Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas.
Department of Pathology, UT Southwestern Medical Center, Dallas, Texas.
Clin Gastroenterol Hepatol. 2023 May;21(5):1351-1353.e2. doi: 10.1016/j.cgh.2022.03.009. Epub 2022 Mar 17.
Patients with cirrhosis are high risk for developing hepatocellular carcinoma (HCC) and warrant surveillance using abdominal ultrasound and α-fetoprotein. Those with positive surveillance results should undergo diagnostic evaluation with multiphase computed tomography (CT) or magnetic resonance imaging (MRI). The LI-RADS system is an evidence-based system to classify observations on CT or MRI in at-risk patients, ranging from LR-1 (definite benign) to LR-5 (definite HCC), with LR-3 and LR-4 observations being intermediate risk for HCC. LR-3 and LR-4 observations are observed on CT or MRI in more than one-fourth of patients undergoing HCC surveillance and have a high, yet variable, risk for progression to HCC. Approximately one-third of patients with LR-3 observations and more than two-thirds of LR-4 observations develop HCC, and surveillance strategies vary widely in practice. Variation in radiographic appearance and natural history of these observations suggests that this may be a heterogeneous group of patients; however, their histopathology has not been well described. Herein, we correlated imaging findings and explant histopathology from liver transplant recipients with at least 1 LR-3 or LR-4 observation on CT or MRI within 6 months preceding transplantation.
肝硬化患者发生肝细胞癌（HCC）的风险较高，需要进行腹部超声和甲胎蛋白检查进行监测。对于监测结果阳性的患者，应通过多期 CT 或 MRI 进行诊断评估。LI-RADS 系统是一种基于证据的系统，用于对 CT 或 MRI 上处于风险中的患者的观察结果进行分类，范围从 LR-1（明确良性）到 LR-5（明确 HCC），LR-3 和 LR-4 的观察结果为 HCC 的中间风险。在 HCC 监测中，超过四分之一的患者在 CT 或 MRI 上观察到 LR-3 和 LR-4 观察结果，并且 HCC 的进展风险较高，但具有可变。大约三分之一的 LR-3 观察患者和超过三分之二的 LR-4 观察患者会发生 HCC，并且在实践中监测策略差异很大。这些观察结果的影像学表现和自然史的差异表明，这可能是一组异质的患者；然而，它们的组织病理学尚未得到很好的描述。在此，我们将接受肝移植的患者的影像学发现与移植前 6 个月内 CT 或 MRI 上至少有 1 次 LR-3 或 LR-4 观察结果的患者的影像学发现与肝移植供体的组织病理学进行了相关性分析。
