根据2013版肝脏影像报告与数据管理系统诊断肝脏病灶的一致性

Consistency of diagnosing hepatic lesions according to LI-RADS(v2013)

目的观察根据2013版肝脏影像报告与数据管理系统[LI-RADS(v2013)]诊断肝细胞癌(HCC)发病高风险人群肝脏病灶的一致性。方法由2名医师(医师1、2)独立双盲阅读813例有HCC发病风险患者的1115个病灶的CT/MRI资料,分别采用LI-RADS(v2013)、LI-RADS(v2012,第1版)[即LI-RADS(v1.0)]进行诊断。分析医师间根据LI-RADS(v2013)评估病灶直径、主要影像学征象及分级诊断结果的一致性;以病理结果为金标准,比较根据LI-RADS(v2013)与LI-RADS(v1.0)进行诊断的结果差异。结果医师1、2评估病灶直径的组内相关系数(ICC)为0.998;评价动脉期高强化、门静脉期/延迟期低强化及包膜的Kappa系数分别为0.87、0.86、0.72;LI-RADS(v2013)分级诊断观察者内Kappa系数为0.85。2名医师协商后的最终分级诊断结果与金标准的Kappa系数为0.85;诊断阳性(LR3~5级)病灶的敏感度、特异度、阳性预测值(PPV)及阴性预测值(NPV)分别为100%(757/757)、80.17%(287/358)、91.43%(757/828)及100%(287/287)。根据LI-RADS(v2013)、LI-RADS(v1.0)诊断阳性病灶差异有统计学意义(P<0.001)。结论医师间评价LI-RADS(v2013)主要影像学征象及分级诊断结果的一致性均较好。

Objective To observe the consistency of diagnosing liver lesions according to liver imaging reporting and data system of 2013(LI-RADS[v2013])in people with high risk of hepatocellular carcinoma(HCC).Methods CT/MRI data of 813 patients(1115 liver lesions)with high risk of HCC were double-blindly reviewed by 2 physicians independently,and LI-RADS(v2013)and LI-RADS(v1.0)were used for qualitative diagnosis of lesions.The consistency of lesion diameter,three major imaging features and grading diagnosis results based on LI-RADS(v2013)were evaluated between 2 observers.Pathological results were taken as the gold standards,and the diagnosis results obtained according to LI-RADS(v2013)and LI-RADS(v1.0)were compared.Results Intraclass correlation coefficient(ICC)of lesion diameter evaluated by physician 1 and 2 was 0.998,while the Kappa coefficient of arterial phase hyperenhancement,portal venous phase/later phase hypoenhancement and substantial for capsule was 0.87,0.86 and 0.72,respectively.The Kappa coefficient of interobserver agreement of grading diagnosis using LI-RADS(v2013)was 0.85,same as that of final grading diagnosis after consultation of physicians and gold standards.The sensitivity,specificity,positive predictive value(PPV)and negative predictive value(NPV)for diagnosing positive(LR3-5)lesions was 100%(757/757),80.17%(287/358),91.43%(757/828)and 100%(287/287),respectively.There was significant difference in diagnosis of positive lesions between LI-RADS(2013)and LI-RADS(v1.0)(P<0.001).Conclusion The intraobserver consistency of diagnosing liver lesions with major imaging features and grading of lesions using LI-RADS(v2013)are both good.