基于超声造影LI-RADS分类标准对乙肝肝硬化肝细胞癌的一致性评价

Consistency evaluation of hepatocellular carcinoma with hepatitis B liver cirrhosis based on LI-RADS classification criteria of contrast-enhanced ultrasound

目的探讨超声造影LI-RADS分类标准对乙肝肝硬化患者肝细胞癌的一致性.方法选取我院2018年12月~2019年11月收治的疑似肝细胞癌患者112例,所有患者均于入院后行超声造影检查,根据LI-RADS分类标准进行诊断.将超声造影LI-RADS分类标准结果与病理诊断结果进行比较,以病检结果为金标准,计算前者的灵敏度、特异度、准确率.经Kappa检验分析LI-RADS分类标准与病检诊断的一致性.结果在112例乙肝肝硬化患者中,观察者之间一致性的Kappa值分别为0.624和0.633.肝细胞癌的始增时间、达峰时间、始消时间、持续时间均短于其他类型肝癌,具有统计学意义(P<0.05).经超声造影检出103个单发病灶,其中LR-1类21(20.39%)个、LR-2类6(5.80%)个、LR-3类5(4.80%)个、LR-4类26(25.24%)个、LR-5类15(14.56%)个、LR-M类30(29.13%)个.绘制ROC曲线评价的阳性预测值为65.22%,阴性预测值为89.17%,ROC曲线评价的AUC为0.774,拟合效果良好.结论超声LI-RADS分类诊断乙肝肝硬化病变具有一定的临床应用价值,超声造影LI-RADS分类标准对乙肝肝硬化患者肝细胞癌的评价具有一致性.

Objective To explore the consistency of the LI-RADS classification criteria of contrast-enhanced ultrasound for hepatocellular carcinoma in patients with hepatitis B cirrhosis.Methods We selected 112 patients with suspected hepatocellular carcinoma admitted in our hospital from December 2018 to November 2019.All patients underwent contrast-enhanced ultrasound examination after admission and were diagnosed according to IJ-RADS classification criteria.The LI-RADS classification standard results of contrast-enhanced ultrasound were compared with the pathological diagnosis results,and the disease examination results were used as the gold standard to calculate the sensitivity,specificity,and accuracy of the former.The consistency between LI-RADS classification criteria and disease diagnosis was analyzed by Kappa test.Results In 112 patients with hepatitis B cirrhosis,the inter-observer agreement Kappa values were 0.624 and 0.633,respectively.The initial growth time,peak time,initial disappearance time and duration of hepatocellular carcinoma were shorter than other types of liver cancer(P<0.05),which was statistically significant.103 lesions were detected by contrast-enhanced ultrasound,of which 21(20.39%)of LR-1 category,6(5.80%)of LR-2,5(4.80%)of LR-3,26(25.24)of (LR-4%),LR-5 category 15(14.56%),LR-M category 30(29.13%).The positive predictive value of the ROC curve evaluation was 65.22%,the negative predictive value was 89.17%,and the AUC of the ROC curve evaluation was 0.774.The fitting effect was good.Conclusion Ultrasound LI-RADS classification has certain clinical application value in the diagnosis of hepatitis B liver cirrhosis,and the LI-RADS classification standard of contrast-enhanced ultrasound is consistent with hepatocellular carcinoma in patients with hepatitis B cirrhosis.