基于钆塞酸二钠增强MRI 2017版与2018版肝脏影像报告与数据系统分类标准对肝硬化背景下肝细胞癌诊断效能的对照研究

Comparison of the diagnostic performance in the hepatocellular carcinoma with cirrhosis between the 2017 and 2018 versions of LI-RADS based on Gd-EOB-DTPA enhanced MRI

目的基于钆塞酸二钠(Gd-EOB-DTPA)增强MRI,比较2017版肝脏影像报告与数据系统(LI-RADS v2017)与2018版(LI-RADS v2018)分类标准对肝硬化背景下肝细胞癌(HCC)的诊断效能。方法回顾性收集2015年10月至2020年5月于南通大学附属南通第三医院行Gd-EOB-DTPA检查的213例肝硬化高危结节患者,共246个病灶。由2名放射科医师根据LI-RADS v2017和v2018分类标准,对MRI主要征象进行分析评估后对病灶分别进行分类。以术后病理或随访结果为金标准,分别以LR-5和LR-4+LR-5为诊断HCC的标准,计算LI-RADS v2017和v2018诊断HCC的灵敏度、特异度、准确度,两者的比较采用McNemar检验或Fisher确切概率法。结果246个病灶中,HCC 165个,非HCC恶性病变31个,良性病变50个。由于LI-RADS v2018中阈值增长和LR-5分类标准修订和简化,共38个(15.4%,38/246)病灶分类发生调整。LI-RADS v2017中84.6%(33/39)满足阈值增长的病变v2018归为亚阈值增长。10个病灶分类下调,7个由LR-5下调至LR-4,3个由LR-4下调至LR-3。28个病灶由LI-RADS v2017 LR-4类病变上调至LR-5,其中25个病灶为小HCC。以LR-5为诊断标准,LI-RADS v2018诊断HCC的灵敏度、准确度为66.7%(110/165)、73.6%(181/246),v2017为55.8%(92/165)、67.5%(166/246),差异均有统计学意义(χ^(2)=4.13,P=0.001;χ^(2)=6.20,P<0.001);特异度分别为87.7%(71/81)、91.4%(74/81),差异无统计学意义(χ^(2)=0.59,P=0.442)。在小病灶(最大径10~19 mm)中,LI-RADS v2018诊断HCC的灵敏度由v2017的40.4%(36/89)提升至62.9%(56/89),差异有统计学意义(χ^(2)=9.00,P<0.001)。以LR-4+LR-5为诊断标准,LI-RADS v2017与v2018诊断HCC的灵敏度、特异度、准确度差异均无统计学意义(P均>0.05)。结论基于Gd-EOB-DTPA增强MRI,与LI-RADS v2017相比,LI-RADS v2018诊断HCC具有较高的灵敏度和相似的特异度,尤其在小HCC(10~19 mm)诊断中灵敏度明显提升。

Objective To compare the diagnostic performance in the hepatocellular carcinoma(HCC)with cirrhosis between the 2017 version of liver imaging reporting and data system(LI-RADS v2017)and 2018 version of LI-RADS(LI-RADS v2018)based on gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid(Gd-EOB-DTPA)enhanced MRI.Methods Clinical data of 213 patients with 246 hepatic lesions with cirrhosis who underwent Gd-EOB-DTPA enhanced MRI in the Third Affiliated Nantong Hospital of Nantong University from October 2015 to July 2020 were retrospectively collected.The MRI major features and LR categories of lesions were respectively reviewed by two radiologists according to LI-RADS v2017 and LI-RADS v2018,respectively.Taking postoperative histopathological results or follow-up imaging as references,with the LR-5 and LR-4+LR-5 as the diagnosis of HCC,the sensitivity,specificity and accuracy of the LI-RADS v2017 and LI-RADS v2018 were evaluated,respectively.The McNemar test or Fisher exact test was used to compare the diagnostic performance between the two LI-RADS versions.Results In 246 hepatic lesions,165 were HCCs,31 were non-HCC malignancies and 50 were benign lesions.Due to the threshold growth and more simplified definition and changes in the LR-5 classification criteria in LI-RADS v2018,the categories of 38(15.4%,38/246)lesions were changed.The threshold growths of 84.6%(33/39)lesions in v2017 were reclassified to subthreshold growth in v2018.Using LI-RADS v2018,10 lesions were down-categorized compared with LI-RADS v2017,including LR-5 to LR-4 in 7 lesions and LR-4 to LR-3 in 3 lesions,and 28 lesions were up-categorized LR-4 to LR-5,in which 25 were small HCC.With LR-5 as the diagnosis criteria of HCC,the sensitivity and accuracy of LI-RADS v2018 were 66.7%(110/165)and 73.6%(181/246);and the sensitivity and accuracy of LI-RADS v2017 were 55.8%(92/165)and 67.5%(166/246),both with statistical differences(χ^(2)=4.13,P=0.001,χ^(2)=6.20,P<0.001).No significant difference was found in the specificity values of LI-RADS v2018 and v2017[87.7%(71/81)vs.91.4%(74/81)],(χ^(2)=0.59,P=0.442).Compared with v2017,LI-RADS v2018 increased the sensitivity in the diagnosis of small HCC lesions(10-19 mm)[62.9%(56/89)vs.40.4%(36/89),χ^(2)=9.00,P<0.001].With LR-4+LR-5 as the diagnostic criteria of HCC,there was no significant difference in the sensitivity,specificity and accuracy of LI-RADS v2017 and v2018 in the diagnosis of HCC(all P>0.05).Conclusions Based on Gd-EOB-DTPA enhanced MRI,LI-RADS v2018 has higher sensitivity and similar specificity in the diagnosis of HCC compared to v2017,especially in the diagnosis of small HCC(10-19 mm).