Morad Kholoud, Moustafa Amr F, Refaat Amal M, AbdEllatif Ahmed, ElAzab Mohammed S
National Cancer Institute, Cairo University, Cairo, Egypt.
Pol J Radiol. 2021 Sep 23;86:e557-e563. doi: 10.5114/pjr.2021.110647. eCollection 2021.
The study aimed to compare the diagnostic performance of the Liver Imaging Reporting and Data System (LI-RADS), which incorporates fixed criteria, and the Likert scale (LS), which mainly depends on an overall impression in liver lesion diagnosis.
Diagnostic data of 110 hepatic nodules in 103 high-risk patients for hepatocellular carcinoma (HCC) were included. Data including diameter, arterial hyperenhancement, washout, and capsule were reviewed by 2 readers using LI-RADS and LS (range, score 1-5). Inter-reader agreement (IRA), intraclass agreement (ICA), and diagnostic performance were determined by Fleiss, Cohen's k, and logistic regression, respectively.
There were 53 triphasic enhanced computed tomography (CT) and 50 dynamic magnetic resonance (MR) examinations. Overall, IRA was excellent (k = 0.898). IRA was good for arterial hyperenhancement (k = 0.705), washout (k = 0.763), and capsule (k = 0.771) and excellent for diameter (k = 0.981) and tumour embolus (k = 0.927). Overall, ICA between LI-RADS and LS was fair 0.32; ICA was good for scores of 1 (k = 0.682), fair for scores of 2 (k = 0.36), moderate for scores of 5 (k = 0.52), but no agreement was found for scores of 3 (k = -0.059) and 4 (k = -0.022). LIRADS produced relatively high accuracy (87.3% vs. 80%), relatively low sensitivity (84.3% vs. 98%), and significantly higher specificity (89.83% vs. 64.4%) and positive likelihood ratio (+LR: 8.29 vs. 2.75) compared to LS approach.
LI-RADS revealed higher diagnostic accuracy as compared to LS with statistical proof higher specificity and +LR showing its ability to foretell malignancy in high-risk patients. We recommend the practical application of the LI-RADS system in the detection and treatment response monitoring of patients with HCC.
本研究旨在比较采用固定标准的肝脏影像报告和数据系统（LI-RADS）与主要依赖整体印象的李克特量表（LS）在肝脏病变诊断中的诊断性能。
纳入103例肝细胞癌（HCC）高危患者的110个肝结节的诊断数据。两名阅片者使用LI-RADS和LS（范围为1-5分）对包括直径、动脉期强化、廓清和包膜等数据进行评估。阅片者间一致性（IRA）、组内一致性（ICA）和诊断性能分别通过Fleiss检验、Cohen's k检验和逻辑回归分析来确定。
共有53例进行了三期增强计算机断层扫描（CT）检查，50例进行了动态磁共振（MR）检查。总体而言，IRA良好（k = 0.898）。IRA在动脉期强化（k = 0.705）、廓清（k = 0.763）和包膜（k = 0.771）方面良好，在直径（k = 0.981）和肿瘤栓子（k = 0.927）方面优秀。总体而言，LI-RADS和LS之间的ICA为中等（0.32）；ICA在1分（k = 0.682）时良好，在2分（k = 0.36）时中等，在5分（k = 0.52）时中等，但在3分（k = -0.059）和4分（k = -0.022）时未发现一致性。与LS方法相比，LI-RADS具有相对较高的准确性（87.3%对80%）、相对较低的敏感性（84.3%对98%），以及显著更高的特异性（89.8%对64.4%）和阳性似然比（+LR：8.29对2.75）。
与LS相比LI-RADS显示出更高的诊断准确性，统计学证据表明其具有更高的特异性和+LR，表明其能够预测高危患者的恶性肿瘤。我们建议在HCC患者的检测和治疗反应监测中实际应用LI-RADS系统。
