对比增强超声与对比增强磁共振成像在肝脏影像报告与数据系统诊断局灶性肝脏病变中的比较。
Comparison of Contrast-Enhanced Ultrasound versus Contrast-Enhanced Magnetic Resonance Imaging for the Diagnosis of Focal Liver Lesions Using the Liver Imaging Reporting and Data System.
机构信息
Sino-German Tongji-Caritas Research Center of Ultrasound in Medicine, Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Department of Ultrasound, Sixth People's Hospital of Zhengzhou, Zhengzhou, China.
出版信息
Ultrasound Med Biol. 2020 May;46(5):1216-1223. doi: 10.1016/j.ultrasmedbio.2020.01.023. Epub 2020 Feb 27.
The aim of this retrospective study was to evaluate the Liver Imaging Reporting and Data System (LI-RADS) categorization of focal liver lesions (FLLs) on contrast-enhanced ultrasound (CEUS) in comparison with contrast-enhanced magnetic resonance imaging (CE-MRI). A total of 63 patients with 84 FLLs were included in the final study population, after review of the electronic medical records and clinical data. Two trained radiologists evaluated all CEUS and CE-MRI images independently. They assigned a LI-RADS category to each FLL and assessed major features based on CEUS LI-RADS Version 2017 and computed tomography/MRI LI-RADS Version 2018. The generalized estimating equation method was used to compare the diagnostic performance of the LI-RADS algorithm between CEUS and CE-MRI. The sensitivity of LR-5/LR-TIV (tumor in vein) categories for diagnosing hepatocellular carcinoma (HCC) differed significantly between CEUS and CE-MRI (88.9% [40/45], 95% confidence interval [CI]: 76.5%-95.2%), versus 64.4% (29/45; 95% CI: 49.8%-76.8%), p = 0.006; 82.2% (37/45; 95% CI: 68.7%-90.7%), versus 62.2% (28/45; 95% CI: 47.6%-74.9%), p = 0.034. Inter-observer agreement was substantial for assigning LR-5 on both CEUS and CE-MRI. For both reviewers, there was a higher frequency of LR-5 (44.0% vs. 25.0%, p = 0.009; 42.9% vs. 26.2%, p = 0.023) in CEUS compared with CE-MRI. Arterial phase hyper-enhancement (APHE) was less frequently observed on CEUS than on CE-MRI (46.4% vs. 61.9%, p = 0.044). However, the washout appearance was observed more frequently on CEUS than on CE-MRI (50.0% vs. 28.6%, p = 0.004). Inter-observer agreement between the two reviewers on APHE and washout appearance was excellent for both CEUS and CE-MRI. These findings suggest that CEUS had a much higher sensitivity than CE-MRI in the diagnosis of HCC using LI-RADS, and although the frequencies of major features differed, inter-observer agreement between the two reviewers on major features of HCC was excellent for both CEUS and CE-MRI.
本回顾性研究旨在比较对比增强超声（CEUS）与对比增强磁共振成像（CE-MRI）在肝脏成像报告和数据系统（LI-RADS）对局灶性肝脏病变（FLL）分类中的表现。在回顾电子病历和临床数据后，共有 63 例 84 个 FLL 的患者被纳入最终研究人群。两名经过培训的放射科医生独立评估了所有的 CEUS 和 CE-MRI 图像。他们根据 CEUS LI-RADS 版本 2017 和 CT/MRI LI-RADS 版本 2018 为每个 FLL 分配了 LI-RADS 类别，并评估了主要特征。采用广义估计方程方法比较了 CEUS 和 CE-MRI 之间 LI-RADS 算法的诊断性能。CEUS 和 CE-MRI 对肝细胞癌（HCC）的 LR-5/LR-TIV（肿瘤在静脉中）分类的敏感性差异有统计学意义（88.9% [40/45]，95%置信区间 [CI]：76.5%-95.2%），而 64.4%（29/45；95%CI：49.8%-76.8%），p=0.006；82.2%（37/45；95%CI：68.7%-90.7%），而 62.2%（28/45；95%CI：47.6%-74.9%），p=0.034。两位观察者在 CEUS 和 CE-MRI 上分配 LR-5 的一致性均为中等。对于两位观察者，CEUS 上的 LR-5 频率（44.0% vs. 25.0%，p=0.009；42.9% vs. 26.2%，p=0.023）均高于 CE-MRI。CEUS 上动脉期高增强（APHE）的频率低于 CE-MRI（46.4% vs. 61.9%，p=0.044）。然而，CEUS 上的洗脱外观比 CE-MRI 更常见（50.0% vs. 28.6%，p=0.004）。CEUS 和 CE-MRI 上两位观察者之间在 APHE 和洗脱外观上的一致性均为极好。这些发现表明，在使用 LI-RADS 诊断 HCC 时，CEUS 的敏感性明显高于 CE-MRI，尽管主要特征的频率不同，但两位观察者对 HCC 主要特征的一致性在 CEUS 和 CE-MRI 上均为极好。
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