超声造影对CT/MRI诊断为LI-RADS-4类结节的诊断价值

Diagnostic value of contrast-enhanced ultrasound onLI-RADS-4 nodules categorized by CT/MRI

目的探讨超声造影在CT/MRI诊断为LI-RADS-4(LR-4)类结节的诊断价值。方法收集2019年1月至2020年12月期间经CT/MRI诊断为LR-4类结节的72例患者,一共90个结节,进行超声造影检查,利用肝脏影像和数据报告系统(LI-RADS)对结节重新分类,以手术或者活检病理诊断为"金标准",分析超声造影对这类结节的诊断价值。结果 90个CT/MRI诊断为LR-4的结节中,CEUS与CE CT/MRI在诊断模式及一致性上,有64个(71.11%)动脉相为高增强,24个(26.67%)等增强,2个环状增强(2.22%),延迟期无廓清38个(42.22%),轻度廓清50个(55.56%),显著廓清2个(2.22%)。CEUS与CT/MRI在动脉期表现的一致性是44.44%,在门脉期表现的一致性是73.33%,在延迟期表现的一致性是97.78%,40例(62.50%,40/64)在再次CEUS检查时动脉期呈高增强,2例环状增强,早期廓清(2个,LR-M),延迟期廓清(34个,LR-5),无廓清(6个,LR-4);重新使用CEUS LI-RADS分类后,升级为LR-5 38个,LR-M 2个,降级为LR-3 18个;其中LR-3类结节HCC 4个(22.22%),良性14个;LR-4类结节32个,HCC 20个(62.50%),良性12个;LR-5类结节38个,均为HCC(100.00%);LR-M类结节2个,均为HCC(100.00%);90个CT/MRI提示LR-4类结节HCC 63个,占71.11%;重新分类为LR-3、LR-4、LR-5、LR-M的结节中,其诊断效能显示,准确性分别为:17.70%、37.78%、71.11%、31.11%;敏感性分别为:6.25%、31.25%、59.38%、3.13%;特异性分别为:46.15%、53.50%、100.00%、100.00%;阳性预测值分别为:22.22%、62.50%、100.00%、100.00%;阴性预测值分别为:16.67%、24.14%、50.00%、29.55%。结论在CT/MRI诊断为LR-4的结节中增加超声造影分类,能明显提高诊断HCC的特异性、敏感性及准确性。

Objective To investigate the diagnostic value of contrast-enhanced ultrasound(CEUS)in the diagnosis of LI-RADS-4(LR-4)nodules categorized by CT/MRI.Methods From January 2019 to December 2020,72 patients with LR-4 nodules diagnosed by CT/MRI in our hospital(including 90 nodules)were collected for contrast-enhanced ultrasound examination.Liver imaging reporting and data system(LI-RADS)was used to reclassify the nodules,and surgery or biopsy pathological diagnosis were taken as the"gold standard".In addition,the diagnostic value of contrast-enhanced ultrasound in such nodules was analyzed.Results Among 90 nodules diagnosed as lR-4 by CT/MRI,in the diagnostic mode and consistency of CEUS and CE CT/MRI,64 nodules(71.11%)had high enhancement in arterial phase,24 nodules(26.67%)had equal enhancement,2 nodules(2.22%)had annular enhancement,38 nodules(42.22%)had no clearance in delayed phase,50 nodules(55.56%)had mild clearance,and 2 nodules(2.22%)had significant clearance.The consistency of CEUS and CT/MRI was 44.44%in arterial phase,73.33%in portal phase and 97.78%in delayed phase.40 cases(62.50%,40/64)showed high enhancement in arterial phase in re-examine of CEUS,2 cases showed annular enhancement,2 nodules showed early clearance(LR-M),34 nodules showed delayed clearance(LR-5)and 6 nodules showed no clearance(LR-4).After reusing CEUS LI-RADS classification,38 nodules were upgraded to LR-5,and 2 nodules to LR-M,and 18 nodules were downgraded to LR-3;among LR-3 nodules,4(22.22%)were HCC,and 14 were benign;of 32 LR-4 nodules,20(62.5%)were HCC,and 12 were benign;among 38 LR-5 nodules,all of them were HCC(100%);among 2 LR-M nodules,all of which were HCC(100%);CT/MRI showed that there were 63 HCC among 90 LR-4 nodules,accounting for 71.11%;among the nodules reclassified as LR-3,LR-4,LR-5,LR-M,the diagnostic efficiency showed that the accuracy was 17.70%,37.78%,71.11%,and 31.11%,respectively;the sensitivity was 6.25%,31.25%,59.38%,and 3.13%,respectively;the suggestibility was 46.15%,53.50%,100.00%,and 100.00%,respectively;the positive predictive value was 22.22%,62.50%,100.00%,and 100.00%,respectively;and the negative predictive value was 16.67%,24.14%,50.00%,and 29.55%,respectively.Conclusion In the CT/MRI diagnosis of LR-4 nodules,adding contrast-enhanced ultrasound classification can significantly improve the specificity,sensitivity and accuracy of diagnosis of HCC.