肝硬化背景下MRI肝脏影像报告和数据系统LR-2、LR-3、LR-4类结节的变化与预后

Category modifications and prognosis of cirrhotic nodules depending on MRI imaging report and data system of LR-2, LR-3 and LR-4

目的探讨肝硬化背景下肝脏影像报告和数据系统（LI-RADS）LR-2、LR-3、LR-4类病变的分类改变及预后转归。方法回顾性分析2012年9月至2017年2月南通市第三人民医院，在影像科进行过至少2次肝脏MRI检查，首次MRI评价为LR-2、LR-3、LR-4类病变，且未进行过活检、手术的109例（151个病灶）肝硬化患者。LR-2结节48个、LR-3结节71个、LR-4结节32个。所有患者进行肝脏MRI常规平扫、DWI和多期动态增强扫描，记录随访时长及LI-RADS分类调整（上调、不变、下调）情况。采用单因素方差分析比较LR-2、LR-3、LR-4类病变的随访时间，采用Kaplan-Meier曲线分析LR-2、LR-3、LR-4结节分类上调的发生率，并采用Log-Rank检验比较。 结果LR-2、LR-3、LR-4类病变的随访时间分别为（17.4±9.2）、（16.3±8.5）和（12.4±9.3）个月，差异有统计学意义（F=3.30，P=0.041）。48个LR-2结节中，1个随访52.3个月后进展至LR-5，4个上调至LR-3，29个保持不变，14个下调至LR-1。71个LR-3结节中，13个上调至LR-5，其中12个显示超阈值生长，9个新增廓清征象，7个出现包膜，3个富血供转变；6个上调至LR-4；34个保持不变；18个下调至LR-1。32个LR-4结节中，14个上调至LR-5，其中11个显示超阈值生长，1个新增廓清征象，6个出现包膜，1个富血供转变；1个门静脉癌栓形成进展为LR-5V；15个保持不变；2个下调至LR-1。LR-4结节上调至LR-5的累积发生率较LR-2、LR-3结节高，差异有统计学意义（P均〈0.01），其中3、6、12个月进展至LR-5的累积发生率LR-4结节分别为6.3%、18.8%、34.4%，LR-3结节分别为0、4.2%、5.6%，LR-2结节均为0。LR-3结节分类进展为LR≥4的累积发生率高于LR-2结节，差异有统计学意义（P〈0.01）。结论基于LI-RADS的MRI分类诊断标准，自然病程肝硬化背景下的LR-2、LR-3、LR-4结节存在不同的预后转归，LR-4结节进展为LR-5的累积发生率较高。

Objective To evaluate the category modifications and prognosis of cirrhotic nodules depending on MRI imaging report and data system of LR-2, LR-3 and LR-4.MethodsClinical data of 109 patients （151 lesions） with cirrhosis who underwent two or more MRI examinations in the Third People＇s Hospital of Nantong City from September 2012 to February 2017 were retrospectively collected. All the patients were diagnosed as LR-2, LR-3 and LR-4 lesions for the first time without biopsy or operation. Among all the lesions, 40 were LR-2, 71 were LR-3 and 32 were LR-4. Routine liver MRI scanning, DWI and multiphase dynamic contrast-enhanced MRI were performed on all patients. The follow-up time and category modifications were recorded for each lesion. The single-factor analysis was used to analyze the follow-up time of LR-2, LR-3 and LR-4 lesions. The incidence of up-regulation of LR-2, LR-3 and LR-4 nodules were analyzed by Kaplan-Meier curve. Log-Rank test was used to compare the results.ResultsThe mean follow-up time of LR-2, LR-3 and LR-4 was （17.4±9.2）, （16.3±8.5） and （12.4±9.3） months respectively, the difference were statistically significant （F=3.30, P=0.041） . Among 48 index LR-2 lesions, 1 upgraded to LR-5 after 52.3 months of follow-up, 4 upgraded to LR-3, 29 remained stable, and 14 decreased to LR-1. Among 71 index LR-3 lesions, 13 upgraded to LR-5, among which 12 demonstrated threshold growth, 9 developed newly enriched pleural signs, 7 showed capsules and 3 demonstrated hypervascular transformation;6 upgraded to LR-4, 34 remained stable and 18 decreased to LR-1. Among 32 index LR-4 lesions, 14 upgraded to LR-5, among which 11 demonstrated threshold growth, 1 developed newly enriched pleural signs, 6 showed capsules and 1 demonstrated hypervascular transformation;1 leision developed to LR-5V with portal vein thrombosis, 15 remained stable and 2 decreased to LR-1. The cumulative incidence of LR-4 nodules up-regulated to LR-5 was higher than that of LR-2 and LR-3 nodules （all P〈0.01）. The cumulative incidence of LR-4 nodules at 3, 6, 12 months to LR-5 were 6.3%, 18.8%, 34.4%, and LR-3 nodules were 0, 4.2%, 5.6%. LR-2 nodules are 0. The cumulative incidence of LR-3 nodules classified as LR≥4 was higher than that of LR-2 nodules （P〈0.01）.ConclusionLR-2, LR-3, and LR-4 nodules have different prognostic outcomes based on the LI-RADS classification criteria for MRI, and the cumulative incidence of LR-4 progression to LR-5 was higher.