肝硬化相关铁沉积结节的LI-RADS MRI分类诊断及随访价值

Category Diagnosisand Follow-up of Cirrhotic Siderotic Nodules Depending on MRI Liver Imaging Reporting and Data System

目的基于肝脏影像报告和数据系统(LI-RADS)2018版分类标准,探讨MRI在肝硬化相关铁沉积结节(SN)的评分及随诊价值。方法回顾性分析本院54例肝硬化患者合并SN(167个病灶)的MRI随访资料,随访时长7~56个月,平均21.4个月。首诊LI-RADS评分,LI-RADS 2类105个,LI-RADS 3类56个,LI-RADS 4类6个,且未进行过活检、手术等治疗。记录随访期间病灶影像改变及LI-RADS分类调整情况。采用Kaplan-Meier曲线分析LI-RADS 2、LI-RADS≥3类SN上调至LI-RADS 5的累积发生率,并采用Log-Rank检验比较。结果105个LI-RADS 2类SN中,3个上调至LI-RADS 5,1个上调至LI-RADS 4,3个上调至LI-RADS 3;56个LI-RADS 3类SN中,4个上调至LI-RADS 5,2个上调LI-RADS 4;6个LI-RADS 4类SN中,2个上调至LI-RADS 5。9个SN演变为HCC中,均表现为病灶内铁廓清、T2WI信号的增高以及富血供转变。SN进展至LI-RADS 5的累积发生率为5.4%,其中LI-RADS≥3类病变上调至LI-RADS 5的累积发生率较LI-RADS 2类稍高,差异有统计学意义(P<0.05),12、24、36个月进展至LI-RADS 5的累积发生率LI-RADS≥3类SN分别为1.6%、8.1%、9.7%,LI-RADS 2类SN分别为0、1.0%、1.9%。结论约5.4%的SN转归为明确的HCC,其中LI-RADS≥3类病灶较LI-RADS 2类高,铁廓清、T2WI信号增高及富血供转变为SN多步癌演变重要的过程。

Objective To evaluate the category diagnosis and prognosis of cirrhotic siderotic nodules based on MRI liver imaging reporting and Data system(LI-RADS)version 2018.Methods The retrospective study included 54 patients with 167 cirrhotic siderotic nodules,the mean follow-up period was 21.4 months(range,7-56 months).Among all the lesions,105 were LR-2,56 were LR-3 and 6 were LR-4.The imaging features and category modifications were recorded for each lesion.The incidence for upgrade to LR-5 of LR-2 and LR≥3 siderotic nodules were analyzed by Kaplan-Meier curve.Log-Rank test was used to compare the results.Results Among 105 index LR-2 lesions,3 were upgraded to LR-5,1 upgraded to LR-4,3 upgraded to LR-3.Among 56 index LR-3 lesions,4 were upgraded to LR-5 and 2 were upgraded to LR-4.Among 6 index LR-4 lesions,2 were upgraded to LR-5.9 siderotic nodules of progression to HCC showed iron clearance,hyperintense on T2WI and hypervascular transformation during follow-up periods.The cumulative incidence of siderotic nodules up-regulated to LR-5 was 5.4%.The cumulative incidence of LR≥3 siderotic nodules at 12,24,36 months to LR-5 was 1.6%、8.1%、9.7%,and LR-2 lesions was 0、1.0%、1.9%(P<0.05).Conclusion Approximately 5.4%of siderotic nodules were upgraded to definite HCC.Iron clearance,hyperintense signal on T2WI and increased hypervascularity on the follow-up MRI indicated the multi-phase malignant transformation.