LI-RADS 用于 MRI 和 CT 检测 HCC 的诊断性能：系统评价和诊断荟萃分析。
Diagnostic performance of LI-RADS for MRI and CT detection of HCC: A systematic review and diagnostic meta-analysis.
机构信息
Department of Radiology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, 1Panfu Road, Guangzhou, Guangdong Province 510180, China.
Department of Radiology, Guangzhou Red Cross Hospital, Medical College, Jinan University, 396 Tongfu Road, Guangzhou, Guangdong Province 510220, China.
出版信息
Eur J Radiol. 2021 Jan;134:109404. doi: 10.1016/j.ejrad.2020.109404. Epub 2020 Dec 1.
PURPOSE
To perform a meta-analysis evaluating the diagnostic accuracy of the Liver Imaging Reporting and Data System (LI-RADS) category ≥ 3 (LI-RADS 3-5v) for detecting hepatocellular carcinoma (HCC).
METHOD
A systematic PubMed, Embase, and Web of Science electronic database search was performed for original diagnostic studies published through July 31, 2018. Statistical analysis included data pooling, forest plot construction, heterogeneity testing, meta-regression, and subgroup analyses.
RESULTS
Eighteen studies (v2011, v2014 and v2017) involving 3386 patients were included in the meta-analysis. The pooled sensitivity and specificity of LI-RADS ≥ 3 for diagnosing HCC were 0.86 (95 % confidence interval (CI): 0.78-0.91) and 0.85 (95 % CI: 0.78-0.90), respectively. The area under the curve (AUC) was 0.92 (95 % CI: 0.89-0.94). Meta-regression analysis showed that the publication year, blinding to the reference standard and the number of readers were significant factors affecting heterogeneity. In subgroup analyses, magnetic resonance imaging (MRI) demonstrated higher sensitivity (0.82 vs. 0.73) and comparable specificity (0.79 vs. 0.78) than computed tomography (CT). For HCCs ≤30 mm, LI-RADS showed lower sensitivity of 0.72 and specificity of 0.80 compared with HCC of all sizes. LR-5 showed higher sensitivity and specificity than LR-3 (sensitivity: 0.67 vs. 0.07, P = 0.02; specificity: 0.93 vs. 0.75, p < 0.001) and higher sensitivity than LR-4 (sensitivity: 0.67 vs. 0.29, P = 0.02; specificity: 0.93 vs. 0.80, p = 0.75). LR ≥ 5 had higher specificity at the cost of decreased sensitivity than LR ≥ 3 (specificity: 0.94 vs. 0.68, p < 0.001; sensitivity: 0.66 vs. 0.74, P = 0.70) and LR ≥ 4 (specificity: 0.94 vs. 0.84, p < 0.001; sensitivity: 0.66 vs. 0.74, P = 0.77).
CONCLUSIONS
LI-RADS ≥ 3 shows high diagnostic accuracy for HCCs, with a pooled sensitivity of 0.86 and specificity of 0.85. The specificity is higher for LR-5 and LR ≥ 5. However, further prospective studies on LI-RADS ≥ 3 are needed to elucidate its value for diagnosing small HCCs (≤20 mm).
目的
进行荟萃分析评估肝脏成像报告和数据系统（LI-RADS）类别≥3（LI-RADS 3-5v）在诊断肝细胞癌（HCC）中的诊断准确性。
方法
对 2018 年 7 月 31 日前发表的原始诊断研究进行了系统的 PubMed、Embase 和 Web of Science 电子数据库搜索。统计分析包括数据合并、森林图构建、异质性检验、元回归和亚组分析。
结果
纳入了 18 项研究（v2011、v2014 和 v2017），涉及 3386 例患者。LI-RADS ≥3 诊断 HCC 的汇总敏感性和特异性分别为 0.86（95%置信区间（CI）：0.78-0.91）和 0.85（95%CI：0.78-0.90），曲线下面积（AUC）为 0.92（95%CI：0.89-0.94）。元回归分析表明，发表年份、对参考标准的盲法和读者数量是影响异质性的重要因素。在亚组分析中，磁共振成像（MRI）显示出比计算机断层扫描（CT）更高的敏感性（0.82 与 0.73）和相当的特异性（0.79 与 0.78）。对于≤30mm 的 HCC，LI-RADS 的敏感性为 0.72，特异性为 0.80，低于所有大小的 HCC。LR-5 的敏感性和特异性均高于 LR-3（敏感性：0.67 与 0.07，P=0.02；特异性：0.93 与 0.75，p<0.001），敏感性也高于 LR-4（敏感性：0.67 与 0.29，P=0.02；特异性：0.93 与 0.80，p=0.75）。LR≥5 的特异性高于 LR≥3（特异性：0.94 与 0.68，p<0.001；敏感性：0.66 与 0.74，P=0.70）和 LR≥4（特异性：0.94 与 0.84，p<0.001；敏感性：0.66 与 0.74，P=0.77），但特异性更高。
结论
LI-RADS ≥3 对 HCC 具有较高的诊断准确性，汇总敏感性为 0.86，特异性为 0.85。LR-5 和 LR≥5 的特异性更高。然而，需要进一步的前瞻性研究来阐明 LI-RADS ≥3 对诊断小 HCC（≤20mm）的价值。
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