LI-RADS超声造影分类标准对肝细胞癌的诊断价值

摘要

Objective To investigate the clinical value of liver imaging reporting and data system(LI-RADS) for hepatocellular carcinoma(HCC) by contrast-enhanced ultrasound(CEUS).Methods One hundred and twenty-nine patients (148 nodules) with high risk with HCC factors were included in this study,all the patients were examined by CEUS,the results were compared to histology and/or clinical diagnosis as reference standards.The sensitivity,specificity,positive predictive value (PPV),negative predictive value(NPV),and the area under the ROC curve in the diagnosis of HCC by LI-RADS categorization were calculated.Results Twenty-three nodules were initially assigned as LR-1,12 nodules were initially assigned as LR-2, 9 nodules were initially assigned as LR-3,24 nodules were initially assigned as LR4,43 nodules were initially assigned as LR-5, 37 nodules were initially assigned as LR-M.Category LR-1 and LR-2 were benign nodules proved by clinical diagnosis.Of 76 nodules in category LR-3,4,5,there were 67 HCCs.Of 37 nodules in category LR-M,there was 1 HCC.If LR1 and LR2 were considered negative,and LR-3,4,5 were positive,then the sensitivity,specificity and PPV were 100%,79.5% and 88.2%, respectively.If LR-1 and LR-2 were considered negative,and LR-4 and LR-5 were positive,the sensitivity,specificity and PPV were 100%,87.5% and 92.5%,respectively.The area under the ROC curve were 0.949 and 0.952,respectively.Conclusion LI-RADS offers a CEUS algorithm for standardized assessment and reporting of liver nodules,it is demonstrated as a valuable tool in the diagnosis of HCC.%目的 探讨肝脏影像报告和数据管理系统(LI-RADS)超声造影分类标准诊断肝细胞癌的临床价值.方法 选取具有肝细胞癌高危因素的肝脏局灶性病变患者129例(共148个病灶),均行超声造影检查,以病理组织学诊断或最终临床诊断为标准,计算LI-RADS超声造影分类标准诊断肝细胞癌的敏感性、特异性、阳性预测值及阴性预测值;绘制受试者工作特征曲线并计算其曲线下面积.结果 148个病灶LI-RADS诊断LR-1类23个,LR-2类12个,LR-3类9个,LR-4类24个,LR-5类43个,LR-M类病灶37个.LR-1、LR-2类病灶临床均诊断为良性;LR-3、LR-4、LR-5类病灶中,67个为肝细胞癌;LR-M类病灶中,1个为肝细胞癌.将LR-1、LR-2类归为阴性,LR-3、LR-4、LR-5类归为阳性或LR-4、LR-5类归为阳性,其诊断肝细胞癌的敏感性分别为100%、100%,特异性分别为79.5%、87.5%,阳性预测值分别为88.2%、92.5%;曲线下面积分别为0.949和0.952.结论 LI-RADS为超声造影的标准化评估和规范报告提供了参考标准,对肝细胞癌具有较好的诊断效能.