From the Department of Radiology (M. Cerny, C.B., J.S.B., J.M.L., D.O., J.B., B.F., P.P., A.T.), Department of Hepatology and Liver Transplantation (H.C.), and Department of Surgery, Hepatopancreatobiliary and Liver Transplantation Division (S.T.), Centre hospitalier de l'Université de Montréal (CHUM), 1000 rue Saint-Denis, Montréal, QC, Canada H2X 0C2; Centre de Recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Montréal, QC, Canada (S.T., A.T.); and Department of Mathematics and Statistics, Université de Montréal, Montréal, QC, Canada (M. Chagnon).
Radiology. 2018 Jul;288(1):118-128. doi: 10.1148/radiol.2018171678. Epub 2018 Apr 10.
Purpose To evaluate the performance of major features, ancillary features, and categories of Liver Imaging Reporting and Data System (LI-RADS) version 2014 at magnetic resonance (MR) imaging for the diagnosis of hepatocellular carcinoma (HCC). Materials and Methods This retrospective institutional review board-approved study included patients with liver MR imaging and at least one pathologically proved lesion. Between 2004 and 2016, 102 patients (275 observations including 113 HCCs) met inclusion criteria. Two radiologists independently assessed major and ancillary imaging features for each liver observation and assigned a LI-RADS category. Per-lesion estimates of diagnostic performance of major features, ancillary features, and LI-RADS categories were assessed by using generalized estimating equation models. Results Major features (arterial phase hyperenhancement, washout, capsule, and threshold growth) had a sensitivity of 88.5%, 60.6%, 32.9%, and 41.6%, and a specificity of 18.6%, 84.8%, 98.8%, and 83.2% for HCC, respectively. Ancillary features (mild-moderate T2 hyperintensity, restricted diffusion, mosaic architecture, intralesional fat, lesional fat sparing, blood products, and subthreshold growth) had a sensitivity of 62.2%, 54.8%, 9.9%, 30.9%, 23.1%, 2.8%, and 48.3%, and a specificity of 79.4%, 90.6%, 99.4%, 94.2%, 83.1%, 99.3%, and 91.4% for HCC, respectively. The LR-5 or LR-5 V categories had a per-lesion sensitivity of 50.8% and a specificity of 95.8% for HCC, respectively. The LR-4, LR-5, or LR-5 V categories (determined by using major features only vs combination of major and ancillary features) had a per-lesion sensitivity of 75.9% and 87.9% and a per-lesion specificity of 87.5% and 86.2%, respectively. Conclusion The use of ancillary features in combination with major features increases the sensitivity while preserving a high specificity for the diagnosis of HCC.
目的 评估磁共振成像（MRI）中肝脏成像报告和数据系统（LI-RADS）版本 2014 的主要特征、辅助特征和分类在肝细胞癌（HCC）诊断中的性能。
材料与方法 本回顾性机构审查委员会批准的研究纳入了进行肝脏 MRI 检查且至少有一个经病理证实病变的患者。在 2004 年至 2016 年间，共有 102 名患者（275 个病灶，包括 113 个 HCC）符合纳入标准。两名放射科医生独立评估每个肝脏病灶的主要和辅助影像学特征，并分配 LI-RADS 分类。使用广义估计方程模型评估主要特征、辅助特征和 LI-RADS 分类的诊断性能。
结果 主要特征（动脉期强化、洗脱、包膜和阈值生长）对 HCC 的敏感度分别为 88.5%、60.6%、32.9%和 41.6%，特异度分别为 18.6%、84.8%、98.8%和 83.2%。辅助特征（轻度至中度 T2 高信号、弥散受限、马赛克样结构、瘤内脂肪、瘤内脂肪保留、血液产物和亚阈值生长）对 HCC 的敏感度分别为 62.2%、54.8%、9.9%、30.9%、23.1%、2.8%和 48.3%，特异度分别为 79.4%、90.6%、99.4%、94.2%、83.1%、99.3%和 91.4%。LR-5 或 LR-5V 分类对 HCC 的病灶敏感度分别为 50.8%和特异性为 95.8%。LR-4、LR-5 或 LR-5V 分类（仅通过主要特征或主要特征和辅助特征的组合确定）的病灶敏感度分别为 75.9%和 87.9%，特异性分别为 87.5%和 86.2%。
结论 联合使用主要特征和辅助特征可提高 HCC 诊断的敏感度，同时保持较高的特异性。
