2018版MRI肝脏影像报告和数据系统对肝内≤3.0 cm实质性病变的诊断效能分析

Analysis of the diagnostic performance of MRI Liver Imaging Reporting and Data System version 2018 for intrahepatic parenchymal substantial lesions≤3.0 cm

目的探讨2018版MRI肝脏影像报告和数据系统(LI-RADS v2018)对肝细胞癌(HCC)高危风险患者肝内≤3.0 cm实质性病变的诊断效能。方法回顾性分析2014年9月至2020年4月间经病理证实且病灶长径≤3.0 cm的131例非HCC病例资料,并按1∶1比例随机匹配131例病灶长径≤3.0 cm的HCC病例,分为良性组(56例)、肝脏其他恶性肿瘤(OM)组(75例)、HCC组(131例)。分析病灶的MRI征象并依据LI-RADS v2018标准对病灶进行分类(对兼有HCC征象和LR-M征象的病灶运用平局决胜规则)。以病理结果为金标准,计算LI-RADS v2018分类标准和更严格的LR-5标准(同时具备3个HCC主要征象)对诊断HCC、OM或良性病变的灵敏度、特异度。分类结果的比较采用Mann-Whitney U检验。结果应用平局决胜规则后HCC组归类为LR-M、LR-1、LR-2、LR-3、LR-4、LR-5的例数分别为14、0、0、12、28、77例,OM组分别为40、0、0、4、17、14例,良性组分别为8、5、1、26、13、3例;HCC组、OM组、良性组归为LR-5的病灶中符合更严格LR-5标准的例数分别为41例(41/77)、4例(4/14)、1例(1/3);以LR-4联合LR-5(LR-4/5)标准、LR-5标准、“更严格的LR-5标准”诊断HCC的灵敏度分别为80.2%(105/131)、58.8%(77/131)、31.3%(41/131),特异度分别为64.1%(84/131)、87.0%(114/131)、96.2%(126/131);以LR-M标准诊断OM的灵敏度为53.3%(40/75)、特异度为88.2%(165/187);以LR-1联合LR-2(LR-1/2)标准诊断肝良性病变的灵敏度为10.7%(6/56)、特异度为100%(206/206)。结论对肝内长径≤3.0 cm的病灶,LR-1/2、LR-5、LR-M标准相应的诊断特异度均较高;归类为LR-3的病灶更可能是良性病变;以LR-4/5标准诊断HCC的特异度低;更严格的LR-5标准对诊断HCC具有更高的特异度。

Objective To investigate the diagnostic performance of MRI Liver Imaging Reporting and Data System version 2018 in high-risk hepatocellular carcinoma(HCC)patients with intrahepatic parenchymal substantial lesions≤3.0 cm.Methods A retrospective analysis was conducted in hospitals between September 2014 to April 2020.131 pathologically confirmed non-HCC cases with lesions≤3.0 cm in diameter were randomly matched with 131 cases with lesions≤3.0 cm in diameter and divided into benign(56 cases),other hepatic malignant tumor(OM,75 cases),and HCC group(131 cases)in a 1:1 ratio.MRI features of the lesions were analyzed and classified according to LI-RADS v2018 criteria(tie-break rule was applied to lesions with both HCC and LR-M features).Taking the pathological results as the gold standard,the sensitivity and specificity of the LI-RADS v2018 classification criteria and the more stringent LR-5 criteria(with three main signs of HCC at the same time)were calculated for HCC,OM or benign lesions diagnosis.Mann-Whitney U test was used to compare the classification results.Results The number of cases classified as LR-M,LR-1,LR-2,LR-3,LR-4,and LR-5 in HCC group after applying the tie-break rule were 14,0,0,12,28,and 77,respectively.There were 40,0,0,4,17,14 and 8,5,1,26,13,3 cases in benign and OM group,respectively.There were 41(41/77),4(4/14)and 1(1/3)lesion case in the HCC,OM and benign group,respectively,that met the more stringent LR-5 criteria.The sensitivity of LR-4 combined with LR-5(LR-4/5)criteria,LR-5 criteria and more stringent LR-5 criteria for HCC diagnosis were 80.2%(105/131),58.8%(77/131)and 31.3%(41/131),respectively,and the specificity were 64.1%(84/131),87.0%(114/131)and 96.2%(126/131),respectively.The sensitivity and specificity of LR-M were 53.3%(40/75)and 88.2%(165/187),respectively.The sensitivity and specificity using LR-1 combined with LR-2(LR-1/2)criteria for the diagnosis of benign liver lesions were 10.7%(6/56)and 100%(206/206),respectively.Conclusions LR-1/2,LR-5,and LR-M criteria have high diagnostic specificity for intrahepatic lesions with a diameter of≤3.0 cm.Lesions classified as LR-3 are more likely to be benign.The specificity of LR-4/5 criteria is low,while the more stringent LR-5 criteria has a high specificity for HCC diagnosis.