基于LI-RADSv2018原则CT及MRI对肝脏肿瘤的诊断价值  

Diagnostic value of CT and MRI based on LI-RADS v2018 principle for liver tumors

作　　者：李珊玫 郭小芳[1] 陈长春[1] 张照喜[1] 陈迢 袁子龙[1] 刘玉林[1] LI Shanmei;GUO Xiaofang;CHEN Changchun;ZHANG Zhaoxi;CHEN Tiao;YUAN Zilong;LIU Yulin(Department of Radiology,Hubei Cancer Hospital,Wuhan 430079,China)

机构地区：[1]湖北省肿瘤医院放射科,湖北武汉430079

出　　处：《实用放射学杂志》2022年第4期581-585,共5页Journal of Practical Radiology

摘　　要：目的探讨2018版肝脏影像报告与数据系统(LI-RADS)在CT及MRI诊断肝脏肿瘤中的应用价值.方法收集符合LI-RADSv2018纳入原则肝脏肿瘤患者的影像学及临床资料,所有患者在治疗前行CT及MRI检查,由2名诊断者分别对病灶的CT及MRI扫描结果行LI-RADS分级,第3位诊断者先后对病灶的CT及MRI行LI-RADS分级,统计各征象在CT联合MRI出现频率,分别判断CT组、MRI组及CT联合MRI组的LI-RADS分级,应用Kappa检验行一致性分析,结合病理计算3组诊断的准确性.结果93例患者共检出93个病灶[72个肝癌、11个胆管细胞癌、4个混合型肝癌胆管细胞癌、2个炎性假瘤及硬化结节、1个局灶性结节增生(FNH)及血管瘤],MRI组诊断肝脏肿瘤的一致性高于CT组及CT联合MRI组,Kappa值分别为0.92、0.87、0.84;CT联合MRI组的诊断准确性高于MRI组及CT组,分别为98.89%、97.78%、91.11%;MRI组对廓清、包膜及次要征象的显示明显优于CT组,而CT组对动脉强化显示稍优于MRI组.结论基于临床的最新反馈及一定的影像诊断经验,LI-RADSv2018系统化、标准化肝脏肿瘤的影像学特征并分级,对诊断具有极好一致性及较高的准确性.Objective To explore the application value of liver imaging reporting and data system(LI-RADS)v2018 in CT and MRI diagnosis of liver tumors.Methods The imaging and clinical data of liver tumor patients were collected in accordance with the principle of LI-RADS v2018.Before treatment,all patients were examined with CT and MRI.The results of CT and MRI were graded with LI-RADS by two radiologists respectively,and then those were graded by the third radiologist successively.The frequency of each sign on CT and MRI images was counted,and the LI-RADS grades of CT group,MRI group and CT+MRI group were judged respectively.Kappa test was used for consistency analysis,and the accuracy of diagnosis in three groups was calculated combined with pathology.Results A total of 93 lesions were detected in 93 patients[72 hepatocarcinomas,11 cholangiocarcinomas,4 mixed hepatoma cholangiocarcinomas,2 inflammatory pseudotumors,2 sclerosing nodules,1 focal nodular hyperplasia(FNH)and 1 hemangioma].The consistency of diagnosis of liver tumor in MRI group was higher than that in CT group and CT+MRI group,with Kappa values of 0.92,0.87 and 0.84 respectively.The accuracy of diagnosis in CT+MRI group(98.89%)was higher than that in MRI group(97.78%)and CT group(91.11%)respectively.The wash out,capsule and secondary signs of MRI group were significantly better than those of CT group,while the arterial enhancement of CT group was slightly better than that of MRI group.Conclusion Based on the latest clinical feedback and some imaging diagnosis experience,LI-RADS v2018 is helpful for systematization,standardization of imaging features and grading of liver tumors,and has excellent consistency and high accuracy in the diagnosis of liver tumors.

关 键 词：肝脏影像报告与数据系统 肝肿瘤 计算机体层成像 磁共振成像 

分 类 号：R735.7[医药卫生—肿瘤] R814.42[医药卫生—临床医学] R445.2