采用六氟化硫或全氟丁烷的CT/MRI肝脏影像报告和数据系统（LI-RADS）联合二线对比增强超声检查用于诊断高危患者肝细胞癌
Combination of CT/MRI LI-RADS With Second-Line Contrast-Enhanced Ultrasound Using Sulfur Hexafluoride or Perfluorobutane for Diagnosing Hepatocellular Carcinoma in High-Risk Patients.
作者信息
Li Yu, Li Sheng, Li Qing, Li Kai, Han Jing, Mao Siyue, Xu Xiaohong, Su Zhongzhen, Zuo Yanling, Xie Shousong, Wen Hong, Zou Xuebin, Shen Jingxian, Li Lingling, Zhou Jianhua
机构信息
Department of Ultrasound, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, China.
Department of Radiology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, China.
出版信息
Korean J Radiol. 2025 Apr;26(4):346-359. doi: 10.3348/kjr.2024.0980. Epub 2025 Feb 20.
OBJECTIVE
The CT/MRI Liver Imaging Reporting and Data System (LI-RADS) demonstrates high specificity with relatively limited sensitivity for diagnosing hepatocellular carcinoma (HCC) in high-risk patients. This study aimed to explore the possibility of improving sensitivity by combining CT/MRI LI-RADS v2018 with second-line contrast-enhanced ultrasound (CEUS) LI-RADS v2017 using sulfur hexafluoride (SHF) or perfluorobutane (PFB).
MATERIALS AND METHODS
This retrospective analysis of prospectively collected multicenter data included high-risk patients with treatment-naive hepatic observations. The reference standard was pathological confirmation or a composite reference standard (only for benign lesions). Each participant underwent concurrent CT/MRI, SHF-enhanced US, and PFB-enhanced US examinations. The diagnostic performances for HCC of CT/MRI LI-RADS alone and three combination strategies (combining CT/MRI LI-RADS with either LI-RADS SHF, LI-RADS PFB, or a modified algorithm incorporating the Kupffer-phase findings for PFB [modified PFB]) were evaluated. For the three combination strategies, apart from the CT/MRI LR-5 criteria, HCC was diagnosed if CT/MRI LR-3 or LR-4 observations met the LR-5 criteria using LI-RADS SHF, LI-RADS PFB, or modified PFB.
RESULTS
In total, 281 participants (237 males; mean age, 55 ± 11 years) with 306 observations (227 HCCs, 40 non-HCC malignancies, and 39 benign lesions) were included. Using LI-RADS SHF, LI-RADS PFB, and modified PFB, 20, 23, and 31 CT/MRI LR-3/4 observations, respectively, were reclassified as LR-5, and all were pathologically confirmed as HCCs. Compared to CT/MRI LI-RADS alone (74%, 95% confidence interval [CI]: 68%-79%), the three combination strategies combining CT/MRI LI-RADS with either LI-RADS SHF, LI-RADS PFB, or modified PFB increased sensitivity (83% [95% CI: 77%-87%], 84% [95% CI: 79%-89%], 88% [95% CI: 83%-92%], respectively; all < 0.001), while maintaining the specificity at 92% (95% CI: 84%-97%).
CONCLUSION
The combination of CT/MRI LI-RADS with second-line CEUS using SHF or PFB improved the sensitivity of HCC diagnosis without compromising specificity.
目的
CT/MRI肝脏影像报告和数据系统（LI-RADS）在诊断高危患者的肝细胞癌（HCC）时显示出较高的特异性，但敏感性相对有限。本研究旨在探讨将CT/MRI LI-RADS v2018与使用六氟化硫（SHF）或全氟丁烷（PFB）的二线对比增强超声（CEUS）LI-RADS v2017相结合以提高敏感性的可能性。
材料与方法
这项对前瞻性收集的多中心数据的回顾性分析纳入了未经治疗的肝脏观察的高危患者。参考标准为病理证实或综合参考标准（仅用于良性病变）。每位参与者同时接受了CT/MRI、SHF增强超声和PFB增强超声检查。评估了单独使用CT/MRI LI-RADS以及三种联合策略（将CT/MRI LI-RADS与LI-RADS SHF、LI-RADS PFB或纳入PFB Kupffer期表现的改良算法[改良PFB]相结合）对HCC的诊断性能。对于这三种联合策略，除了CT/MRI LR-5标准外，如果CT/MRI LR-3或LR-4观察结果符合使用LI-RADS SHF、LI-RADS PFB或改良PFB的LR-5标准，则诊断为HCC。
结果
总共纳入了281名参与者（237名男性；平均年龄55±11岁），有306次观察结果（227例HCC、40例非HCC恶性肿瘤和39例良性病变）。使用LI-RADS SHF、LI-RADS PFB和改良PFB时，分别有20、23和31次CT/MRI LR-3/4观察结果被重新分类为LR-5，且所有结果均经病理证实为HCC。与单独使用CT/MRI LI-RADS（74%，95%置信区间[CI]：68%-79%）相比，将CT/MRI LI-RADS与LI-RADS SHF、LI-RADS PFB或改良PFB相结合的三种联合策略提高了敏感性（分别为83%[95%CI：77%-87%]、84%[95%CI：79%-89%]、88%[95%CI：83%-92%]；均P<0.001），同时特异性保持在92%（95%CI：84%-97%）。
结论
CT/MRI LI-RADS与使用SHF或PFB的二线CEUS相结合提高了HCC诊断的敏感性，且不影响特异性。
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