LI-RADS MRI分类标准对肝细胞癌的诊断效能

摘要

目的：探讨肝脏影像报告和数据管理系统（LI-RADS）MRI 分级诊断标准对肝细胞癌（HCC）的诊断价值。方法：回顾性分析88例肝脏病变患者的上腹部MRI资料，并根据LI-RADS分类标准对病变进行分析评估，并与临床客观诊断结果进行比较。结果：88例患者MRI共发现117个病灶，其中LI-RADS 1～5类病灶99个：1类和2类病灶25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，其中1个为HCC（阳性预测值为33．3％）；4类病灶8个，其中5个为 HCC（阳性预测值为62．5％）；63个5类病灶中61个为 HCC（阳性预测值为96．8％）。受试者工作特征（ROC）曲线下面积为0．96（P＜0．001）。若将LI-RADS 1～2类病灶归为阴性，3～5类归为阳性，LI-RADS对诊断 HCC的总符合率为92．9％（92／99），敏感度为100％（67／67），特异度为78．1％（25／32），阳性预测值为90．5％（67／74），阴性预测值为100％（25／25）。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，LI-RADS对 HCC的诊断符合率为94．8％（91／96），敏感度为100％（66／66），特异度为83．3％（25／30），阳性预测值为93．0％（66／71），阴性预测值为100％（25／25）。结论：LI-RADS分类标准对HCC的MRI诊断具有很好的诊断效果，有利于提高MRI诊断报告的准确性。%Objective:To investigate the diagnositic efficacy of MRI liver imaging reporting and data system (LI-RADS)for the diagnosis of hepatocellular carcinoma (HCC).Methods:88 patients at high risk of HCC underwent MRI examination.All the MR images were retrospectively analyzed and the lesions were categorized into 1 of 5 scales according to the LI-RADS.The diagnostic results were compared with the results of clinical final diagnosis.The sensitivity,specifici-ty,negative (NPV)and positive predictive value (PPV),and receiver operating characteristic (ROC)curve of MRI LI-RADS were then produced.Results:117 lesions were detected in all 88 patients,including 99 lesions in LI-RADS category 1~5.Of the 99 lesions,25 lesions of category 1 or 2 were all benign (NPV= 100%);one of the three lesions in category 3 was HCC;of the eight lesions in category 4,five were HCCs (PPV= 62.5%);among the 63 lesions in category 5,there were 61 HCCs (PPV= 96.8%).The area underneath the ROC curve was 0.96 with statistic significance (P<0.001).If category 1 and 2 were considered as negative and category 3~5 as positive,the accuracy,sensitivity,specificity,PPV and NPV of the MRI LI-RADS classification for the diagnosis of HCC were 92.9%,100%,78.1%,90.5% and 100% respec-tively.If lesions in category 3 were excluded,lesions in category 1 and 2 lesions were considered as negative and lesions in category 4~5 as positive,the accuracy,sensitivity,specificity,PPV and NPV of the LI-RADS classification for the diagnosis of HCC were 94.8%,100%,83.3%,93.0% and 100% respectively.Conclusion:LI-RADS MRI classification provides high efficacy for the diagnosis of HCC,it may be very useful to improve the accuracy of MRI reports.