基于2018年版肝脏影像报告数据系统对比分析CT和MRI诊断肝细胞癌的效能  

Computed tomography and magnetic resonance imaging in the diagnosis of patients with hepatocellular carcinoma based on liver imaging report data system v2018

作　　者：梁旭[1] 刘圆圆 杨学刚[1] 任静[1] Liang Xu;Liu Yuanyuan;Yang Xuegang(Department of Radiology,Provincial Tumor Hospital,Chengdu 610041,Sichuan Province,China)

机构地区：[1]四川省肿瘤医院影像科,成都市610041

出　　处：《实用肝脏病杂志》2021年第5期725-728,共4页Journal of Practical Hepatology

基　　金：四川省医学科研课题计划基金资助项目(编号:Q18004)。

摘　　要：目的比较CT和MRI按照2018年版肝脏影像报告数据系统(LI-RADS)诊断肝细胞癌(HCC)的效能。方法2017年9月~2020年7月四川省肿瘤医院诊治的有HCC高危因素的72例患者(HCC 53例、非HCC恶性肿瘤10例、良性病变9例),接受CT和MRI检查。根据2018年版LI-RADS定义的影像学征象和分类法则,对所有病灶进行分类,采用kappa一致性检验两种检查方法的分类结果,以组织病理学检查结果为金标准,比较CT和MRI诊断HCC的ROC曲线下面积(AUC),计算LR-5类诊断HCC的敏感性和特异性。结果CT和MRI的LI-RADS分类结果一致性较好,kappa值为0.693【(95%CI:0.545~0.841),P<0.001】;两种检查方法诊断HCC的AUC分别为0.827(95%CI:0.708~0.946)和0.856(95%CI:0.761~0.952),差异无统计学意义(P>0.05);以LR-5为阳性,MRI诊断HCC的敏感性为81.1%(43/53),显著高于CT诊断的66.0%(35/53),差异有统计学意义(P<0.05);CT和MRI诊断HCC的特异性分别为78.9%(15/19)和89.5%(17/19),差异无统计学意义(P>0.05);在LI-RADS定义的主要征象中,MRI对强化包膜的显示率为40.3%,显著高于CT的5.5%(P<0.001)。结论基于肝脏影像报告数据系统,CT和MRI诊断HCC有相当高的效能,而MRI诊断肝细胞癌的敏感性高于CT,特别在显示强化病灶包膜方面优于CT。Objective This study aimed to compare the efficacy of computed tomography(CT)and magnetic resonance imaging(MRI)in the diagnosis of patients with hepatocellular carcinoma(HCC)based on liver imaging report data system(LIRADS)v2018.Methods We performed a retrospective study in 72 patients with high risk of HCC(proven pathologically HCC in 53,non-HCC malignant tumors in 10 and benign lesions in 9),and all patients underwent CT and MRI scan between September 2017 and July 2020.Two independent radiologists assigned a LI-RADS category for all hepatic foci in consensus.The intraclass agreement for the LI-RADS category between CT and MRI was evaluated by using Kappa statistic.The area under receiver operating characteristic curve(AUC)was analyzed for diagnostic accuracy of LI-RADS v2018.Results The intraclass agreement for the LI-RADS category between CT and MRI was substantial,and the kappa value was 0.693(95%CI:0.545-0.841),P<0.001];the AUCs of the two modalities were 0.827(95%CI:0.708-0.946)and 0.856(95%CI:0.761-0.952),respectively,without significant difference(P>0.05);the sensitivities of CT and MRI in diagnosing HCC based on the LR-5 were significantly different[66.0%(35/53)vs.81.1%(43/53),P<0.05],while the specificities of CT and MRI were comparable[(78.9%(15/19)vs.89.5%(17/19),P>0.05];among the major features defined by LI-RADS,the display rate of enhanced capsule of tumors by MRI was 40.3%,significantly higher than 5.5%by CT(P<0.001).Conclusion Based on the LI-RADS v2018,the CT and MRI show a considerable efficacy in diagnosing patients with HCC,and the sensitivity of MRI is high with obvious presentation of enhanced capsule of tumors.

关 键 词：肝细胞癌 磁共振成像 计算机X线体层摄影术 肝脏影像报告数据系统 诊断 

分 类 号：R735.7[医药卫生—肿瘤]