初探超声造影基于LI-RADS分类标准诊断肝细胞癌的可行性

摘要

目的：探讨基于肝脏影像报告和数据管理系统（LI-RADS）的超声造影检查诊断肝细胞癌（HCC）的可行性。方法：回顾性分析108例有肝癌高风险的单发肝脏病变患者的超声造影资料，并基于LI-RADS分类标准对肝脏病变进行分析评估，并与病理或临床诊断结果相对照。结果：108个病灶中LI-RADS 1～5类病灶共106个：1类和2类病灶19个，临床客观诊断结果均为良性（阴性预测值为100％）；3类病灶3个；22个4类病灶中17个为 HCC（阳性预测值为77．3％）；62个5类病灶中有54个为 HCC（阳性预测值为87．1％）。受试者工作特征（ROC）曲线下面积为0．83（P＜0．001）。若将LI-RADS 3～5类病灶归为阳性，基于LI-RADS的超声造影检查对HCC的诊断符合率为83．9％（92／106），敏感度为100％（73／73），特异度为57．6％（19／33），阳性预测值为83．9％（73／87），阴性预测值为100％（19／19）；若将 LI-RADS 3类病灶排除、1～2类病灶归为阴性、4～5类病灶归为阳性，则诊断符合率为87．4％（90／103），敏感度为100％（71／71），特异度为59．4％（19／32），阳性预测值为84．5％（71／84），阴性预测值为100％（19／19）。结论：超声造影检查中应用LI-RADS分类标准诊断 HCC具有一定的可行性。%Objective:To explore the feasibility of liver imaging reporting and data system (LI-RADS)with contrast-enhanced ultrasound for diagnosis of hepatocellular carcinoma (HCC ).Methods:The contrast-enhanced ultrasound (CEUS)data of 108 patients at high risk of HCC were retrospectively analyzed using LI-RADS.The diagnostic results of CEUS were compared with the results of clinical objective diagnosis.Sensitivity,specificity,negative (NPV)and positive predictive values (PPV),and receiver operating characteristic (ROC)curve were then produced.Results:108 lesions were found by CEUS including 106 lesions in LI-RADS category 1~5:19 lesions oincategory 1 or 2 were all benign (NPV=100%);there were 3 lesions in category 3;of 22 lesions in category 4,there were 17 HCCs (PPV= 77.3%);of 62 lesions in category 5,there were 54 HCCs (PPV= 87.1%).The area underneath the ROC curve was 0.83 with statistic significance (P<0.001).If category 1 and 2 were considered as negative and category 3~5 were considered as positive,the accuracy, sensitivity,specificity,PPV and NPV of CEUS based on the LI-RADS classification for the diagnosis of HCC were 83 .9%, 100%,57.6%,83.9% and 100% respectively.If the lesions in category 3 were excluded,and category 1 and 2 were con-sidered as negative,category 4~5 were considered as positive,the accuracy,sensitivity,specificity,PPV and NPV of CEUS based on the LI-RADS classification for diagnosis of HCC were 87.4%,100%,59.4%,84.5%and 100% respectively.Con-clusion:Contrast-enhanced ultrasound based on LI-RADS is feasible for diagnosis of HCC.