Department of Medical Ultrasound, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China.
World J Gastroenterol. 2022 Jun 7;28(21):2350-2360. doi: 10.3748/wjg.v28.i21.2350.
Contrast-enhanced ultrasound (CEUS) can be used to diagnose focal liver lesions (FLLs) in children. The America College of Radiology developed the CEUS liver imaging reporting and data system (LI-RADS) for standardizing CEUS diagnosis of FLLs in adult patients. Until now, no similar consensus or guidelines have existed for pediatric patients to improve imaging interpretation as adults.
To evaluate the performance of CEUS LI-RADS combined with alpha-fetoprotein (AFP) in differentiating benign and malignant FLLs in pediatric patients.
Between January 2011 and January 2021, patients ≤ 18 years old who underwent CEUS for FLLs were retrospectively evaluated. The following criteria for diagnosing malignancy were proposed: Criterion I considered LR-4, LR-5, or LR-M lesions as malignancies; criterion II regarded LR-4, LR-5 or LR-M lesions with simultaneously elevated AFP (≥ 20 ng/mL) as malignancies; criterion III took LR-4 Lesions with elevated AFP or LR-5 or LR-M lesions as malignancies. The sensitivity, specificity, accuracy and area under the receiver operating characteristic curve (AUC) were calculated to determine the diagnostic value of the aforementioned criteria.
The study included 63 nodules in 60 patients (mean age, 11.0 ± 5.2 years; 26 male). There were no statistically significant differences between the specificity, accuracy, or AUC of criterion II and criterion III (95.1% 80.5%, 84.1% 87.3%, and 0.794 0.902; all > 0.017). Notably, criterion III showed a higher diagnostic sensitivity than criterion II (100% 63.6%; < 0.017). However, both the specificity and accuracy of criterion I was inferior to those of criterion II and criterion III (all < 0.017). For pediatric patients more than 5 years old, the performance of the three criteria was overall similar when patients were subcategorized by age when compared to all patients in aggregate.
CEUS LI-RADS combined with AFP may be a powerful diagnostic tool in pediatric patients. LR-4 with elevated AFP, LR-5 or LR-M lesions is highly suggestive of malignant tumors.
对比增强超声（CEUS）可用于诊断儿童局灶性肝脏病变（FLL）。美国放射学院制定了 CEUS 肝脏成像报告和数据系统（LI-RADS），以规范成人患者 FLL 的 CEUS 诊断。迄今为止，尚无类似的共识或指南用于儿科患者，以改善成人的影像学解读。
评估 CEUS LI-RADS 联合甲胎蛋白（AFP）在鉴别儿童 FLL 良恶性中的性能。
回顾性分析 2011 年 1 月至 2021 年 1 月期间因 FLL 接受 CEUS 的≤18 岁患者。提出以下恶性肿瘤诊断标准：标准 I 将 LR-4、LR-5 或 LR-M 病变视为恶性肿瘤；标准 II 将 LR-4、LR-5 或 LR-M 病变同时伴有 AFP 升高（≥20ng/mL）视为恶性肿瘤；标准 III 将 LR-4 病变伴有 AFP 升高或 LR-5 或 LR-M 病变视为恶性肿瘤。计算灵敏度、特异度、准确性和受试者工作特征曲线（ROC）下面积（AUC），以确定上述标准的诊断价值。
本研究纳入了 60 例患者的 63 个结节（平均年龄 11.0±5.2 岁，男性 26 例）。标准 II 和标准 III 的特异性、准确性或 AUC 之间无统计学差异（95.1% vs. 80.5%，84.1% vs. 87.3%，0.794 vs. 0.902；均>0.017）。值得注意的是，标准 III 的诊断敏感度高于标准 II（100% vs. 63.6%；<0.017）。然而，标准 I 的特异性和准确性均低于标准 II 和标准 III（均<0.017）。对于年龄大于 5 岁的儿科患者，与所有患者相比，按年龄对患者进行亚组分类时，三种标准的性能总体相似。
CEUS LI-RADS 联合 AFP 可能是儿科患者的一种强大诊断工具。LR-4 伴有 AFP 升高、LR-5 或 LR-M 病变高度提示恶性肿瘤。
