多期 CT 对肝细胞癌的结构化报告：对分期和移植适用性的影响。

Structured Reporting of Multiphasic CT for Hepatocellular Carcinoma: Effect on Staging and Suitability for Transplant.

机构信息

1 Department of Radiology, Division of Body Imaging, Stanford University, 300 Pasteur Dr, Stanford, CA 94305-5621.

2 Department of Surgery, Division of Multi Organ Transplantation, Stanford University, Stanford, CA.

出版信息

AJR Am J Roentgenol. 2018 Apr;210(4):766-774. doi: 10.2214/AJR.17.18725. Epub 2018 Feb 22.

DOI:10.2214/AJR.17.18725

PMID:29470153

Abstract

OBJECTIVE

The purpose of this study is to evaluate whether use of a standardized radiology report template would improve the ability of liver transplant surgeons to diagnose stage T2 hepatocellular carcinoma (HCC) and determine patient suitability to undergo orthotopic liver transplant (OLT).

MATERIALS AND METHODS

In this retrospective study, a standardized template was devised, and its use was mandated for reporting of liver CT findings for patients with cirrhosis and HCC. Two surgeons analyzed 200 reports (100 before and 100 after template implementation) for descriptions of cirrhosis, portal hypertension, lesion enhancement characteristics, tumor thrombus, portal and superior mesenteric vein patency, and Organ Procurement Transplantation Network (OPTN) class. Ability to determine Milan criteria and surgeon satisfaction were also assessed. Data obtained before and after template implementation were statistically analyzed using the Cochran-Mantel-Haenszel test.

RESULTS

Template implementation increased the percentage of reports documenting the presence or absence of portal hypertension (74% to 88% for surgeon 1 and 86% to 87% for surgeon 2; p = 0.042); lesion number (76% to 88% for surgeon 2 [no change for surgeon 1]; p = 0.038), size (95% to 96% for surgeon 1 and 82% to 93% for surgeon 2; p = 0.03), and enhancement (93% to 94% for surgeon 1 and 80% to 91% for surgeon 2; p = 0.049); presence of tumor thrombus (10% to 57% for surgeon 1 and 31% to 63% for surgeon 2; p < 0.001); and OPTN class (8% to 82% for surgeon 1 and 2% to 81% for surgeon 2; p < 0.001). The surgeons were significantly more able to determine the presence of T2 disease and qualification for exception points after implementation of the template (increasing from 80% to 94%; p = 0.025). Satisfaction with reports also improved (p < 0.0001).

CONCLUSION

The reporting template improved determination of patient suitability to undergo transplant according to the Milan criteria.

摘要

目的

本研究旨在评估使用标准化影像学报告模板是否能提高肝移植外科医生诊断 T2 期肝细胞癌（HCC）的能力，并确定患者是否适合接受原位肝移植（OLT）。

材料与方法

在这项回顾性研究中，设计了一个标准化模板，并规定在报告肝硬化和 HCC 患者的肝脏 CT 结果时使用该模板。两位外科医生分析了 200 份报告（模板实施前 100 份，后 100 份），评估了肝硬化、门静脉高压、病变增强特征、肿瘤血栓、门静脉和肠系膜上静脉通畅性以及器官获取与移植网络（OPTN）分类的描述。还评估了确定米兰标准的能力和外科医生满意度。使用 Cochran-Mantel-Haenszel 检验对模板实施前后的数据进行统计学分析。

结果

模板实施后，记录门静脉高压存在或不存在的报告比例增加（外科医生 1 从 74%增加到 88%，外科医生 2 从 86%增加到 87%；p = 0.042）；病变数量（外科医生 2 从 76%增加到 88%[外科医生 1 无变化]；p = 0.038）、大小（外科医生 1 从 95%增加到 96%，外科医生 2 从 82%增加到 93%；p = 0.03）和增强程度（外科医生 1 从 93%增加到 94%，外科医生 2 从 80%增加到 91%；p = 0.049）；肿瘤血栓的存在（外科医生 1 从 10%增加到 57%，外科医生 2 从 31%增加到 63%；p < 0.001）；和 OPTN 分类（外科医生 1 从 8%增加到 82%，外科医生 2 从 2%增加到 81%；p < 0.001）。模板实施后，外科医生能够更准确地确定 T2 疾病的存在和符合例外标准的资格（从 80%增加到 94%；p = 0.025）。报告满意度也有所提高（p < 0.0001）。