超声造影LI-RADS 2017版与MRI LI-RADS 2018版对肝内局灶性病变恶性风险的预测价值

Value of contrast-enhanced ultrasound liver imaging reporting and data system version 2017 and MRI liver imaging reporting and data system version 2018 in predicting the malignant risk of focal liver lesion

目的比较超声造影(CEUS)肝脏影像报告与数据系统(LI-RADS)2017版(v2017)和磁共振成像(MRI)LI-RADS 2018版(v2018)单独以及联合应用对肝细胞癌(HCC)高危患者肝内局灶性病变(FLL)恶性风险的预测价值。方法对2018年1月至2021年10月于上海交通大学医学院附属瑞金医院及瑞金医院无锡分院同时行CEUS和增强MRI检查的212例患者300个FLL的临床和影像学资料进行回顾性分析,入组结节均根据CEUS LI-RADS v2017和CT/MRI LI-RADS v2018分类标准进行分类,对2种影像学LI-RADS分类结果行Cohen′s Kappa检验。以组织病理学诊断或随访结果为金标准,比较2种影像学LI-RADS分类标准单独以及联合应用对FLL的恶性风险预测价值。结果CEUS LI-RADS v2017和MRI LI-RADS v2018两种影像学分类标准间总体一致性中等(Kappa=0.441)。CEUS LR-5和MRI LR-5单独应用以及联合应用诊断HCC的特异性分别为93.66%、95.07%、88.73%(P>0.05),阳性预测值分别为93.13%、93.81%、89.81%(P>0.05)。CEUS LR-M和MRI LR-M单独应用以及联合应用诊断非HCC恶性肿瘤的敏感性分别为85.71%、82.86%、100%,联合应用高于MRI LR-M(P=0.033),但与CEUS LR-M相当(P=0.063)。结论CEUS LI-RADS v2017与MRI LI-RADS v2018分类总体一致性中等,CEUS LR-5诊断HCC特异性和阳性预测值与MRI LR-5相似,CEUS LR-M诊断非HCC恶性肿瘤敏感性与MRI LR-M相似,联合应用CEUS和MRI LR-M可提高非HCC恶性肿瘤的诊断敏感性。

Objective To compare the predictive value of contrast-enhanced ultrasound(CEUS)Liver Imaging Reporting and Date System(LI-RADS)version 2017 with magnetic resonance imaging(MRI)LI-RADS version 2018 applied alone or in combination for focal liver lesions in high-risk patients.Methods From January 2018 to October 2021,the clinical and imaging datas of 212 patients with 300 nodules underwent CEUS and contrast-enhanced MRI(CEMRI)within 4 weeks in Ruijin Hospital and its Wuxi branch were retrospectively analyzed.Each nodule was categorized according to the CEUS LI-RADS v2017 and CT/MRI LI-RADS v2018.Inter-modalities agreement was assessed with Cohen′s Kappa.The diagnostic performances of the two classification criteria applied alone and in combination for the predictive value of malignant risk of focal liver lesions were compared using histopathology or follow-up as gold standard.Results The inter-modalities agreement of CEUS LI-RADS v2017 and MRI LI-RADS v2018 was moderate(Kappa=0.441).The specificity of CEUS LR-5,MRI LR-5 and CEUS LR-5+MRI LR-5 in the diagnosis of HCC was 93.66%,95.07%and 88.73%(P>0.05),respectively,positive predictive values of them were 93.13%,93.81%and 89.81%(P>0.05),respectively.The sensitivity of CEUS LR-M,MRI LR-M and CEUS LR-M+MRI LR-M in the diagnosis of non-HCC malignancy was 85.71%,82.86%and 100%,respectively.CEUS LR-M+MRI LR-M had higher sensitivity than MRI LR-M(P=0.033),whereas no difference was found between CEUS LR-M+MRI LR-M and CEUS LR-M(P=0.063).Conclusions The inter-modalities agreement of the LI-RADS category between CEUS and MRI is moderate.The specificity and positive predictive values of HCC in LR-5 of the CEUS and MRI LI-RADS are comparable.In addition,the sensitivity of non-HCC malignancy in LR-M of the CEUS and MRI LI-RADS are comparable.The combined application of CEUS and MRI LR-M can improve the diagnostic sensitivity of non-HCC malignancy.