2018与2017版LI-RADS基于钆塞酸二钠增强MRI对肝细胞癌诊断效能的对比研究  

Comparative study of LI-RADS v2018 and v2017 on the diagnosis of hepatocellular carcinoma based on Gd-EOB-DTPA enhanced MRI

作　　者：吕蓉[1] 胡维娟[1] 王迪[1] 陈晨[1] 郑冲霄 于长路[1] Lyu Rong;Hu Weijuan;Wang Di;Chen Chen;Zheng Chongxiao;Yu Changlu(Department of Radiology,the Third Central Hospital of Tianjin,Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases,Artificial Cell Engineering Technology Research Center,Tianjin Institute of Hepatobiliary Disease,Tianjin 300170,China)

机构地区：[1]天津市第三中心医院放射科,天津市重症疾病体外生命支持重点实验室,天津市人工细胞工程技术研究中心天津市肝胆研究所,300170

出　　处：《中华放射学杂志》2021年第8期859-864,共6页Chinese Journal of Radiology

摘　　要：目的探讨基于钆塞酸二钠(Gd-EOB-DTPA)增强MRI的2018版肝脏影像报告和数据系统(LI-RADS v2018)和2017版LI-RADS(LI-RADS v2017)对高危人群肝细胞癌(HCC)诊断效能的差异。方法回顾性收集2016年6月至2019年12月天津市第三中心医院行Gd-EOB-DTPA增强MRI并于1个月内取得术后或穿刺病理结果的237例HCC高危人群的临床及影像资料,共纳入282枚病灶。由2名放射科医师进行独立盲法阅片,分别根据LI-RADS v2018和v2017将病灶分类,采用Kappa值评价2名医师分类结果的一致性。以病理结果为金标准,分别计算LI-RADS v2018和v2017以LR-5和LR-4+5为标准对HCC的诊断效能,包括灵敏度、特异度、准确度和约登指数,并采用配对样本McNemar检验比较两者差异。结果2名医师对病灶分类的一致性较好,Kappa值在0.536~0.793之间。以LR-5为标准诊断HCC,LI-RADS v2018的约登指数(0.687)高于v2017(0.612),灵敏度[80.6%(166/206)]、准确度[82.6%(233/282)]均高于LI-RADS v2017[70.4%(145/206)、75.9%(214/282)](χ^(2)=19.048、14.087,P均<0.001),特异度分别为88.2%(67/76)、90.8%(69/76),差异无统计学意义(χ^(2)=0.500,P=0.500)。以LR-4+5为标准诊断HCC,2个版本的诊断效能相同,其灵敏度[91.3%(188/206)]、准确度[87.6%(247/282)]高于、特异度[77.6%(59/76)]低于LI-RADS v2018的LR-5标准,差异均有统计学意义(χ^(2)=20.045,P<0.001;χ^(2)=5.633,P=0.018;χ^(2)=16.056,P<0.001),其约登指数(0.689)亦高于LI-RADS v2018的LR-5标准。结论基于Gd-EOB-DTPA增强图像的LI-RADS v2018诊断HCC较v2017拥有更高的灵敏度和准确度,合理应用可以为临床提供更加客观的诊断依据。Objective To explore the differences of the diagnostic performance between the most recent 2018 version of liver imaging reporting and data system(LI-RADS v2018)and 2017 version(LI-RADS v2017)based on gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid(Gd-EOB-DTPA)enhanced MRI to diagnose hepatocellular carcinoma(HCC)in high-risk patients.Methods The clinical data and imaging findings of 237 patients in high-risk of HCC who underwent Gd-EOB-DTPA enhanced MRI and obtained postoperative or biopsy pathological results within one month from June 2016 to December 2019 in Tianjin Third Central Hospital were collected retrospectively.A total of 282 observations were obtained as study objects.Two independent radiologists blindly reviewed the preoperative MRI of all patients.The observations were categorized according to LI-RADS v2018 and v2017 respectively.The inter-observer agreement of the categorization between the two radiologists was tested by kappa analysis.With the LR-5 and LR-4+5 as the diagnosis of HCC,the sensitivity,specificity,accuracy,and Youden index of the LI-RADS v2017 and LI-RADS v2018 were evaluated with postoperative histopathological results as references.The McNemar test was used to compare the diagnostic performance between the two versions.Results The two physicians had good consistency in the categorization of observations,with kappa values between 0.536 and 0.793.Using LR-5 as the criterion for HCC diagnosis,the Youden index(0.687)of LI-RADS v2018 was higher than that of v2017(0.612).The sensitivity[80.6%(166/206)]and accuracy[82.6%(233/282)]were both higher than those of LI-RADS v2017[70.4%(145/206)and 75.9%(214/282)](χ^(2)=19.048,14.087,both P<0.001).The specificity was slightly lower[88.2%(67/76)and 90.8%(69/76),respectively],but there was no statistical difference(χ^(2)=0.500,P=0.500).With LR-4+5 as the diagnosis of HCC,the diagnostic performance of the two versions was the same.The sensitivity[91.3%(188/206)]and accuracy[87.6%(247/282)]were higher,and the specificity[77.6%(59/76)]w

关 键 词：癌 肝细胞 磁共振成像 肝脏影像报告和数据系统 

分 类 号：R735.7[医药卫生—肿瘤]