超声造影与普美显磁共振成像对具有高危因素的≤3 cm肝结节进行LI-RADS分类诊断的前瞻性研究  

Contrast-enhanced ultrasound versus gadoxetic acid-enhanced magnetic resonance imaging for LI-RADS classification of focal liver lesions≤3 cm in patients at high risk of hepatocellular carcinoma:a prospective study

作　　者：丁建民[1,3] 秦正义 张翔 周燕[1,3] 周洪雨 王彦冬[1,3] 经翔 Ding Jianmin;Qin Zhengyi;Zhang Xiang;Zhou Yan;Zhou Hongyu;Wang Yandong;Jing Xiang(Department of Ultrasound,The Third Central Hospital,Tianjin 300170,China;Department of Radiology,The Third Central Hospital,Tianjin 300170,China;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超声科,300170 [2]天津市第三中心医院放射科,300170 [3]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：《中华医学超声杂志（电子版）》2023年第9期930-938,共9页Chinese Journal of Medical Ultrasound(Electronic Edition)

基　　金：国家自然科学基金(82371986);天津市卫生健康科技项目(MS20017,TJWJ2023XK022);天津市医学重点学科(专科)建设项目(TJYXZDXK-074C)。

摘　　要：目的比较超声造影(CEUS)和普美显磁共振成像(EOB-MRI)两者肝脏影像报告和数据系统(LI-RADS)对具有肝细胞癌(HCC)高危因素的≤3 cm的肝局灶性病变分类的一致性和诊断效能。方法前瞻性收集天津市第三中心医院同时接受CEUS和EOB-MRI检查且具有HCC高危因素的结节直径≤3 cm的病例。在对患者信息、病理及相关检查均未知的情况下,对每个肝结节的CEUS及EOB-MRI图像进行观察,利用Kappa值评估观察者间一致性,分别按照CEUS LI-RADS(2017年版)及CT/MRI LI-RADS(2018年版)标准对结节进行分类。恶性病灶诊断以病理结果、良性病灶以病理结果和(或)随访作为参考标准,计算2种影像方式LI-RADS分类的诊断效能,利用χ^(2)检验及Z检验比较两者诊断效能的差异。结果107例114个结节满足入排标准。CEUS、EOB-MRI分类中LR-5、LR-4、LR-3和LR-M类结节的数量分别占45.6%、11.4%、19.3%、23.7%和25.4%、57.9%、10.5%、6.1%,2种影像方式对结节分类的一致性较差(Kappa=0.17,P<0.001)。CEUS LI-RADS和EOB-MRI LI-RADS分类各自观察者之间一致性良好(Kappa=0.83、0.77,P<0.001)。CEUS和EOB-MRI LR-5、LR-4、LR-3类对HCC的阳性预测值分别为98.1%、38.5%、13.6%和100%、71.2%、16.7%。CEUS和EOB-MRI LR-5类诊断HCC的敏感度、特异度、曲线下面积(AUC)分别为64.6%、97.1%、0.81和36.7%、100%、0.68。两者的阳性预测值、特异度差异均无统计学意义,AUC差异具有统计学意义(Z=4.29,P<0.01)。结论CEUS和EOB-MRI对≤3 cm肝结节的分类一致性较差;两者各自LI-RADS分类不同观察者之间一致性较好。CEUS与EOB-MRI LR-5类对≤3 cm HCC具有同等良好的阳性预测值和特异度。Objective To compare the consistency and diagnostic performance of contrast-enhanced ultrasound(CEUS)versus gadoxetic acid-enhanced magnetic resonance imaging(EOB-MRI)in liver imaging reporting and data system(LI-RADS)classification of focal liver lesions≤3 cm in patients at high risk of hepatocellular carcinoma(HCC).Methods Patients with focal liver lesions≤3 cm at high risk of HCC who underwent CEUS and EOB-MRI at Tianjin Third Central Hospital were prospectively collected.The CEUS and EOB-MRI images of each liver nodule were observed to evaluate interobserver consistency using kappa coefficient and category according to the CEUS LI-RADS V2017 and CT/MRI LI-RADS V2018 criteria in a double blind manner.Pathology was used as the reference standard of malignant lesions and pathology and/or follow-up results were used as the reference standard for benign lesions to calculate the diagnostic performance of the two modalities,andχ^(2)test and Z test were used to compare the difference between the two modalities.Results A total of 114 nodules of 107 cases met the inclusion criteria.The proportions of LR-5,LR-4,LR-3,and LR-M diagnosed by CEUS and EOB-MRI accounted for 45.6%,11.4%,19.3%,and 23.7%,and 25.4%,57.9%,10.5%,and 6.1%,respectively.The consistency of nodule classification between the two modalities was poor(Kappa=0.17,P<0.001).There was good consistency between readers on CEUS LI-RADS and EOB-MRI LI-RADS(Kappa=0.83 and 0.77,P<0.001).The positive predictive values of CEUS and EOB-MRI LR-5,LR-4,and LR-3 for HCC were 98.1%,38.5%,and 13.6%,and 100%,71.2%,and 16.7%,respectively.The sensitivity,specificity,and area under the curve(AUC)of CEUS and EOB-MRI LR-5 for HCC were 64.6%,97.1%,and 0.81,and 36.7%,100%,and 0.68,respectively.The was no statistical difference in the positive predictive value or specificity between the two groups,while the difference of AUC was statistically significant(Z=4.29,P<0.01).Conclusion CEUS and EOB-MRI have poor consistency in classification of liver nodules≤3 cm.The consistency betw

关 键 词：肝细胞癌 超声造影 普美显磁共振成像 肝脏影像报告及数据系统 

分 类 号：R445.1[医药卫生—影像医学与核医学] R575[医药卫生—诊断学]