超声造影LI-RADS分类在肝细胞癌诊断及鉴别诊断中的应用价值

Application value of contrast-enhanced ultrasound LI-RADS classification in diagnosis and differential diagnosis of hepatocellular carcinoma

摘要:

目的 评估美国放射协会的超声造影肝脏影像报告与数据系统（LI-RADS）分类标准在肝细胞癌（HCC）诊断及鉴别诊断中的临床价值。方法 选取2018年1月—2019年12月于锦州医科大学附属第一医院就诊的具有HCC高危风险的肝脏局灶性病变患者163例，回顾性分析所有患者的超声造影图像，并依据超声造影LI-RADS标准进行分类。以病理组织学诊断为金标准，计算该分类标准诊断HCC的敏感性、特异性、准确性、阳性预测值（PPV）及阴性预测值（NPV），以此绘制受试者工作特征（ROC）曲线并计算曲线下面积（AUC）。结果 163例患者共192个结节，经病理证实HCC145个（75.5%），肝内胆管细胞癌（ICC）10个（5.2%），混合型肝癌4个（2.1%），转移瘤2个（1.0%），良性病灶31个（16.1%）。超声造影LI-RADS分类结果为：LR-3类17个（8.9%），LR-4类33个（17.2%），LR-5类120个（62.5%），LR-M类22个（11.5%）；各分类中HCC的PPV分别为17.6%（3/17）、51.5%（17/33）、98.3%（118/120）和31.8%（7/22）。LR-5类诊断HCC的敏感性、特异性和PPV分别为81.4%、95.7%和98.3%；LR-4类联合LR-5类的敏感性、特异性和PPV为93.1%、61.7%和88.2%，AUC分别为0.886（95% CI：0.836，0.937）和0.782（95% CI：0.696，0.868），差异有统计学意义（P <0.05）。LR-M中95.5%（21/22）的病灶为恶性病灶，其中HCC占31.8%（7/22），非HCC恶性病灶为63.6%（14/22）；全部ICC均被正确划分至LR-M类。LR-3类中大部分（75.0%）为良性病灶。结论 美国放射协会的超声造影LI-RADS分类标准对HCC的诊断及鉴别诊断具有较高的应用价值，对HCC高危患者具有较好的风险预测价值，推荐在临床实践中应用。

关键词:肝细胞癌;超声造影;肝脏影像报告和数据系统

Abstract:

Objective To evaluate the clinical value of the American College Radiology Liver Imaging Report and Data System（LI-RADS）classification criteria with contrast- enhanced ultrasound in the diagnosis and differential diagnosis of hepatocellular carcinoma（HCC）.Methods From January 2018 to December 2019, A total of 163 patients (192 lesions) with focal liver lesion who had high risk of HCC and were diagnosed in the First Affiliated Hospital of Jinzhou Medical University were selected. Retrospective analysis of the contrast-enhanced ultrasound images of all patients was performed, and all lesions were classified according to ACR CEUS LI-RADS standard, using histopathological diagnosis as the gold standard. The sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) of CEUS LR-RADS classification criteria in the diagnosis of hepatocellular carcinoma were calculated. The ROC curve was constructed and the area under the curve was calculated.Results A total of 192 nodules was found in 163 patients, including 145 case of HCC (75.5%), 10 case of ICC (5.2%), 4 case of HCC-ICC (2.1%), 2 case of metastatic tumors (1.0%), and 31 case of benign lesions (16.1%), and all lesions were confirmed by pathology. The CEUS LI-RADS classification results showed: 17 cases were LR-3 classification (8.9%), 33 cases were LR-4 classification (17.2%), 120 cases were LR-5 classification (62.5%), and 22 cases were LR-M classification (11.5%). The PPV of HCC in each category were 17.6% (3/17), 51.5% (17/33), 98.3% (118/120), and 31.8% (7/22), respectively. The sensitivity, specificity and PPV of LR-5 in the diagnosis of HCC were 81.4%, 95.7%, and 98.3%, respectively. With the combination of LR-4 and LR-5, the sensitivity, specificity, and PPV were 93.1%, 61.7% and 88.2%, respectively; the AUC were 0.886 (95% CI: 0.836, 0.937) and 0.782 (95% CI: 0.696, 0.868), with statistically significant differences (P < 0.05). In LR-M, 95.5% (21/22) of the lesions were malignant, of which 31.8% (7/22) were HCC and 63.6% (14/22) were non-HCC malignant lesions. All HCC are correctly classified as LR-M. Most (75%) of LR-3 were benign lesions.Conclusions American College Radiology contrast-enhanced ultrasound LI-RADS has high application value in the diagnosis and differential diagnosis of HCC, and excellent risk prediction value for patients with high risk of HCC. It can be recommended for clinical practice.

Key words:hepatocellular carcinoma;contrast-enhanced ultrasound;liver imaging reporting and data system