MRI 影像特征：肝细胞癌、肝内胆管细胞癌及联合肿瘤的 LI-RADS 2014 版诊断
Imaging features of hepatocellular carcinoma compared to intrahepatic cholangiocarcinoma and combined tumor on MRI using liver imaging and data system (LI-RADS) version 2014.
机构信息
Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.
Department of Radiology, Hospital Sírio-Libanês, Sao Paulo, Brazil.
出版信息
Abdom Radiol (NY). 2018 Jan;43(1):169-178. doi: 10.1007/s00261-017-1261-x.
PURPOSE
To evaluate the prevalence of major and ancillary imaging features from liver imaging reporting and data systems (LI-RADS) version 2014 and their interreader agreement when comparing hepatocellular carcinoma (HCC) to intrahepatic cholangiocarcinoma (ICC) and combined tumor (cHCC-CC).
METHODS
The Institutional Review Board approved this HIPAA-compliant retrospective study and waived the requirement for patients' informed consent. Patients with resected HCC (n = 51), ICC (n = 40), and cHCC-CC (n = 11) and available pre-operative contrast-enhanced MRI were included from 2000 to 2015. Imaging features and final LI-RADS category were evaluated by four radiologists. Imaging features were compared by Fisher's exact test and interreader agreements were assessed by κ statistics.
RESULTS
None of the features were unique to either HCC or non-HCC. Imaging features that were significantly more common among HCC compared to ICC and cHCC-CC included washout (76%-78% vs. 10%-35%, p < 0.001), capsule (55%-71% vs. 16%-49%, p < 0.05), and intralesional fat (27%-52% vs. 2%-12%, p < 0.002). Features that were more common among ICC and cHCC-CC included peripheral arterial phase hyperenhancement (40%-64% vs. 10%-14%, p < 0.001) and progressive central enhancement (65%-82% vs. 14%-25%, p < 0.001). The interreader agreement was moderate for each of these imaging features (κ = 0.41-0.55). Moderate agreement was also achieved in the assignment of LR-M (κ = 0.53), with an overall sensitivity and specificity for non-HCC malignancy of 86.3% and 78.4%, respectively.
CONCLUSION
HCC and non-HCC show significant differences in the prevalence of imaging features defined by LI-RADS, and are identified by radiologists with moderate interreader agreement. Using LI-RADS, radiologists also achieved moderate interreader agreement in the assignment of the LR-M category.
目的
评估 2014 版肝脏影像报告和数据系统（LI-RADS）的主要和辅助影像学特征的流行程度，并比较肝细胞癌（HCC）与肝内胆管细胞癌（ICC）和混合型肿瘤（cHCC-CC）之间的读者间一致性。
方法
本机构审查委员会批准了这项符合 HIPAA 标准的回顾性研究，并豁免了患者知情同意的要求。该研究纳入了 2000 年至 2015 年间接受过手术切除的 HCC（n=51）、ICC（n=40）和 cHCC-CC（n=11）患者，且均有术前增强 MRI 资料。由四位放射科医生评估影像学特征和最终的 LI-RADS 分类。采用 Fisher 确切检验比较影像学特征，采用κ 统计评估读者间的一致性。
结果
没有任何特征是 HCC 或非 HCC 所特有的。与 HCC 相比，ICC 和 cHCC-CC 更常见的影像学特征包括：洗脱（76%-78%比 10%-35%，p<0.001）、包膜（55%-71%比 16%-49%，p<0.05）和瘤内脂肪（27%-52%比 2%-12%，p<0.002）。ICC 和 cHCC-CC 更常见的特征包括：外周动脉期强化（40%-64%比 10%-14%，p<0.001）和渐进性中央强化（65%-82%比 14%-25%，p<0.001）。这些影像学特征的读者间一致性为中等（κ=0.41-0.55）。LR-M 的赋值也达到了中等一致性（κ=0.53），非 HCC 恶性肿瘤的总灵敏度和特异性分别为 86.3%和 78.4%。
结论
LI-RADS 定义的 HCC 和非 HCC 的影像学特征存在显著差异，放射科医生可以通过这些特征进行识别，并且读者间的一致性为中等。放射科医生使用 LI-RADS 对 LR-M 类别进行赋值，也获得了中等的读者间一致性。
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