超声造影肝脏成像报告和数据系统对HBV感染肝细胞癌患者分类诊断的价值

Contrast-enhanced ultrasound LI-RADS classification in the diagnosis of hepatocellular carcinoma in patients with hepatitis B infection

目的探讨超声造影(CEUS)肝脏成像报告和数据系统(LI-RADS)对HBV感染肝细胞癌(HCC)患者诊断的价值,并评估CEUS LI-RADS M类(LR-M类)标准调整后的诊断效能。方法回顾丽水市中心医院2018年1月至2021年12月298例HBV抗原阳性患者的326个肝结节,分为CEUS LR-1类~LR-5类和LR-M类。通过调整标准早期廓清(60 s调整为45 s),以及晚期有无显著廓清(5 min内),将LR-M类亚组部分结节调整分类为LR-5类,并进行分析。通过准确度、灵敏度、特异度、阳性预测值和阴性预测值评估CEUS LI-RADS诊断效能。结果将早期廓清时间在45~60 s的LR-M类部分结节调整分类为LR-5类,LR-5类诊断HCC的准确度和灵敏度均有提高(0.601对0.779,0.557对0.788,P<0.01);LR-M类诊断非HCC恶性肿瘤的准确度和特异度均有提高(0.702对0.880,0.711对0.923,P<0.01)。根据5 min内未出现晚期显著廓清重新分类后,LR-5类的准确度和灵敏度均有提高(0.601对0.752,0.557对0.758,P<0.01);调整分类的LR-M类准确度和特异度均有提高(0.602对0.853,0.711对0.896,P<0.01)。结论CEUS LI-RADS 2017版LR-5类可以有效预测HBV感染患者中HCC的存在。通过对LR-M类中动脉期高增强、早期廓清(45~60 s)且5 min内无晚期显著廓清的结节进行重新分类为LR-5类,可能会进一步提高其诊断效能。

Objective To investigate the diagnostic efficiency of contrast-enhanced ultrasound(CEUS)liver imaging reporting and data system(LI-RADS)in HBV-infected patients with hepatocellular carcinoma.Methods A total of 326 hepatic nodules of 298 HBV infected patients were selected in Lishui Centcral Hospital from January 2018 to December 2021,and the nodules were classified into CEUS LR-1-LR-5 and LR-M.By adjusting the standard early washout(60 s to 45 s)and adding whether there was significant late washout(within 5 min),some nodules in the LR-M subgroup were adjusted and classified into LR-5.Reference criteria included pathological biopsy or multiphasic imaging and clinical follow-up results,and the diagnostic performance of LI-RADS was assessed.Results Some LR-M nodules with early clearance time of 45-60 s were reclassified into LR-5.The accuracy and sensitivity of LR-5 in the diagnosis of HCC were improved(0.601 vs.0.779,0.557 vs.0.788,P<0.01).The accuracy and specificity of LR-M in the diagnosis of non-HCC malignancies were improved(0.702 vs.0.880,0.711 vs.0.923,P<0.01).After reclassification based on the absence of late significant washout within 5 min,the accuracy and sensitivity of the LR-5 were improved(0.601 vs.0.752,0.557 vs.0.758,P<0.01),the accuracy and specificity of LR-M were increased(0.602 vs.0.853,0.711 vs.0.896,P<0.01).Conclusion CEUS LI-RADS 2017 version LR-5 class can effectively predict the presence of hepatocellular carcinoma in HBV-infected patients.The diagnostic performance can be further improved by reclassifying the LR-5 nodules with high arterial phase enhancement,early clearance(45-60 s)and no late significant clearance within 5 min in the LR-M category.