超声造影LI-RADS v2017对MR LI-RADS v2018中LR-3类病灶的辅助诊断价值

Auxiliary diagnostic value of CEUS LI-RADS v2017 for LR-3 lesions in MR LI-RADS v2018

目的探讨超声造影(CEUS)肝脏影像报告和数据系统(LI-RADS)v2017(简称CEUS v2017)对MR LI-RADS v2018(简称MR v2018)中LR-3类病灶的辅助诊断价值。方法回顾性分析2017年1月至2021年8月间在丽水市中心医院就诊的274例肝细胞癌(HCC)高危风险患者超声增强造影与MR影像资料;对59个被MR v2018评估为LR-3的病灶[33个HCC,2个其他肝脏恶性肿瘤(OM),24个良性病变]再行CEUS v2017评估,采用χ2检验比较两套系统的评估结果差异。结果有43个LR-3(MR v2018)病灶在CEUS v2017再次评估中出现LR类别变化,最终被CEUS v2017归类为LR-M、LR-3、LR-4、LR-5者分别为5、16、22、16个,无LR-1和LR-2者。33个被MR v2018归为LR-3的HCC在CEUS v2017中被归类为LR-M、LR-3、LR-4、LR-5的个数分别为3、4、12、14个;2个被MR v2018归为LR-3的OM在CEUS v2017中均被归类为LR-5;24个被MR v2018归为LR-3的良性病变在CEUS v2017中被归类为LR-M、LR-3、LR-4、LR-5的个数分别为2、12、10、0个。MR v2018与CEUS v2017在LR-3类病变中HCC、OM与良性病变的例数比较差异有统计学意义(P<0.05)。结论在CEUS v2017的再评估结果中符合LR-5者有很大的概率是HCC,而符合LR-3者有很大的概率是良性病变;但被CEUS v2017评估为LR-4者可能仍难以区分良恶性。

Objective To explore the auxiliary diagnostic value of contrast-enhanced ultrasound(CEUS)liver imaging reporting and data system(LI-RADS)v2017 for LR-3 lesions in MR LI-RADS v2018.Methods CEUS and MRI data of 274 patients with high risk for hepatocellular carcinoma(HCC)admitted to Lishui Municipal Central Hospital from January 2017 to August 2021 were retrospectively analyzed.Fifty-nine lesions,including 33 HCC,2 other hepatic malignancy(OM)and 24 benign lesions assessed as LR-3 by MR LI-RADS v2018 were reevaluated by CEUS LI-RADS v2017.The difference between the evaluation results by the two systems was compared usingχ2 test.Results Forty-three LR-3 lesions assessed by MRI LI-RADS v2018 showed LR classification changes when reassessed by CEUS LI-RADS v2017;and 5,16,22,and 16 patients were finally classified as LR-M,LR-3,LR-4,and LR-5,respectively,while none was LR-1 or LR-2.Among the 33 HCC patients classified as LR-3 by MR LI-RADS v2018,3,4,12,and 14 cases were classified as LR-M,LR-3,LR-4,and LR-5 by CEUS LI-RADS v2017,respectively.Two cases of OM classified as LR-3 by MR LI-RADS v2018 were classified as LR-5 by CEUS LI-RADS v2017.Among the 24 benign lesions classified as LR-3 by MR LI-RADS v2018,2,12,10,and 0 were classified as LR-M,LR-3,LR-4,and LR-5 by CEUS LI-RADS v2017,respectively.The difference between MR LI-RADS v2018 and CEUS LI-RADS v2017 in the number of HCC,OM and benign lesions of LR-3 lesions was statistically significant(P<0.05).Conclusion Patients who meet LR-5 in the CEUS LI-RADS v2017 reassessment results have a high probability of being HCC,while those who meet LR-3 have a high probability of being benign lesions.However,those assessed as LR-4 by CEUS LI-RADS v2017 may still have difficulty for distinguishing between benign and malignant.