应用肝影像报告和数据系统MRI分级标准诊断原发性肝癌的诊断效能评价  

Diagnostic value of liver imaging reporting and data system MRI on primary hepatocellular carcinoma

作　　者：赵伟[1] 李文政[1] 易小平[1] 裴贻刚[1] 刘慧[1] 张丽青[1] 刘华平[1] 

机构地区：[1]中南大学湘雅医院放射科,长沙410008

出　　处：《中南大学学报（医学版）》2016年第4期380-387,共8页Journal of Central South University ：Medical Science

基　　金：湖南省自然科学基金(13JJ6007);湖南省教育厅项目(13CS13038)~~

摘　　要：目的:初步探讨肝影像报告和数据系统(liver imaging reporting and data system,LI-RADS)磁共振成像(magnet ic resonance imag ing,MR I)分级标准对原发性肝癌的诊断价值。方法:搜集2014年1月至2015年1月在中南大学湘雅医院术后病理证实的100例(原发性肝癌72例,再生结节4例,血管瘤13例,肝囊肿4例,肝脓肿3例,炎性假瘤2例,肝动静脉瘘1例,局限性脂肪变性1例)具有原发性肝癌高危因素患者的MRI影像资料,由3位影像学副教授在不知道病理结果的前提下,严格按照LI-RADS MRI分级标准对图像进行评阅,计算出LI-RADS MRI分级标准诊断原发性肝癌的敏感性、特异性及ROC曲线下面积。结果:应用LI-R ADS MRI分级标准诊断100例患者为原发性肝癌的ROC曲线下面积为0.925。100例患者图像的肝病变分类中LR1类和LR2类20例,术后病理检查均为良性(阴性预测值为100%),31例LR3类中术后病理检查有25例为原发性肝癌,29例LR4类中术后病理检查有27例为原发性肝癌(阳性预测值为93.1%),20例LR5类中术后病理检查表明全部为原发性肝癌(阳性预测值为100%)。将LR3,4,5类归为阳性,则该分级标准的敏感性和特异性分别为100%和71.4%,ROC曲线下面积为0.925。若将LR4,5类归为阳性,则敏感性和特异性可以达到100%和90.9%,ROC曲线下面积为0.974。结论:采用LI-RADS的MRI分级标准诊断原发性肝癌有很好的敏感性及特异性,具有较高的诊断正确率。Objective：To evaluate the diagnostic value of liver imaging reporting and classification criteria of data system（LI-RADS） MRI on primary hepatic carcinoma（HCC）.Methods：The MRI images of 100 patients（72 patients with HCC,4 with regenerative nodules,13 with hemangioma,4 with liver cyst,3 with Liver abscess,2 with inflammatory pseudotumor,1 with hepatic arteriovenous fistula,1 with Limitations of steatosis） with liver disease were collected in Xiangya Hospital from January,2014 to January,2015.All patients were at the risk of HCC.The images were reviewed according to the LI-RADS categorization by American College of Radiology（ACR） under a condition of blindness to the pathological data.The sensitivity,specificity and the area under the ROC curve in the diagnosis of HCC with the LI-RADS categorization were calculated by three associate professors from the Department of Radiology,Xiangya Hospital.Results：The area under the ROC curve was 0.925 in the 100 patients with HCC.Of the100 pathologically confirmed patients,20 cases were LR1 and LR2.However,the postoperation pathological examination showed benign tumor（negative predictive value was 100%）.There were 25 HCC in 31 cases of LR3,27 HCC in 29 cases of LR4（positive predictive value was 93.1%）.All of 20 cases of LR5 were HCC（positive predictive value was 100%）.If LR1 and LR2 were considered negative,and LR3,4,5 were positive,then the sensitivity,the specificity and the area under the ROC curve was 100%,71.4%and0.925,respectively.If LR1,2 and 3 were considered negative and LR4 and LR5 were positive,the sensitivity,the specificity and the area under the ROC curve was 100%,90.9%and 0.974,respectively.Conclusion：The MRI LI-RADS categorization is highly sensitive and specific in the diagnosis of HCC,which can improve the diagnostic accuracy.

关 键 词：肝影像报告和数据系统 磁共振成像 原发性肝癌 

分 类 号：R445.2[医药卫生—影像医学与核医学] R735.7[医药卫生—诊断学]