Department of Ultrasound, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, No. 651 Dongfeng Road East, Guangzhou, China.
Department of Anesthesiology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, No. 651 Dongfeng Road East, Guangzhou, China.
Eur Radiol. 2020 Jan;30(1):461-470. doi: 10.1007/s00330-019-06317-2. Epub 2019 Jul 11.
To assess the diagnostic performance of the LR-M criteria of Contrast-Enhanced Ultrasound Liver Imaging Reporting and Data System version 2017 in differentiating intrahepatic cholangiocarcinoma (ICC) from hepatocellular carcinoma (HCC) in patients with and without risk factors for HCC.
Fifty-four ICC in patients with risks and 55 ICC in patients without risks and matched control cases of HCC with and without risks (n = 59 and n = 55, respectively) were enrolled. The enhanced features of the lesions were retrospectively analyzed according to LR-M criteria. The diagnostic performances including the area under the receiver operating characteristic curve (AUC), sensitivity, and specificity of LR-M criteria were assessed.
Peripheral rim-like hyperenhancement, early washout (< 45 or 60s), and marked washout did not differ between ICCs with and without risks, while all of these features were more common in ICCs than in HCCs (p < 0.05) no matter if patients were with and without risk factors. Using the LR-M criteria to differentiate ICC from HCC, the AUC, sensitivity, specificity, and accuracy were 0.92, 97.25%, 87.72%, and 92.38%, respectively. If early washout onset was adjusted to < 45 s, the specificity was significantly increased to 95.61% (p = 0.004) without losing sensitivity (96.33%, p = 0.945). The rate of HCCs misdiagnosed as ICCs would decrease from 12.3 to 4.4%.
Although the LR-M criteria showed high sensitivity in distinguishing ICCs from HCCs in patients with and without risks, the specificity would be significantly increased after adjustments to current criteria.
• The LR-M criteria of CEUS-LI-RADS v2017 could be used for distinguishing ICC from HCC not only in patients with risk factors for HCC but also in those without risk factors. • The diagnostic performance of differentiating ICC from HCC by using the LR-M criteria showed high AUC (0.92), high sensitivity (97.25%), intermediate specificity (87.72%), and high accuracy (92.38%). • If the onset of early washout was adjusted to < 45 s, the specificity was significantly increased from 87.72 to 95.61% (p = 0.004) without losing sensitivity (p = 0.945), and the rate of HCCs misdiagnosed as ICCs would decrease from 12.3 to 4.4%.
评估 2017 版对比增强超声肝脏成像报告和数据系统 LR-M 标准在有和无 HCC 风险因素的患者中鉴别肝内胆管细胞癌（ICC）与肝细胞癌（HCC）的诊断性能。
纳入有风险的 54 例 ICC 患者和无风险的 55 例 ICC 患者以及有和无风险因素的 HCC 匹配对照病例（分别为 59 例和 55 例）。根据 LR-M 标准回顾性分析病变的增强特征。评估 LR-M 标准的诊断性能，包括受试者工作特征曲线下面积（AUC）、敏感性和特异性。
边缘环形强化、早期廓清（<45 或 60s）和明显廓清在有和无风险的 ICC 之间无差异，而所有这些特征在 ICC 中比在 HCC 中更为常见（p<0.05），无论患者是否有风险因素。使用 LR-M 标准鉴别 ICC 与 HCC，AUC、敏感性、特异性和准确性分别为 0.92、97.25%、87.72%和 92.38%。如果将早期廓清起始时间调整为<45s，特异性显著增加至 95.61%（p=0.004），而敏感性无损失（p=0.945）。将误诊为 ICC 的 HCC 比例从 12.3%降至 4.4%。
尽管 LR-M 标准在有和无 HCC 风险因素的患者中鉴别 ICC 与 HCC 具有较高的敏感性，但调整当前标准后特异性会显著提高。
2017 版 CEUS-LI-RADS 的 LR-M 标准不仅可用于有 HCC 风险因素的患者，也可用于无 HCC 风险因素的患者鉴别 ICC 与 HCC。
使用 LR-M 标准鉴别 ICC 与 HCC 的诊断性能表现为 AUC 高（0.92）、敏感性高（97.25%）、特异性中等（87.72%）和准确性高（92.38%）。
如果将早期廓清起始时间调整为<45s，特异性从 87.72%显著提高至 95.61%（p=0.004），而敏感性无损失（p=0.945），将误诊为 ICC 的 HCC 比例从 12.3%降至 4.4%。
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