Department of Radiology, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea.
King Faisal University College of Medicine, Al Ahsa, 31982, Saudi Arabia.
Abdom Radiol (NY). 2020 Nov;45(11):3789-3799. doi: 10.1007/s00261-020-02581-9.
The purpose of this study was to evaluate the diagnostic performance of the Liver Imaging Reporting and Data System (LI-RADS) in patients with both chronic liver disease and a history of extrahepatic malignancy.
This retrospective study included 59 hepatocellular carcinomas (HCCs) and 45 metastases pathologically confirmed between 2008 and 2017 in 104 patients with chronic liver disease (cirrhosis or chronic hepatitis B) and a history of extrahepatic malignancy. Two radiologists blinded to the final diagnosis independently reviewed MRI (95 patients) or CT (9 patients) images, and their consensus data were used to calculate the diagnostic performance of LI-RADS categories. Serum tumor markers, tumor multiplicity, and suspected metastatic lymph nodes were also evaluated.
The sensitivity, specificity, and accuracy of LR-5 for diagnosing HCC were 69% (95% confidence intervals [CI] 56-81), 98% (95% CI 88-99), and 82% (95% CI 73-89), respectively, and those of LR-M for diagnosing metastasis were 89% (95% CI 76-96), 88% (95% CI 77-95), and 88% (95% CI 81-94), respectively. Elevation of serum carcinoembryonic antigen (P = 0.01) or carbohydrate antigen 19-9 levels (P = 0.02) and tumor multiplicity (P = 0.004) were more frequently observed in metastasis than in HCC. Three of four metastases categorized as LR-4 or LR-5 were smaller than 2 cm.
The LI-RADS provides high specificity (98%) for differentiating HCC from metastases in patients with both chronic liver disease and a history of extrahepatic malignancy.
本研究旨在评估肝脏影像报告和数据系统（LI-RADS）在患有慢性肝病和肝外恶性肿瘤病史的患者中的诊断性能。
本回顾性研究纳入了 2008 年至 2017 年间 104 例患有慢性肝病（肝硬化或慢性乙型肝炎）和肝外恶性肿瘤病史的患者中经病理证实的 59 例肝细胞癌（HCC）和 45 例转移瘤。两名放射科医生在不了解最终诊断的情况下，分别对 MRI（95 例）或 CT（9 例）图像进行了盲法评估，并使用他们的共识数据计算了 LI-RADS 类别对 HCC 及转移瘤的诊断性能。还评估了血清肿瘤标志物、肿瘤多发性和可疑转移性淋巴结。
LR-5 对 HCC 诊断的敏感度、特异度和准确率分别为 69%（95%置信区间 [CI] 56-81）、98%（95% CI 88-99）和 82%（95% CI 73-89），LR-M 对转移瘤诊断的敏感度、特异度和准确率分别为 89%（95% CI 76-96）、88%（95% CI 77-95）和 88%（95% CI 81-94）。与 HCC 相比，转移瘤患者的血清癌胚抗原（P=0.01）或糖类抗原 19-9 水平（P=0.02）升高和肿瘤多发性（P=0.004）更为常见。4 个被归类为 LR-4 或 LR-5 的转移瘤中有 3 个直径小于 2cm。
LI-RADS 对患有慢性肝病和肝外恶性肿瘤病史的患者中 HCC 与转移瘤的鉴别具有较高的特异性（98%）。
