Department of Medical Ultrasonics, Ultrasomics Artificial Intelligence X-Lab, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.
Department of Endoscopy Center, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.
J Ultrasound Med. 2023 Jun;42(6):1333-1344. doi: 10.1002/jum.16151. Epub 2022 Dec 19.
To develop an effective strategy for accurate diagnosis of focal liver lesions (FLLs) in patients with non-high risk for hepatocellular carcinoma (HCC).
From January 2012 to December 2015, consecutive patients with non-high risk for HCC who underwent contrast-enhanced ultrasound (CEUS) were included in this retrospective double-reader study. All patients were stratified into 2 different risks (intermediate, low-risk) groups according to criteria based on clinical characteristics, known as clinical risk stratification criteria. For the intermediate-risk group, the CEUS criteria for identifying benign lesions and HCCs were constructed based on selected CEUS features. The diagnostic performance of the clinical risk stratification criteria, and CEUS criteria for identifying benign lesions and HCCs was evaluated.
This study included 348 FLLs in 348 patients. The sensitivity and specificity of the clinical risk stratification criteria for malignancy was 97.8 and 69.8%. Patients were classified as intermediate risk if they were male, or older than 40 years of age, or HBcAb positive, or having positive tumor markers. Otherwise, patients were classified as low risk. Among the 348 patients, 327 were in the intermediate-risk group and 21 were in the low-risk group. In the intermediate-risk group, the CEUS criteria for identifying benign lesions were any of the following features: 1) hyper/isoenhancement in the arterial phase without washout, 2) nonenhancement in all phases, 3) peripheral discontinuous globular enhancement in the arterial phase, 4) centrifugal enhancement or peripheral enhancement followed by no central enhancement, or 5) enhanced septa. The accuracy, sensitivity, and specificity of the CEUS criteria for identifying benign lesions were 94.5, 83.0, and 99.6%, respectively. Arterial phase hyperenhancement followed by mild and late washout (>60 seconds) was more common in HCC patients than in non-HCC patients (P < .001). Using arterial phase hyperenhancement followed by mild and late washout as the CEUS criteria for identifying HCCs, the sensitivity and specificity were 52.6 and 95.3%, but unfortunately, the positive predictive value was only 82.0%. For the low-risk group, no further analysis was performed due to the small sample size.
Initial clinical risk stratification followed by assessment of certain CEUS features appears to be a promising strategy for the accurate diagnosis of FLLs in patients not at high risk for HCC.
为非高危肝细胞癌（HCC）患者的局灶性肝脏病变（FLL）的准确诊断制定有效的策略。
本回顾性双读片研究纳入了 2012 年 1 月至 2015 年 12 月间因非高危 HCC 而接受超声造影（CEUS）检查的连续患者。所有患者根据临床特征和已知的临床风险分层标准，分为 2 种不同风险（中危、低危）组。对于中危组，基于所选的 CEUS 特征，建立了用于识别良性病变和 HCC 的 CEUS 标准。评估了临床风险分层标准和用于识别良性病变和 HCC 的 CEUS 标准的诊断性能。
本研究共纳入了 348 例 348 名患者的 348 个 FLL。临床风险分层标准对恶性肿瘤的灵敏度和特异性分别为 97.8%和 69.8%。如果患者为男性，或年龄大于 40 岁，或乙型肝炎核心抗体（HBcAb）阳性，或肿瘤标志物阳性，则被归类为中危。否则，患者被归类为低危。在 348 名患者中，327 名患者为中危组，21 名患者为低危组。在中危组中，用于识别良性病变的 CEUS 标准为以下任何一种特征：1）动脉期高/等增强且无廓清，2）各期均无增强，3）动脉期外周不连续球状增强，4）离心性增强或外周增强后无中央增强，或 5）增强的间隔。用于识别良性病变的 CEUS 标准的准确性、灵敏度和特异性分别为 94.5%、83.0%和 99.6%。与非 HCC 患者相比，HCC 患者更常见动脉期高增强后轻度和延迟廓清（>60 秒）（P<0.001）。将动脉期高增强后轻度和延迟廓清作为识别 HCC 的 CEUS 标准，灵敏度和特异性分别为 52.6%和 95.3%，但不幸的是，阳性预测值仅为 82.0%。由于样本量小，对低危组未进行进一步分析。
初始临床风险分层，随后评估某些 CEUS 特征，似乎是一种有前途的策略，可用于非高危 HCC 患者的 FLL 准确诊断。
