基于肿瘤生长率的LI-RADS阈值增长对肝细胞癌(≤3.0 cm)的诊断价值  

Diagnostic Value of LI-RADS Threshold Growth Based on Tumor Growth Rate for Hepatocellular Carcinoma(≤3.0 cm)

作　　者：邢飞[1,2] 朱文静[1] 姜吉锋[1] 陆健[1] 张涛[1] 邢伟[2] XING Fei;ZHU Wenjing;JIANG Jifeng(Department of Radiology,The Third Hospital Affiliated of Nantong University,Nantong,Jiangsu Province 226006,P.R.China)

机构地区：[1]南通大学附属南通第三医院影像科,226000 [2]苏州大学附属第三医院影像科,常州213003

出　　处：《临床放射学杂志》2025年第1期95-101,共7页Journal of Clinical Radiology

摘　　要：目的探讨基于肿瘤生长率的肝脏影像报告和数据系统(LI-RADS)阈值增长(TG)对肝细胞癌(HCC)(≤3.0 cm)的诊断价值。方法回顾性分析基线、随访均行MRI检查的肝脏局灶性病变(≤3.0 cm),阅片者记录每个病灶随访期间的大小及LR分类调整变化。肿瘤生长率定义为每月病灶增长百分比,包括增长≥10%/月(TG-10%)、≥20%/月(TG-20%)、≥30%/月(TG-30%),并作为改良版TG(mTG)。通过计算诊断优势比(DOR)来确定TG与HCC诊断的相关性。以LR-5为诊断HCC的标准,分别计算基于LI-RADS TG(-,不作为主要征象)、LI-RADS TG(+,作为主要征象)、LI-RADS mTG(+)标准对HCC的诊断效能,包括敏感度、特异度及准确率,两者的比较采用McNemar检验或Fisher’s确切概率法。结果217例患者251个病灶,HCC 159个、非HCC恶性肿瘤23个、良性病变67个。相较于LI-RADS TG(-)标准,基于LI-RADS TG(+)标准可导致14个HCC分类调整,其中,9个由LR-3上调至LR-5[≤19 mm+非环状动脉期高强化(APHE)+TG],5个由LR-4上调至LR-5[(≤19 mm+非环状APHE+强化包膜+TG),n=1;(≥20 mm+非环状APHE+TG),n=5]。TG与HCC显著相关,DOR值为3.65(95%CI:1.63~8.18,P<0.001)。基于LI-RADS TG(+)标准诊断HCC的敏感度(66.7%vs.57.9%,P<0.001)、准确率(82.2%vs.78.4%,P=0.002)高于LI-RADS TG(-),并保持相似特异度(97.8%vs.98.9%,P=0.317)。相较于LI-RADS TG(+)标准,基于LI-RADS mTG-10%标准诊断HCC的准确率显著提高(87.9%vs.82.2%,P<0.001),而mTG-20%(81.2%vs.82.2%,P=0.440)和mTG-30%(78.7%vs.82.2%,P=0.003)的准确率相当或降低。基于LI-RADS mTG-10%标准诊断HCC的敏感度高于LI-RADSTG(+)(78.0%vs.66.7%,P<0.001),而其特异度差异不大(97.8%vs.97.8%,P>0.999)。结论TG作为LI-RADS v2018中的主要征象之一,与HCC显著相关,基于LI-RADS TG(+)标准提高了HCC(尤其表现为非环状APHE+TG)诊断的敏感度、准确率。同时,基于LI-RADS mTG-10%标准进一步提高HCC的诊断效能。Objective To investigate the diagnostic value of Liver Imaging Reporting and Data System(LI-RADS)threshold growth(TG)based on tumor growth rate for hepatocellular carcinoma(HCC)(≤3.0 cm).Methods A retrospective analysis was conducted on liver focal lesions(≤3.0 cm)with baseline and follow-up MRI examinations.Radiologists documented changes in lesion size and LR classification adjustments for each observation during the follow-up period.Tumor growth rate was defined as the percentage increase in lesion size per month,with growth rates of≥10%per month(TG-10%),≥20%per month(TG-20%),and≥30%per month(TG-30%)categorized as modified TG(mTG).The association of TG with a diagnosis of HCC was determined by calculating the diagnostic odds ratio(DOR).With LR-5 as the diagnosis criteria of HCC,the diagnostic performance using LI-RADS TG(-,not as a major feature),LI-RADS TG(+,as a major feature),and LI-RADS mTG(+)criteria was calculated separately,including sensitivity,specificity,and accuracy,and compared using McNemar's test or Fisher's exact probability method.Results 217 patients with 259 observations were included,among which 159 were HCC,23 were non-HCC malignancies,and 67 were benign lesions.Compared to LI-RADS TG(-)criteria,LI-RADS TG(+)criteria resulted in LR adjustments in 14 HCCs.Specifically,9 cases were upgraded from LR-3 to LR-5[≤19 mm+non-rim arterial phase hyperenhancement(APHE)and TG],and 5 cases were upgraded from LR-4 to LR-5[(≤19 mm+non-rim APHE+enhancing capsule+TG),n=1;(≥20 mm+non-rim APHE+TG),n=5].TG was significantly associated with HCC,with a diagnostic odds ratio(DOR)of 3.65(95%CI:1.63–8.18,P<0.001).LI-RADS TG(+)criteria for diagnosing HCC showed higher sensitivity(66.7%vs.57.9%,P<0.001)and accuracy(82.2%vs.78.4%,P=0.002)compared to LI-RADS TG(-)criteria,while maintaining similar specificity(97.8%vs.98.9%,P=0.317).Compared to LI-RADS TG(+)criteria,LI-RADS mTG-10%criteria significantly improved accuracy for diagnosing HCC(87.9%vs.82.2%,P<0.001).However,the accuracy with mTG-20%(81.2%v

关 键 词：肝细胞癌 肝脏影像报告和数据系统 阈值增长 肿瘤生长率 

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