超声造影LI-RADS分类在肝细胞癌诊断中的应用价值

摘要

目的 探讨超声造影肝脏影像报告与数据系统(LI-RADS)在肝细胞癌(HCC)诊断中的应用价值.方法 回顾性分析2012年10月至2018年7月于华中科技大学附属同济医院就诊的具有HCC高危风险的肝脏局灶性病变患者的超声造影资料,参照2017版超声造影LI-RADS分类标准对178例患者的197个病灶进行分级.以手术病理作为最终诊断,评价超声造影LI-RADS分类与病理诊断之间的关系.结果 197个病灶的最大径平均为(2 .9 ± 1 .6 ) cm ,经病理证实 HCC 170个(86 .3%) ,非HCC恶性病变17个(8 .6%) ,肝脏良性病变10个(5 .1%) .超声造影 LI-RADS 分类 LR-3 、 LR-4 、LR-5 、 LR-M类分别有6个(3 .0%) 、 37个(18 .8%) 、134个(68 .0%) 、 20个(10 .2%) . LR-3 、 LR-4 、 LR-5类病灶诊断 HCC的阳性预测值分别为 16 .7% (1／6)、 89 .2% (33／37)、 97 .0% (130／134) , LR-5类诊断HCC的阳性预测值最高,但敏感性偏低(76 .5%) ,若将LR-4+ LR-5类诊断为 HCC ,其诊断准确度明显优于LR-5类(92.4% 对 77.7%),差异有统计学意义(P ＜0.05).LR-M 中 95.0%(19／20)的病灶为恶性病变,其中 HCC 6 个. 76 .9% (10／13 )的胆内胆管细胞癌超声造影表现为LR-M 类.结论 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.%Objective To explore the clinical value of the Liver Imaging Report and Data System ( LI-RADS) with contrast enhanced ultrasound(CEUS) in the diagnosis of hepatocellular carcinoma ( HCC) . Methods From October 2012 to July 2018 , the CEUS data of patients at high risk for HCC were retrospectively analyzed . A total of 197 lesions in 178 patients were classified with reference to the 2017 version of CEUS LI-RADS classification standard . Diagnostic reference standard was surgical pathology . The relationship between the LI-RADS classification and the pathological diagnosis was evaluated . Results One hundred and ninety-seven lesions ,with an average size of ( 2 .9 ± 1 .6)cm ,were pathologically confirmed to be 170 HCC ( 86 .3% ) ,17 non-HCC malignant lesions ( 8 .6% ) ,and 10 liver benign lesions ( 5 .1% ) . There were 6 (3 .0% ) ,37(18 .8% ) ,134 (68 .0% ) and 20 (10 .2% ) lesions classified into LR-3 ,LR-4 ,LR-5 and LR-M category ,respectively . Positive predictive values of HCC in LR-3 ,LR-4 and LR-5 category were 16 .7% (1/6) ,89 .2% (33/37) ,97 .0% (130/134) ,respectively . LR-5 category had high positive predictive value of HCC( 97 .0% ) ,but low sensitivity ( 76 .5% ) . If LR-5 category combined with LR-4 category were diagnosed as HCC ,the diagnostic accuracy was significantly higher than that of LR-5 category ( 92 .4% vs 77 .7% ) ,and the difference was statistically significant ( P ＜ 0 .05 ) . 95 .0% ( 19/20 ) lesions of LR-M category were malignant ,of which 30 .0% ( 6/20 ) lesions were HCC . 76 .9% ( 10/13 ) of intrathecal cholangiocarcinoma was characterized by LR-M . Conclusions The LI-RADS classification of CEUS has high application value for diagnosis and differentiation of HCC .