超声造影在CT和MRI所发现肝脏病变的影像学分类中的作用。
The role of contrast-enhanced ultrasound in the radiological classification of liver observations identified by CT and MRI.
作者信息
Huang Hui, He Dan-Ni, Lu Rui-Fang, Tong Wen-Juan, Wang Ying, Qin Si, Wen Rong, Wu Shao-Hong, Ruan Si-Min, Liu Guang-Jian, Lu Ming-De, Kuang Ming, Wang Wei, Cheng Mei-Qing, Yang Hong, Chen Li-Da
机构信息
Department of Medical Ultrasonics, Ultrasomics Artificial Intelligence X-Laboratory, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-sen University, No. 58 Zhongshan Rd 2, Guangzhou, 510080, People's Republic of China.
Department of Medical Ultrasonics, the Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, People's Republic of China.
出版信息
Radiol Med. 2025 Mar 24. doi: 10.1007/s11547-025-01995-z.
BACKGROUND & AIMS: Timely and accurate diagnosis of hepatocellular carcinoma (HCC) is essential for improving patient outcomes and guiding treatment. This multicenter study aimed to optimize the diagnostic workflow for HCC through a step-wise combination of CT/MRI and contrast-enhanced ultrasound (CEUS) Liver Imaging Reporting and Data System (LI-RADS).
METHODS
This was a multicenter, retrospective analysis of prospectively recruited high-risk HCC participants with liver observations from 4 institutions, between January 2017 and December 2021. These participants initially underwent CT/MRI followed by CEUS, with observations categorized according to CT/MRI/CEUS LI-RADS. Three step-wise diagnostic strategies were evaluated, starting with CT/MRI and followed by CEUS, and compared to CT/MRI LI-RADS alone. Performance metrics included AUC, accuracy, sensitivity, specificity, PPV, and NPV, using pathology or over one year of follow-up as standards. The impact on clinical decisions was measured by false-negative, false-positive, and biopsy rates.
RESULTS
Of 1264 participants, 874 (69%) were confirmed as HCC. The step-wise strategies outperformed CT/MRI LI-RADS. Strategy-3, which involved subsequent CEUS for CT/MRI LR-3/4 observations, significantly improved sensitivity (88.8% vs. 79.9%, P < 0.001) while maintaining comparable specificity (88.2% vs. 91.3%, P > 0.05). Strategy-3 reduced biopsy rate (31.5-22.4%, P = 0.028) and decreased false-negative rate (20.1-11.2%, P < 0.001). Additionally, 96% (55/57) of CT/MRI LR-3 and 97% (77/79) of CT/MRI LR-4 observations were accurately diagnosed and treated as HCC, with 61% (74/121) of CT/MRI LR-4 observations avoiding biopsy with CEUS-assisted.
CONCLUSION
A step-wise approach using CT/MRI followed by CEUS for LR-3/4 observations improved the diagnostic performance and further refined clinical decision-making in HCC.
TRIAL REGISTRATION
Clinical Trial Registration Number: ChiCTR-DDD-16010089.
背景与目的
肝细胞癌（HCC）的及时准确诊断对于改善患者预后和指导治疗至关重要。这项多中心研究旨在通过CT/MRI和对比增强超声（CEUS）肝脏影像报告和数据系统（LI-RADS）的逐步联合，优化HCC的诊断流程。
方法
这是一项多中心回顾性分析，研究对象为2017年1月至2021年12月期间前瞻性招募的来自4家机构的高危HCC参与者，并对其肝脏进行观察。这些参与者最初接受CT/MRI检查，随后进行CEUS检查，观察结果根据CT/MRI/CEUS LI-RADS进行分类。评估了三种逐步诊断策略，从CT/MRI开始，然后是CEUS，并与单独使用CT/MRI LI-RADS进行比较。性能指标包括AUC、准确性、敏感性、特异性、阳性预测值和阴性预测值，以病理或一年以上的随访作为标准。通过假阴性、假阳性和活检率来衡量对临床决策的影响。
结果
1264名参与者中,874名（69%）被确诊为HCC。逐步策略优于CT/MRI LI-RADS。策略3，即对CT/MRI LR-3/4观察结果进行后续CEUS检查，显著提高了敏感性（88.8%对79.9%，P<0.001），同时保持了相当的特异性（88.2%对91.3%，P>0.05）。策略3降低了活检率（31.5%-22.4%，P=0.028），并降低了假阴性率（20.1%-11.2%，P<0.001）。此外，96%（55/57）的CT/MRI LR-3和97%（77/79）的CT/MRI LR-4观察结果被准确诊断并作为HCC进行治疗，61%（共74/121）的CT/MRI LR-4观察结果通过CEUS辅助避免了活检。
结论
采用CT/MRI然后对LR-3/4观察结果进行CEUS的逐步方法提高了诊断性能，并进一步优化了HCC的临床决策。
试验注册
临床试验注册号：ChiCTR-DDD-16010089。
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