提高 LI-RADS v2018 对细胞外对比增强 MRI 中小肝癌（10-19mm）诊断的灵敏度。
Increasing the sensitivity of LI-RADS v2018 for diagnosis of small (10-19 mm) HCC on extracellular contrast-enhanced MRI.
机构信息
Department of Radiology, The Third Affiliated Hospital of Sun Yat-sen University (SYSU), 600 Tianhe Rd, Guangzhou, 510630, People's Republic of China.
Department of Radiology, Liver Imaging Group, University of California, San Diego, CA, 510630, USA.
出版信息
Abdom Radiol (NY). 2021 Apr;46(4):1530-1542. doi: 10.1007/s00261-020-02790-2. Epub 2020 Oct 11.
PURPOSE
To evaluate whether the LI-RADS v2018 LR-5 criteria can be modified to increase sensitivity without reducing specificity for diagnosing small (10-19 mm) HCC.
METHODS
167 consecutive high-risk patients with 174 small observations reported clinically on extracellular contrast-enhanced MRI from 2014 to 2018 were retrospectively studied. The best available reference standard was applied for each observation. Blinded to the reference standard, two radiologists scored LI-RADS imaging features retrospectively and assigned each observation a LI-RADS category using LI-RADS v2018 and each of four modified LI-RADS versions (mLI-RADS I to IV) with successively more expansive LR-5 criteria. Per-observation sensitivity and specificity of LR-5 for small HCC using each version were assessed. Each modified version was compared to v2018 (McNemar test).
RESULTS
The 174 observations included 135 HCC, 8 non-HCC malignancies, and 31 benign entities. Using LI-RADS v2018, LR-5 provided 70% (both readers) sensitivity and 95% (both readers) specificity for small HCC. Expanding the LR-5 criteria to include nonrim APHE plus at least one additional major feature (mLI-RADS I) or no APHE plus at least two additional major features (mLI-RADS II) significantly increased sensitivity (reader 1/reader 2: 75%/75% vs. 70%, p = 0.016/0.031; 78%/79% vs. 70%, p = 0.001/0.001) without significantly reducing specificity (reader 1/reader 2: 90%/92% vs. 95%, p = 0.500/1.000 for both). mLI-RADS III and IV further increased sensitivity (reader 1/reader 2: 80%/81% vs. 70%, p < 0.001/< 0.001; 94%/92% vs. 70, p < 0.001/< 0.001) but with trend-level (reader 1/reader 2: 85%/80% vs. 95%, p = 0.125/0.063) or significant (reader 1/reader 2: 64%/62% vs. 95%, p < 0.001/< 0.001) specificity reductions.
CONCLUSIONS
Expanding the v2018 LR-5 criteria to include nonrim APHE plus at least one additional major feature or no APHE plus at least two additional major features significantly increases sensitivity without significantly reducing specificity for small HCC. Confirmation is warranted in multi-center prospective studies.
目的
评估 LI-RADS v2018 LR-5 标准是否可以修改，以提高诊断小（10-19mm）肝癌的敏感性而不降低特异性。
方法
回顾性研究了 2014 年至 2018 年连续 167 例高危患者的 174 个小病灶的临床报告，这些病灶在细胞外对比增强 MRI 上有影像学表现。每个观察均应用最佳的现有参考标准。盲法应用 LI-RADS v2018 及四种改良 LI-RADS 版本（mLI-RADS I-IV）对两位放射科医生进行 LI-RADS 成像特征的回顾性评分，并对每个观察进行 LI-RADS 分类，改良版本的 LR-5 标准逐渐放宽。评估每个版本中 LR-5 对小 HCC 的诊断准确性（灵敏度和特异性）。每个改良版本与 v2018 进行比较（McNemar 检验）。
结果
174 个观察包括 135 个 HCC、8 个非 HCC 恶性肿瘤和 31 个良性实体。使用 LI-RADS v2018，LR-5 对小 HCC 的敏感性为 70%（两位读者），特异性为 95%（两位读者）。将 LR-5 标准放宽至包括非边缘 APHE 加至少一个附加主要特征（mLI-RADS I）或无 APHE 加至少两个附加主要特征（mLI-RADS II），显著提高了敏感性（读者 1/读者 2：75%/75% vs. 70%，p=0.016/0.031；78%/79% vs. 70%，p=0.001/0.001），而特异性无明显降低（读者 1/读者 2：90%/92% vs. 95%，p=0.500/1.000）。mLI-RADS III 和 IV 进一步提高了敏感性（读者 1/读者 2：80%/81% vs. 70%，p<0.001/<0.001；94%/92% vs. 70%，p<0.001/<0.001），但特异性有下降趋势（读者 1/读者 2：85%/80% vs. 95%，p=0.125/0.063）或显著降低（读者 1/读者 2：64%/62% vs. 95%，p<0.001/<0.001）。
结论
将 v2018 的 LR-5 标准放宽至包括非边缘 APHE 加至少一个附加主要特征或无 APHE 加至少两个附加主要特征，可显著提高小 HCC 的诊断敏感性，而特异性无明显降低。需要在多中心前瞻性研究中进行验证。
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