胞肝癌中的诊断价值[J]. 癌症进展, 2019, 17(10): 1174-1177. https://www.cnki.com.cn/Article/CJFDTOTAL-AZJZ201910016.htm
[15]	宋珂达, 李梓豪, 姜洪池. 肝内胆管细胞癌的诊疗进展[J]. 国际外科学杂志, 2020, 47(2): 112-117. https://www.cnki.com.cn/Article/CJFDTOTAL-JRFS201803022.htm
[16]	YUAN M, LI R. Enhancement patterns of intrahepatic cholangiocarcinoma on contrast-enhanced ultrasound: correlation with clinicopathologic findings and prognosis[J]. Ultrasound Med Biol, 2019, 45(1): 26-34. doi: 10.1016/j.ultrasmedbio.2018.08.014
[17]	吴琴, 戴莹, 严昆, 等. 肝内胆管细胞癌超声造影增强模式及肝背景的影响[J]. 中国超声医学杂志, 2019, 35(7): 616-619. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGCY201907014.htm
[18]	LI F, LI Q, LIU Y, et al. Distinguishing intrahepatic cholangiocarcinoma from hepatocellular carcinoma in patients with and without risks: the evaluation of the LR-M criteria of contrast-enhanced ultrasound liver imaging reporting and data system version 2017[J]. Eur Radiol, 2020, 30(1): 461-470. doi: 10.1007/s00330-019-06317-2