CT/MRI LI-RADS 联合 CEUS 可提高 HCC 的诊断性能。
Combination of CT/MRI LI-RADS with CEUS can improve the diagnostic performance for HCCs.
机构信息
School of medicine, Nankai University, Tianjin 300071, China; Department of Ultrasound, Tianjin Third Central Hospital, Tianjin 300170, China; Tianjin Institute of Hepatobiliary Disease, Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Artificial Cell Engineering Technology Research Center, Tianjin Third Central Hospital, Tianjin 300170, China.
Department of Ultrasound, Tianjin Third Central Hospital, Tianjin 300170, China; Tianjin Institute of Hepatobiliary Disease, Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Artificial Cell Engineering Technology Research Center, Tianjin Third Central Hospital, Tianjin 300170, China.
出版信息
Eur J Radiol. 2022 Apr;149:110199. doi: 10.1016/j.ejrad.2022.110199. Epub 2022 Feb 9.
BACKGROUND & AIMS: To compare the classifications for focal liver lesions smaller than 3 cm by the CEUS and CT/MRI LI-RADS and explore the discrepancy between the two classifications strategies.
METHODS
Focal liver lesions with a size smaller than 3 cm undergoing CEUS and CT/MRI (MR required on a 3.0 T magnet) within 1 month were enrolled. Each nodule was categorized according to the CEUS LI-RADS v2017 (usLI-RADS) and CT/MRI LI-RADS v2018. Intermodality agreement between the usLI-RADS and LI-RADS for CT/MRI was assessed. The reasons for inconsistent classifications by the CEUS and CT/MRI LI-RADS were clarified.
RESULTS
A total of 213 lesions were included. The positive predictive value (PPV) for HCCs of LR-3, 4 and 5 were 57.1% (95% CI: 32.6-78.6), 75.0% (95% CI: 62.3-84.5) and 94.2% (95% CI: 88.9-97.0) for CT/MRI and 37.5% (95% CI: 18.5-61.4), 56.0% (95% CI: 37.1-73.3) and 97.9% (95% CI: 94.1-99.3) for CEUS, respectively. CECT/MRI and CEUS LI-RADS had a poor agreement in classification with a kappa value of 0.254 (P < 0.001). 84 lesions (39.4%) were classified inconsistently in CT/MRI and CEUS LI-RADS. 40 lesions classified as LR-3 or LR-4 by CT/MRI were upgraded by CEUS. 21 lesions classified as LR-4 or LR-5 by CT/MRI were downgraded by CEUS. We reclassified the lesion in CT/MRI LR-3 and LR-4 by CEUS. The PPVs for HCCs in reclassified LR-3, LR-4 and LR-5 were 27.3% (95% CI: 9.7-56.6), 41.7% (95% CI: 26.2-69.0) and 94.2% (95% CI: 89.3-97.0), respectively, which decreased the incidences of HCCs in CT/MRI LR-3 and LR-4.
CONCLUSION
Lesions in CT/MRI LR-3 and 4 have a higher probability of being HCCs than those in usLR-3 and 4, respectively. Reclassification of lesions in CT/MRI LR-3 and 4 using CEUS can help the corresponding HCCs get a definite diagnosis.
背景与目的
比较超声造影（CEUS）与 CT/MRI（3.0T 磁共振必需）LI-RADS 对小于 3cm 局灶性肝脏病变的分类，并探讨两种分类策略之间的差异。
方法
纳入了在 1 个月内接受 CEUS 和 CT/MRI（3.0T 磁共振必需）检查的小于 3cm 的局灶性肝脏病变患者。根据 CEUS LI-RADS v2017（usLI-RADS）和 CT/MRI LI-RADS v2018 对每个结节进行分类。评估 usLI-RADS 与 CT/MRI 的 LI-RADS 之间的模态间一致性。阐明 CEUS 和 CT/MRI LI-RADS 不一致分类的原因。
结果
共纳入 213 个病变。对于 CT/MRI，LR-3、4 和 5 的 HCC 阳性预测值（PPV）分别为 57.1%（95%CI：32.6-78.6）、75.0%（95%CI：62.3-84.5）和 94.2%（95%CI：88.9-97.0），对于 CEUS，LR-3、4 和 5 的 PPV 分别为 37.5%（95%CI：18.5-61.4）、56.0%（95%CI：37.1-73.3）和 97.9%（95%CI：94.1-99.3）。CECT/MRI 和 CEUS LI-RADS 的分类一致性较差，kappa 值为 0.254（P<0.001）。84 个病变（39.4%）在 CT/MRI 和 CEUS LI-RADS 中分类不一致。40 个 CT/MRI 分类为 LR-3 或 LR-4 的病变被 CEUS 升级。21 个 CT/MRI 分类为 LR-4 或 LR-5 的病变被 CEUS 降级。我们根据 CEUS 重新分类了 CT/MRI LR-3 和 LR-4 的病变。重新分类后的 CT/MRI LR-3、LR-4 和 LR-5 的 HCC 的 PPV 分别为 27.3%（95%CI：9.7-56.6）、41.7%（95%CI：26.2-69.0）和 94.2%（95%CI：89.3-97.0），这降低了 CT/MRI LR-3 和 LR-4 中 HCC 的发生率。
结论
CT/MRI LR-3 和 4 中的病变比 usLR-3 和 4 中的病变更有可能是 HCC。使用 CEUS 对 CT/MRI LR-3 和 4 中的病变进行重新分类有助于明确相应 HCC 的诊断。
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