扩散加权成像在提高小肝癌可疑恶性病变 LI-RADS 分类敏感性中的作用。
The utility of diffusion-weighted imaging in improving the sensitivity of LI-RADS classification of small hepatic observations suspected of malignancy.
机构信息
Department of Radiodiagnosis, Zagazig University, Zagazig, Egypt.
Department of Radiodiagnosis, Ain Shams University, Cairo, Egypt.
出版信息
Abdom Radiol (NY). 2019 May;44(5):1773-1784. doi: 10.1007/s00261-018-01887-z.
PURPOSE
We investigated the added value of diffusion-weighted imaging (DWI)/apparent diffusion coefficient (ADC) in the categorization of small hepatic observation (≤ 20 mm) detected in patients with chronic liver disease in reference to LI-RADS (liver imaging reporting and data system) classification system.
METHODS
We prospectively evaluated 165 patients with chronic liver disease with small hepatic observations (≤ 20 mm) which were previously categorized as LI-RADS grade 3-5 on dynamic contrast-enhanced CT (DCE-CT). All patients were submitted to a functional MRI including DCE and DWI. Using LI-RADS v2017, two radiologists independently evaluated the observations and assigned a LI-RADS category to each observation using DCE-MRI alone and combined DCE-MRI and DWI/ADC. In the combined technique, the radiologists assigned a LI-RADS category based on a modified LI-RADS criteria in which restricted diffusion on DWI was considered a major feature of HCC. We evaluated the inter-reader agreement with Kappa statistics and compared the diagnostic performance of the LI-RADS with two imaging techniques by Fisher's exact test using histopathology as the reference standard.
RESULTS
Combined technique in LI-RADS yielded better sensitivities (reader 1, 97% [65/67]; reader 2, 95.5% [64/67]) for HCC diagnosis than DCE-MRI alone (reader 1, 80.6% [54/67], p = 0.005; reader 2, 83.6% [56/67], p = 0.04). The specificities were insignificantly lower in combined technique (reader 1, 88.4% [107/121]; reader 2, 77.7% [94/121]) than in DCE-MRI alone (reader 1, 90.9% [110/121], p = 0.67; reader 2, 79.3% [96/121], p = 0.88). The inter-reader agreement of the LI-RADS scores between combined technique and DCE-MRI was good (κ = 0.765).
CONCLUSION
The use of DWI/ADC as an additional major criterion, improved the sensitivity of LI-RADS in the diagnosis of HCC while keeping high specificity.
目的
我们研究了扩散加权成像（DWI）/表观扩散系数（ADC）在慢性肝病患者中检测到的小肝观察（≤20mm）分类中的附加价值，该观察在参考 LI-RADS（肝脏成像报告和数据系统）分类系统中被归类为 3-5 级。
方法
我们前瞻性评估了 165 例慢性肝病患者，这些患者的小肝观察（≤20mm）先前在动态对比增强 CT（DCE-CT）上被归类为 LI-RADS 3-5 级。所有患者均接受功能 MRI 检查，包括 DCE 和 DWI。使用 LI-RADS v2017，两位放射科医生独立评估了这些观察结果，并单独使用 DCE-MRI 和 DCE-MRI 联合 DWI/ADC 为每个观察结果分配 LI-RADS 类别。在联合技术中，放射科医生根据改良的 LI-RADS 标准分配 LI-RADS 类别，其中 DWI 上的受限扩散被认为是 HCC 的主要特征。我们使用 Kappa 统计评估了读者间的一致性，并使用 Fisher 精确检验比较了 LI-RADS 与两种成像技术的诊断性能，以组织病理学为参考标准。
结果
LI-RADS 联合技术的 HCC 诊断敏感性（读者 1，97%[65/67]；读者 2，95.5%[64/67]）优于单独使用 DCE-MRI（读者 1，80.6%[54/67]，p=0.005；读者 2，83.6%[56/67]，p=0.04）。联合技术的特异性（读者 1，88.4%[107/121]；读者 2，77.7%[94/121]）略低于单独使用 DCE-MRI（读者 1，90.9%[110/121]，p=0.67；读者 2，79.3%[96/121]，p=0.88）。LI-RADS 评分在联合技术和 DCE-MRI 之间的读者间一致性良好（κ=0.765）。
结论
将 DWI/ADC 作为附加的主要标准，提高了 LI-RADS 在 HCC 诊断中的敏感性，同时保持了较高的特异性。
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