超声造影LI-RADS与增强CT/MRI LI-RADS对肝微小病灶分类的一致性及差异性研究

Inconsistent and consistent classifications for small liver lesions by contrast-enhanced ultrasound LI-RADS and CECT/MRI LI-RADS

目的分析超声造影(CEUS)肝脏影像报告和数据系统(LI-RADS)2017版和增强CT(CECT)/MRI LI-RADS 2018版对长径≤2 cm肝微小病灶分类的一致性及差异性。方法回顾性收集2018年1月至2019年6月在天津市第三中心医院同时接受CEUS和CECT或钆塞酸二钠增强磁共振成像(EOB-MRI)检查且具有肝细胞癌(hepatocellular carcinoma,HCC)高危风险的145例患者共145个病灶,按照CEUS LI-RADS 2017版和CECT/MRI LI-RADS 2018版分类标准对病灶进行LI-RADS分类。通过Kappa检验评估两种影像学LI-RADS分类的一致性。并对CEUS和CECT/MRI LI-RADS分类不一致的病灶行进一步分析。结果145个病灶长径为(1.65±0.33)cm。CEUS及CECT/MRI分类为LR-3、4、5、M病灶数分别为16、23、90、16个和25、31、87、2个。CEUS分类为LR-5、M共106个(73.1%),CECT/MRI分类为LR-5、M共89个(61.4%),差异有统计学意义(P=0.033)。CEUS及CECT/MRI分类为LR-3、4、5类中HCC的阳性预测值分别为37.5%、52.2%、97.8%和56.0%、64.5%、96.6%。56个病灶CEUS与CECT/MRI LI-RADS分类不一致。CECT/MRI分类LR-3、4类中28个被CEUS上调为LR-4、5类,HCC所占比例为82.1%。CEUS分类LR-3、4类中14个被CECT/MRI分类上调,HCC所占比例为85.7%。结论CECT/MRI及CEUS中LR-5类对HCC均具有较高的阳性预测值,但二者对LI-RADS分类的一致性较差。CEUS分类为LR-5、M病灶数较CECT/MRI显著增多。CECT/MRI分类LR-3、4类中HCC比例高于CEUS。

Objective To explore the inconsistent and consistent classifications for lesions≤2 cm by contrast-enhanced ultrasound(CEUS)Liver Imaging Reporting and Data System(LI-RADS)v2017 and contrast-enhanced computed tomography/contrast-enhanced magnetic resonance imaging(CECT/MRI)LI-RADS v2018.Methods The focal liver lesions≤2 cm underwent CEUS and CECT/MRI within 1 month were enrolled in this retrospective study.Each nodule was categorized according to the CEUS LI-RADS v2017 and CECT/MRI LI-RADS v2018.Intermodality agreement between the CEUS LI-RADS and CECT/MRI LI-RADS for each lesion was assessed with Cohen′s Kappa.Lesions with inconsistent classification for CEUS LI-RADS and CECT/MRI were analyzed.Results A total of 145 lesions with a size of(1.65±0.33)cm in 145 patients were included.The numbers of lesions in LR-3,4,5 and M were 16,23,90 and 16 on CEUS LI-RADS,25,31,87 and 2 on CECT/MRI,respectively.And 73.1%lesions were classified as LR-5 or M on CEUS,while 61.4%lesions were classified as LR-5 or M on CECT/MRI(P=0.033).The incidences of HCC in LR-3,4 and 5 were 37.5%,52.2%and 97.8%on CEUS LI-RADS,56.0%,64.5%and 96.6%on CECT/MRI LI-RADS respectively.Among the 145 lesions,56 lesions had inconsistent classifications of CEUS and CECT/MRI LI-RADS.Twenty-eight lesions in CECT/MRI LR-3 and 4 were escalated to LR-4 and 5 by CEUS and 82.1%of them were found to be HCC.Fourteen lesions on CEUS LR-3 and 4 were escalated to LR-4 and 5 by CECT/MRI and 85.7%of them were found to be HCC.Conclusions The LR-5 of the CEUS and CECT/EOB-MRI LI-RADS has a comparable incidence of HCC.However,the inter-modality agreement of the LI-RADS category between CEUS and CECT/EOB-MRI is poor.The proportion of lesions in CEUS LR-5 and M is much higher than that in CECT/MRI LR-5 and M,while the proportion of lesions in CECT/MRI LR-3 and 4 is high than that in CEUS LR-3 and 4.