超声造影肝脏影像报告与数据系统对高危人群肝细胞癌的风险预测  

The predictive value of Liver Imaging Reporting and Data System with contrast-enhanced ultrasound (v2017) in the risk of hepatocellular carcinoma in high-risk population

作　　者：丁建民[1] 龙磊 周洪雨[1] 周燕[1] 王彦冬[1] 经翔[1] Ding Jianmin;Long Lei;Zhou Hongyu;Zhou Yan;Wang Yandong;Jing Xiang(Department of Ultrasound,Tianjin Third Central Hospital,Tianjin Institute of Hepatobiliary Disease,Tianjin Key Laboratory of Artificial Cell,Artificial Cell Engineering Technology Research Center of Public Health Ministry,Tianjin 300170,China)

机构地区：[1]天津市第三中心医院超声科,天津市肝胆疾病研究所,天津市人工细胞重点实验室,卫生部人工细胞工程技术研究中心,300170

出　　处：《中华超声影像学杂志》2020年第2期138-142,共5页Chinese Journal of Ultrasonography

基　　金：天津市科技计划项目(17ZXMFSY00050)。

摘　　要：目的探讨超声造影(contrast enhanced ultrasound,CEUS)肝脏影像报告与数据系统(CEUS LI-RADS v2017)对高危人群肝细胞癌(hepatocellular carcinoma,HCC)的风险预测价值。方法收集天津市第三中心医院2016年1月至2017年12月具有HCC高危因素的571例接受CEUS检查的患者,270例患者(295个结节)符合入选标准,最终结果以超声引导穿刺活检病理和手术病理为参考标准。根据CEUS LI-RADS v2017对每个肝结节的CEUS结果进行分类,分析CEUS LI-RADS v2017对HCC诊断风险预测的准确性。结果295个结节中,最终结果通过手术病理及穿刺活检获得的结节数量分别为95个、200个。其中HCC 245个,肝内胆管细胞癌13个,混合型肝癌8个,转移性肝癌2个,良性结节27个。LR-3、LR-4、LR-5、LR-M类结节数量分别为16个(5.4%)、28个(9.5%)、183个(62.0%)、68个(23.1%),各分类对HCC的阳性预测值分别为43.8%、60.7%、98.4%和60.3%。以LR-5类为标准诊断HCC的敏感性、特异性、阳性预测值分别为73.5%、94.0%、98.4%。经病理证实,LR-M分类中HCC占60.3%(41/68)。结论CEUS LI-RADS v2017分类标准对HCC高危因素患者具有较高的风险预测价值,其中LR-5类对HCC具有良好的阳性预测值,但LR-M分类标准有待进一步研究。Objective To explore the clinical value of Liver Imaging Reporting and Data System(LI-RADS)version 2017 with contrast-enhanced ultrasound(CEUS)for the risk prediction of hepatocellular carcinoma(HCC).Methods Five hundred and seventy-one patients with HCC risk factors had received CEUS examination in Tianjin Third Central Hospital,270 patients with 295 nodules were enrolled in this study according to the inclusion criteria.The final diagnostic reference standard was decided by surgical pathology or ultrasound-guided biopsy pathology.Each nodule was classified according to CEUS LI-RADS v2017.The diagnostic accuracy of CEUS LI-RADS v2017 for the prediction of HCC was analyzed retrospectively.Results Of all 295 nodules,95 nodules were diagnosed by surgical pathology and 200 nodules by ultrasoud-guided biopsy pathology,among which with 245 HCC,13 intrahepatic cholangiocarcinoma(ICC),8 combined hepatocellular cholangiocarcinoma(CHC),2 metastatic neoplasm of other cellular origin and 27 benign nodules.The numbers of LR-3,LR-4,LR-5 and LR-M categories were 16(5.4%),28(9.5%),183(62.0%),68(23.1%)and the positive predictive value(PPV)of LR-3,LR-4 and LR-5 were 43.8%,60.7%,98.4%for HCC,respectively.The sensitivity,specificity and positive predictive value of LR-5 category for HCC were 73.5%,94.0%,98.4%,respectively.60.3%(41/68)LR-M category nodules were pathologically confirmed to be HCC.Conclusions CEUS LI-RADS v2017 classification standard has reliable risk prediction value for patients with high risk factors of HCC,of which the LR-5 category has higher PPV for HCC.However,the differential diagnosis between HCC and other non-HCC malignancies still remains to be further studied for LR-M observations.

关 键 词：超声造影 肝细胞癌 肝脏影像报告和数据系统 

分 类 号：R735[医药卫生—肿瘤] R44[医药卫生—临床医学]