超声造影LI-RADS分类对肝硬化背景下直径<2cm肝脏结节性质诊断的价值

目的探讨超声造影肝脏影像报告和数据管理系统(CEUS LI-RADS)对肝硬化背景下直径<2 cm肝脏结节良恶性鉴别诊断的价值。方法回顾性分析2019年7月至2022年7月肝硬化伴最大直径≤2 cm肝脏单发实性结节患者142例,经肝脏穿刺病理或手术病理确诊恶性67例和良性75例,采用常规多普勒超声及超声造影评估结节位置、大小、增强程度及模式、廓清及廓清时间,LI-RADS分类包括LR-1~5和M,以LR-5为肝细胞癌和LR-M为其他恶性肿瘤评估诊断效能。结果良恶性组患者临床资料包括性别、年龄、饮酒、高血压、糖尿病和高脂血症、肝硬化病程、乙型肝炎和丙型肝炎以及病毒载量,血生化包括空腹血糖、总胆固醇和低密度脂蛋白胆固醇、谷丙转氨酶、总胆红素、乳酸脱氢酶、血肌酐和尿素氮以及白蛋白水平差异无统计学意义(P>0.05)。两组常规超声显示结节位置、最大直径、回声及血流灌注差异无统计学意义(P>0.05)。恶性组动脉期显著增强,门脉期和延迟期等或低增强,“快进快出”模式,延迟廓清,廓清时间延长,差异有统计学意义(P<0.05)。CEUSLI-RADS分类评估LR-5和LR-M共50例,LR-1~492例,以LR-5和LR-M作为诊断肝结节恶性的标准,诊断准确性为83.80%,敏感度为70.15%,特异度为96.00%,阳性预测值为94.00%,阴性预测值为78.26%,阳性似然比为53.73%,阴性似然比为31.09%,假阳性率为4.00%,假阴性率为29.85%。受试者操作曲线(ROC)计算超声造影LI-RADS分类诊断恶性结节的曲线下面积(AUC)为0.846(95%CI=0.797~0.899,P<0.001),最大约登指数为66.15%。结论超声造影LI-RADS分类对肝硬化伴直径<2 cm肝脏结节良恶性质鉴别诊断仍有较高的准确性和特异度,有较好的临床应用价值。

Objective To investigate the value of contrast-enhanced ultrasound(CEUS)liver imaging report and data management system(LI-RADS)classification in the differential diagnosis of liver cirrhosis with liver nodules diameter less than 2 cm.Methods From August 2020 to August 2022,142 patients of liver cirrhosis with single solid nodule maximum diameter≤2 cm in our hospital were reviewed,67 patients were diagnosed as malignant and 75 patients were benign by liver puncture pathology.The node location,size,enhancement degree and mode,clearance and clearance time were evaluated by transabdominal color Doppler CEUS.The LI-RADS classification included 1~5 and M,LR-5 as Hepatocellular Carcinoma and LR-M as other malignant tumors,then to evaluate the diagnostic efficacy of LI-RADS.Results The clinical datas between benign and malignant patients including gender,age,drinking,hypertension,diabetes and hyperlipidemia,the course of liver cirrhosis,hepatitis B,hepatitis C and viral load,blood biochemistry including fasting blood glucose,total cholesterol and low-density lipoprotein cholesterol,alanine aminotransferase,total bilirubin,lactate dehydrogenase,serum creatinine,urea nitrogen and albumin levels had no differences(P>0.05).The location,maximum diameter,echo and blood flow perfusion of the nodules in the two groups showed no differences by the conventional ultrasound(P>0.05).In malignant group,arterial phase was significantly enhanced,portal phase and delayed phase were equivalently enhanced,"fast in and fast out"mode,delayed clearance,and clearance time was longer,too(P<0.05).Fifty LR-5 and LR-M patients were evaluated by CEUS,other 92 patients were evaluated 1~4.The diagnostic accuracy was 83.80%,sensitivity was 70.15%,specificity was 96.00%,positive predictive value was 94.00%,negative predictive value was 78.26%,positive likelihood ratio was 53.73%,negative likelihood ratio was 31.09%,false positive rate was 4.00%,and false negative rate was 29.85%.The area under curve(AUC)of CEUS LI-RADS for malignant nodules diagnosis by receiver operating curve(ROC)was 0.846(95%CI=0.797~0.899,P<0.001),and maximum Jordan-index was 66.15%.Conclusion CEUS LI-RADS classification still has a high accuracy and specificity in the differential diagnosis of benign and malignant liver nodules diameter less than 2 cm under liver cirrhosis background,which has a good clinical value.