超声造影肝脏影像报告与数据系统对甲胎蛋白阴性患者肝脏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 in predicting the malignant risk of focal liver lesions in alphafetoprotein-negative patients

目的 探讨超声造影肝脏影像报告与数据系统2017版(CEUS LI-RADS v2017)对甲胎蛋白(AFP)阴性患者肝脏局灶性病变(FLL)恶性风险的预测价值。方法 选取我院行CEUS检查的108例AFP阴性FLL患者的134个结节,其中肝细胞癌(HCC)52个,非HCC恶性肿瘤(OM)22个,良性病灶60个。采用CEUS LI-RADS v2017对结节进行分类,以组织病理学结果或增强影像学检查和临床随访结果为金标准,计算CEUS LI-RADS v2017对AFP阴性患者FLL恶性风险的预测效能;绘制受试者工作特征曲线分析其曲线下面积(AUC)。结果 LR-5与LR-4、5诊断AFP阴性HCC的敏感性、特异性分别为73.08%和88.46%、93.90%和82.93%,差异均有统计学意义(均P<0.05);AUC分别为0.84和0.86,二者比较差异无统计学意义。LR-M诊断OM的敏感性、特异性和AUC分别为90.91%、97.32%和0.94。结论 CEUS LI-RADS v2017对AFP阴性患者FLL恶性风险有一定的预测价值;其中LR-5预测HCC的特异性高而敏感性低,而LR-4、5可提高其敏感性;LR-M对OM有较好的诊断价值。

Objective To investigate the value of contrast-enhanced ultrasound liver imaging reporting and data system version 2017(CEUS LI-RADS v2017)in predicting the malignant risk of focal liver lesions(FLL)in alpha-fetoprotein(AFP)-negative patients.Methods One hundred and thirty-four lesions in 108 high-risk patients with AFP-negative who underwent CEUS in our hospital were selected,including 52 hepatocellular carcinoma(HCC),22 other malignancies(OM)and 60 benign lesions.Lesions were categorized according to the CEUS LI-RADS v2017.The histopathologicl results or enhanced imaging and follow-up were used as the golden standard,the diagnostic efficacy of CEUS LI-RADS for predicting the malignant risk of FLL in AFP-negative patients were calculated.Receiver operating characteristic(ROC)curve was drawn to analyze the area under the curve(AUC).Results The LR-5 and combination of LR-4,5 were used as criteria for the diagnosis of AFP-negative HCC,there were statistically significant differences in the sensitivity(73.08%vs.88.46%,P<0.05)and specificity(93.90%vs.82.93%,P<0.05),while no significant difference in the AUC(0.84 vs.0.86).LR-M was used as criteria for the diagnosis of OM,the sensitivity,specificity and AUC were 90.91%,97.32%and 0.94,respectively.Conclusion CEUS LI-RADS has a certain value in predicting the malignant risk of FLL in AFP-negative patients,with high specificity of LR-5 and high sensitivity of LR-4,5 in predicting AFP-negative HCC,and has a better diagnostic value of LR-M for OM.