肝脏影像报告和数据系统（LI-RADS）CT及MRI辅助特征与肝细胞癌及恶性肿瘤的关联：一项个体参与者数据荟萃分析
LI-RADS CT and MRI Ancillary Feature Association with Hepatocellular Carcinoma and Malignancy: An Individual Participant Data Meta-Analysis.
作者信息
Dawit Haben, Lam Eric, McInnes Matthew D F, van der Pol Christian B, Bashir Mustafa R, Salameh Jean-Paul, Levis Brooke, Sirlin Claude B, Chernyak Victoria, Choi Sang Hyun, Kim So Yeon, Fraum Tyler J, Tang An, Jiang Hanyu, Song Bin, Wang Jin, Wilson Stephanie R, Kwon Heejin, Kierans Andrea S, Joo Ijin, Ronot Maxime, Song Ji Soo, Podgórska Joanna, Rosiak Grzegorz, Kang Zhen, Allen Brian C, Costa Andreu F
机构信息
From the Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada (H.D.); Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada (H.D., M.D.F.M., J.P.S.); Ottawa Hospital Research Institute, Ottawa, Ontario, Canada (E.L.); Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada (M.D.F.M.); Juravinski Hospital and Cancer Centre, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada (C.B.v.d.P.); Department of Radiology (M.R.B., B.C.A.) and Center for Advanced Magnetic Resonance Development (M.R.B.), Duke University Medical Center, Durham, NC; Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada (J.P.S.); Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada (B.L.); Liver Imaging Group, Department of Radiology, University of California-San Diego, San Diego, Calif (C.B.S.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (V.C.); Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea (S.H.C., S.Y.K.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (T.J.F.); Department of Radiology, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada (A.T.); Department of Radiology, West China Hospital, Sichuan University, Chengdu, China (H.J., B.S.); Department of Radiology, Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China (J.W.); University of Calgary Foothills Medical Centre, Calgary, Alberta, Canada (S.R.W.); Department of Radiology, Dong-A University Hospital, Dong-A University College of Medicine, Busan, Republic of Korea (H.K.); Weill Cornell Medical Center, New York, NY (A.S.K.); Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea (I.J.); Department of Radiology, Assistance Publique-Hôpitaux de Paris, Nord, Université Paris Cité, CRI UMR 1149, Paris, France (M.R.); Hôpital Beaujon, Clichy, France (M.R.); Department of Radiology, Chonbuk National University Medical School and Hospital, Jeonju, Republic of Korea (J.S.S.); Second Radiology Department, Warsaw Medical University, Warsaw, Poland (J.P., G.R.); Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (Z.K.); and Department of Diagnostic Radiology, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Victoria General Building, 3rd Fl, 1276 S Park St, Halifax, NS, Canada B3H 2Y9 (A.F.C.).
出版信息
Radiology. 2024 Feb;310(2):e231501. doi: 10.1148/radiol.231501.
Background The independent contribution of each Liver Imaging Reporting and Data System (LI-RADS) CT or MRI ancillary feature (AF) has not been established. Purpose To evaluate the association of LI-RADS AFs with hepatocellular carcinoma (HCC) and malignancy while adjusting for LI-RADS major features through an individual participant data (IPD) meta-analysis. Materials and Methods Medline, Embase, Cochrane Central Register of Controlled Trials, and Scopus were searched from January 2014 to January 2022 for studies evaluating the diagnostic accuracy of CT and MRI for HCC using LI-RADS version 2014, 2017, or 2018. Using a one-step approach, IPD across studies were pooled. Adjusted odds ratios (ORs) and 95% CIs were derived from multivariable logistic regression models of each AF combined with major features except threshold growth (excluded because of infrequent reporting). Liver observation clustering was addressed at the study and participant levels through random intercepts. Risk of bias was assessed using a composite reference standard and Quality Assessment of Diagnostic Accuracy Studies 2. Results Twenty studies comprising 3091 observations (2456 adult participants; mean age, 59 years ± 11 [SD]; 1849 [75.3%] men) were included. In total, 89% (eight of nine) of AFs favoring malignancy were associated with malignancy and/or HCC, 80% (four of five) of AFs favoring HCC were associated with HCC, and 57% (four of seven) of AFs favoring benignity were negatively associated with HCC and/or malignancy. Nonenhancing capsule (OR = 3.50 [95% CI: 1.53, 8.01]) had the strongest association with HCC. Diffusion restriction (OR = 14.45 [95% CI: 9.82, 21.27]) and mild-moderate T2 hyperintensity (OR = 10.18 [95% CI: 7.17, 14.44]) had the strongest association with malignancy. The strongest negative associations with HCC were parallels blood pool enhancement (OR = 0.07 [95% CI: 0.01, 0.49]) and marked T2 hyperintensity (OR = 0.18 [95% CI: 0.07, 0.45]). Seventeen studies (85%) had a high risk of bias. Conclusion Most LI-RADS AFs were independently associated with HCC, malignancy, or benignity as intended when adjusting for major features. © RSNA, 2024 See also the editorial by Crivellaro in this issue.
背景
肝脏影像报告和数据系统（LI-RADS）的每个CT或MRI辅助特征（AF）的独立贡献尚未明确。目的：通过个体参与者数据（IPD）荟萃分析，在调整LI-RADS主要特征的同时，评估LI-RADS AF与肝细胞癌（HCC）及恶性肿瘤的相关性。材料与方法：检索2014年1月至2022年1月期间的Medline、Embase、Cochrane对照试验中央注册库和Scopus，查找使用2014版、2017版或2018版LI-RADS评估CT和MRI对HCC诊断准确性的研究。采用一步法汇总各研究的IPD。从每个AF与除阈值生长（因报告不频繁而排除）之外的主要特征相结合的多变量逻辑回归模型中得出调整后的优势比（OR）和95%置信区间（CI）。通过随机截距在研究和参与者层面处理肝脏观察聚类。使用复合参考标准和诊断准确性研究质量评估2评估偏倚风险。结果：纳入20项研究，共3091例观察对象（2456名成年参与者；平均年龄59岁±11[标准差]；1849名[75.3%]男性）。总体而言，支持恶性肿瘤的AF中有89%（9项中的8项）与恶性肿瘤和/或HCC相关，支持HCC的AF中有80%（5项中的4项）与HCC相关，支持良性的AF中有57%（7项中的4项）与HCC和/或恶性肿瘤呈负相关。无强化包膜（OR = 3.50[95%CI：1.53，8.01]）与HCC的关联最强。弥散受限（OR = 14.45[95%CI：9.82，21.27]）和轻至中度T2高信号（OR = 10.18[95%CI：7.17，14.44]）与恶性肿瘤的关联最强。与HCC最强的负相关是血池平行强化（OR = 0.07[95%CI：0.01，0.49]）和明显T2高信号（OR = 0.18[95%CI：0.07，0.45]）。17项研究（85%）存在高偏倚风险。结论：在调整主要特征后，大多数LI-RADS AF按预期与HCC、恶性肿瘤或良性独立相关。©RSNA，2024 另见本期Crivellaro的社论。
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