超声造影肝脏影像报告与数据系统指导低年资医师诊断肝细胞癌的应用价值  

Value of contrast-enhanced ultrasound LI-RADS in the guidance of hepatocellular carcinoma for junior physicians

作　　者：郑丽丽 詹维伟[2] 夏蜀珺[2] 任新平[2] ZHENG Lili;ZHAN Weiwei;XIA Shujun;REN Xinping(Department of Ultrasound,Wuxi Branch of Ruijin Hospital,Jiangsu 214028,China)

机构地区：[1]江苏省无锡市新吴区新瑞医院,上海交通大学医学院附属瑞金医院无锡分院超声科,214028 [2]上海交通大学医学院附属瑞金医院超声科

出　　处：《临床超声医学杂志》2022年第5期358-362,共5页Journal of Clinical Ultrasound in Medicine

摘　　要：目的探讨超声造影肝脏影像报告与数据系统2017版(CEUS LI-RADS v2017)分类标准在指导低年资医师预测肝癌高危人群肝内局灶性病变(FLL)中肝细胞癌(HCC)的应用价值。方法选取我院行CEUS检查的HCC高危患者188例,共计225个FLL,医师A组(2名1~2年CEUS工作经验的低年资医师)和医师B组(2名10年以上CEUS工作经验的高年资医师)分别采用传统方法对病灶进行HCC及非HCC(包括良性病变及非HCC恶性肿瘤)诊断,医师A组再采用CEUS LI-RADS v2017对病灶进行分类。以组织病理学或随访结果为金标准,比较医师A、B组采用传统方法,以及医师A组采用CEUS LI-RADS v2017鉴别HCC的诊断效能。结果医师A、B组采用传统方法诊断HCC的准确率、敏感性、特异性、阳性预测值、阴性预测值分别为70.22%vs.89.33%、81.06%vs.96.21%、54.84%vs.79.57%、71.81%vs.86.99%、67.11%vs.93.67%,差异均有统计学意义(均P<0.05)。医师A组以LR-3、4、5类为HCC诊断标准可使敏感性和阴性预测值提高至96.97%和92.45%,以LR-5类为标准可使特异性和阳性预测值提高至90.32%和91.35%,均高于医师A组采用传统方法诊断效能(均P<0.05),且LR-5类诊断HCC的特异性高于医师B组采用传统方法的诊断特异性(P<0.05)。结论CEUS LI-RADS分类标准对提高低年资医师预测肝癌高危人群中HCC的效能有较好的指导作用。Objective system version 2017(CEUS LI-RADS v2017)in improving the prediction of focal liver lesion(FLL)for hepatocellular carcinoma(HCC)in high-risk patients by junior physicians.MethodsOne hundred and eighty-eight patients(225 FLL)at risk for HCC who underwent CEUS in our hospital were included.HCC and non-HCC(including benign lesions and non-HCC malignancies)were diagnosed by group A(two junior physicians who had 1~2 years of experience with CEUS)and group B(two senior physicians who had more than 10 years of experience with CEUS)using traditional methods,respectively.Then each lesion was classified to a category according to CEUS LI-RADS v2017 by group A.Taking histopathology and follow-up results as golden standard,the diagnostic efficacy of traditional methods by group A and B and CEUS LI-RADS by group A for diagnosing HCC were compared.Results traditional methods for diagnosing HCC by group A and B were 70.22%vs.89.33%,81.06%vs.96.21%,54.84%vs.79.57%,71.81%vs.86.99%,67.11%vs.93.67%,respectively(all P<0.05).The sensitivity and negative predictive value were improved to 96.97%and 92.45%when LR-3,4 and 5 were used as the diagnostic criteria of HCC by group A,and the specificity and positive predictive value were improved to 90.32%and 91.35%when LR-5 was used as the criteria,all of which were higher than the diagnostic efficacy of traditional methods by group A(all P<0.05),and the specificity was higher than traditional methods by group B(P<0.05).ConclusionCEUS LI-RADS has a good value in improving the diagnostic efficiency of junor physicians in predicting HCC for high-risk patients.

关 键 词：超声检查 造影剂 肝脏影像报告和数据系统 肝细胞癌 肝局灶性病变 

分 类 号：R445.1[医药卫生—影像医学与核医学] R735.7[医药卫生—诊断学]