Zhang Yafang, Li Qing, Li Lingling, Hong Yong, Qiang Banghong, Yu Yiwen, Guo Ruohan, Deng Hanxia, Han Xu, Zou Xuebin, Guo Zhixing, Zhou Jianhua
Department of Ultrasound, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, China.
Department of Ultrasound, Zhongshan Dongfeng People's Hospital, Zhongshan, China.
Ultrasound Med Biol. 2024 Feb;50(2):243-250. doi: 10.1016/j.ultrasmedbio.2023.10.008. Epub 2023 Nov 18.
The aim of this study was to assess the ability of the modified contrast-enhanced ultrasound (CEUS) Liver Imaging Reporting and Data System (LI-RADS) to distinguish malignancy in patients without known hepatocellular carcinoma (HCC) risk factors and compare diagnostic accuracy with that of the World Federation for Ultrasound in Medicine and Biology (WFUMB) guideline across radiologists with different levels of CEUS experience.
A total of 848 individuals with no hepatitis infection presenting with 870 lesions in non-cirrhotic livers were included and divided into the Testing and Validation groups. The modified CEUS LI-RADS was proposed, including downgrading of focal nodular hyperplasia with typical features. Diagnostic performance of the modified CEUS LI-RADS was assessed in the Testing group. In the Validation group, two radiologists with more than 9 y of CEUS experience (Experts) and two radiologists with less than 6 mo of CEUS experience (Novices) used both the modified CEUS LI-RADS and the WFUMB guideline to evaluate performance in diagnosis of the lesions.
LR-5 + M (combination of modified LR-5 and modified LR-M) revealed optimal performance with a sensitivity, specificity and area under the curve (AUC) of 99.3%, 81.6% and 0.904, respectively. Novices using the modified CEUS LI-RADS outperformed those using the WFUMB guideline (AUC: 0.858 vs. 0.767, p = 0.005). Additionally, the sensitivity, specificity and AUC of Novices were comparable to those of Experts using the modified CEUS LI-RADS (94.1%, 77.6% and 0.858 vs. 96.1%, 77.6% and 0.868 for experts, respectively).
The modified CEUS LI-RADS is a valuable method for distinguishing hepatic malignancy in patients without HCC risk factors. This is particularly beneficial for radiologists with limited CEUS expertise.
本研究旨在评估改良的超声造影（CEUS）肝脏影像报告和数据系统（LI-RADS）在无已知肝细胞癌（HCC）危险因素患者中鉴别恶性肿瘤的能力，并比较不同CEUS经验水平的放射科医生使用该系统与世界医学与生物学超声联合会（WFUMB）指南的诊断准确性。
纳入848例无肝炎感染且非肝硬化肝脏有870个病灶的个体，分为测试组和验证组。提出改良的CEUS LI-RADS，包括对具有典型特征的局灶性结节性增生进行降级。在测试组中评估改良的CEUS LI-RADS的诊断性能。在验证组中，两名有超过9年CEUS经验的放射科医生（专家）和两名CEUS经验少于6个月的放射科医生（新手）使用改良的CEUS LI-RADS和WFUMB指南评估病灶的诊断性能。
LR-5 + M（改良LR-5和改良LR-M的组合）表现最佳，敏感性、特异性和曲线下面积（AUC）分别为99.3%、81.6%和0.904。使用改良CEUS LI-RADS的新手的表现优于使用WFUMB指南的新手（AUC：0.858对0.767，p = 0.005）。此外，新手的敏感性、特异性和AUC与使用改良CEUS LI-RADS的专家相当（专家分别为96.1%、77.6%和0.868，新手分别为94.1%、77.6%和0.858）。
改良的CEUS LI-RADS是鉴别无HCC危险因素患者肝脏恶性肿瘤的有价值方法。这对CEUS专业知识有限的放射科医生尤其有益。
