磁共振成像报告和数据系统分类 4 观察结果：预测升级为分类 5 的危险因素。
Liver imaging reporting and data system category 4 observations in MRI: Risk factors predicting upgrade to category 5.
机构信息
Department of Radiology, Duke University Medical Center, Durham, North Carolina, USA.
Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Japan.
出版信息
J Magn Reson Imaging. 2017 Sep;46(3):783-792. doi: 10.1002/jmri.25627. Epub 2017 Jan 13.
PURPOSE
To identify demographic and imaging features in magnetic resonance imaging (MRI) that are associated with upgrade of Liver Imaging Reporting and Data System (LI-RADS) category 4 (LR-4) observations to category 5 (LR-5), and to assess their effects on risk of upgrade and time to upgrade.
MATERIALS AND METHODS
Institutional Review Board approval was obtained for this retrospective, dual-institution Health Insurance Portability and Accountability Act (HIPAA)-compliant study. Radiologists reviewed 1.5T and 3T MRI examinations for 181 LR-4 observations in 139 patients, as well as follow-up computed tomography (CT) and MRI examinations and treatment. A stepwise multivariate Cox proportional hazards model analysis was performed to identify predictive risk factors for upgrade to LR-5, including patient demographics and LI-RADS imaging features. Overall cumulative risk of upgrade was calculated by using the Kaplan-Meier method. The cumulative risks were compared in the presence/absence of significant predictive risk factors using the log-rank test.
RESULTS
The independent significant predictive risk factors in the 56 LR-4 observations that upgraded to LR-5 were mild-moderate T hyperintensity (P < 0.001; hazard ratio = 1.84), growth (P < 0.001; hazard ratio = 3.71), and hepatitis C infection (P = 0.02; hazard ratio = 1.69). The overall 6-month cumulative risk of upgrade was 32.7%. The 6-month cumulative risk rate was significantly higher in the presence of T hyperintensity (P = 0.03; 48.1% vs. 25.4%).
CONCLUSION
For LR-4 observations, mild-moderate T hyperintensity, threshold growth, and hepatitis C infection are associated with significantly higher risk of upgrade to LR-5. Although mild-moderate T hyperintensity was the most useful risk factor for predicting upgrade, actual risk level was only mildly elevated, and the risk of upgrade associated with LR-4 observations is similar across subtypes.
LEVEL OF EVIDENCE
3 Technical Efficacy: Stage 5 J. MAGN. RESON. IMAGING 2017;46:783-792.
目的
确定磁共振成像（MRI）中与 Liver Imaging Reporting and Data System（LI-RADS）类别 4（LR-4）观察结果升级为类别 5（LR-5）相关的人口统计学和影像学特征，并评估它们对升级风险和升级时间的影响。
材料与方法
本回顾性、双机构健康保险流通与责任法案（HIPAA）合规研究获得了机构审查委员会的批准。放射科医生对 139 名患者的 181 个 LR-4 观察结果的 1.5T 和 3T MRI 检查以及随访的 CT 和 MRI 检查和治疗进行了回顾。采用逐步多变量 Cox 比例风险模型分析来确定升级为 LR-5 的预测风险因素，包括患者的人口统计学和 LI-RADS 影像学特征。通过 Kaplan-Meier 法计算总体升级的累积风险。使用对数秩检验比较存在/不存在显著预测风险因素时的累积风险。
结果
在升级为 LR-5 的 56 个 LR-4 观察中，独立的显著预测风险因素为轻度至中度 T 高信号（P<0.001；风险比=1.84）、生长（P<0.001；风险比=3.71）和丙型肝炎感染（P=0.02；风险比=1.69）。总体 6 个月升级的累积风险为 32.7%。存在 T 高信号时，6 个月累积风险率显著升高（P=0.03；48.1% vs. 25.4%）。
结论
对于 LR-4 观察，轻度至中度 T 高信号、阈值生长和丙型肝炎感染与升级为 LR-5 的风险显著增加相关。虽然轻度至中度 T 高信号是预测升级最有用的风险因素，但实际风险水平仅略有升高，且与 LR-4 观察相关的升级风险在亚型间相似。
证据水平
3 技术功效：5 级 J. MAGN. RESON. IMAGING 2017；46：783-792.
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