Contrast-enhanced ultrasound Liver Imaging Reporting and Data System:Lights and shadows in hepatocellular carcinoma and cholangiocellular carcinoma diagnosis

BACKGROUND Contrast-enhanced ultrasound(CEUS)is considered a secondary examination compared to computed tomography(CT)and magnetic resonance imaging(MRI)in the diagnosis of hepatocellular carcinoma(HCC),due to the risk of misdiagnosing intrahepatic cholangiocarcinoma(ICC).The introduction of CEUS Liver Imaging Reporting and Data System(CEUS LI-RADS)might overcome this limitation.Even though data from the literature seems promising,its reliability in real-life context has not been well-established yet.AIM To test the accuracy of CEUS LI-RADS for correctly diagnosing HCC and ICC in cirrhosis.METHODS CEUS LI-RADS class was retrospectively assigned to 511 nodules identified in 269 patients suffering from liver cirrhosis.The diagnostic standard for all nodules was either biopsy(102 nodules)or CT/MRI(409 nodules).Common diagnostic accuracy indexes such as sensitivity,specificity,positive predictive value(PPV),and negative predictive value(NPV)were assessed for the following associations:CEUS LR-5 and HCC;CEUS LR-4 and 5 merged class and HCC;CEUS LR-M and ICC;and CEUS LR-3 and malignancy.The frequency of malignant lesions in CEUS LR-3 subgroups with different CEUS patterns was also determined.Inter-rater agreement for CEUS LI-RADS class assignment and for major CEUS pattern identification was evaluated.RESULTS CEUS LR-5 predicted HCC with a 67.6%sensitivity,97.7%specificity,and 99.3%PPV(P<0.001).The merging of LR-4 and 5 offered an improved 93.9%sensitivity in HCC diagnosis with a 94.3%specificity and 98.8%PPV(P<0.001).CEUS LR-M predicted ICC with a 91.3%sensitivity,96.7%specificity,and 99.6%NPV(P<0.001).CEUS LR-3 predominantly included benign lesions(only 28.8%of malignancies).In this class,the hypo-hypo pattern showed a much higher rate of malignant lesions(73.3%)than the iso-iso pattern(2.6%).Inter-rater agreement between internal raters for CEUS-LR class assignment was almost perfect(n=511,k=0.94,P<0.001),while the agreement among raters from separate centres was substantial(n=50,k=0.67,P<0.001).Agreement was stronger for arterial phase hyperenhancement(internal k=0.86,P<2.7×10-214;external k=0.8,P<0.001)than washout(internal k=0.79,P<1.6×10-202;external k=0.71,P<0.001).CONCLUSION CEUS LI-RADS is effective but can be improved by merging LR-4 and 5 to diagnose HCC and by splitting LR-3 into two subgroups to differentiate iso-iso nodules from other patterns.

Magnetic resonance imaging ancillary features used in Liver Imaging Reporting and Data System:An illustrative review

Hepatocellular carcinoma (HCC) usually develops in the setting of chronic liver disease. In the adequate clinical context, both multiphasic contrast-enhanced CT and magnetic resonance imaging are non-invasive modalities that allow accurate diagnosis and staging of HCC, although the latter demonstrates greater sensitivity and specificity. Imaging criteria for HCC diagnosis rely on hemodynamic features such as hyperenhancement in the arterial phase and washout in the portal or equilibrium phase. However, imaging performance drops considerably for small (< 20 mm) nodules because their tendency to exhibit atypical enhancement patterns. In order to improve accuracy in the diagnosis and staging of HCC, particularly in cases of atypical nodules, ancillary features, i.e., imaging characteristics that modify the likelihood of HCC, have been described and incorporated into clinical reports, especially in Liver Imaging Reporting and Data System. In this paper, ancillary imaging features will be reviewed and illustrated.

Interobserver agreement for contrast-enhanced ultrasound of liver imaging reporting and data system:A systematic review and metaanalysis

BACKGROUND Hepatocellular carcinoma is the most common primary liver malignancy.From the results of previous studies,Liver Imaging Reporting and Data System(LIRADS)on contrast-enhanced ultrasound(CEUS)has shown satisfactory diagnostic value.However,a unified conclusion on the interobserver stability of this innovative ultrasound imaging has not been determined.The present metaanalysis examined the interobserver agreement of CEUS LI-RADS to provide some reference for subsequent related research.AIM To evaluate the interobserver agreement of LI-RADS on CEUS and analyze the sources of heterogeneity between studies.METHODS Relevant papers on the subject of interobserver agreement on CEUS LI-RADS published before March 1,2020 in China and other countries were analyzed.The studies were filtered,and the diagnostic criteria were evaluated.The selected references were analyzed using the“meta”and“metafor”packages of R software version 3.6.2.RESULTS Eight studies were ultimately included in the present analysis.Meta-analysis results revealed that the summary Kappa value of included studies was 0.76[95%confidence interval,0.67-0.83],which shows substantial agreement.Higgins I2 statistics also confirmed the substantial heterogeneity(I2=91.30%,95%confidence interval,85.3%-94.9%,P<0.01).Meta-regression identified the variables,including the method of patient enrollment,method of consistency testing,and patient race,which explained the substantial study heterogeneity.CONCLUSION CEUS LI-RADS demonstrated overall substantial interobserver agreement,but heterogeneous results between studies were also obvious.Further clinical investigations should consider a modified recommendation about the experimental design.

Hepatocellular carcinoma Liver Imaging Reporting and Data Systems treatment response assessment: Lessons learned and future directions

Hepatocellular carcinoma(HCC)is a leading cause of morbidity and mortality worldwide,with rising clinical and economic burden as incidence increases.There are a multitude of evolving treatment options,including locoregional therapies which can be used alone,in combination with each other,or in combination with systemic therapy.These treatment options have shown to be effective in achieving remission,controlling tumor progression,improving disease free and overall survival in patients who cannot undergo resection and providing a bridge to transplant by debulking tumor burden to downstage patients.Following locoregional therapy(LRT),it is crucial to provide treatment response assessment to guide management and liver transplant candidacy.Therefore,Liver Imaging Reporting and Data Systems(LI-RADS)Treatment Response Algorithm(TRA)was created to provide a standardized assessment of HCC following LRT.LIRADS TRA provides a step by step approach to evaluate each lesion independently for accurate tumor assessment.In this review,we provide an overview of different locoregional therapies for HCC,describe the expected post treatment imaging appearance following treatment,and review the LI-RADS TRA with guidance for its application in clinical practice.Unique to other publications,we will also review emerging literature supporting the use of LI-RADS for assessment of HCC treatment response after LRT.

Liver Imaging Reporting and Data System criteria for the diagnosis of hepatocellular carcinoma in clinical practice: A pictorial minireview

Hepatocellular carcinoma(HCC)is the sixth most common cancer.The main risk factors associated with HCC development include hepatitis B virus,hepatitis C virus,alcohol consumption,aflatoxin B1,and nonalcoholic fatty liver disease.However,hepatocarcinogenesis is a complex multistep process.Various factors lead to hepatocyte malignant transformation and HCC development.Diagnosis and surveillance of HCC can be made with the use of liver ultrasound(US)every 6 mo.However,the sensitivity of this imaging method to detect HCC in a cirrhotic liver is limited,due to the abnormal liver parenchyma.Computed tomography(CT)and magnetic resonance imaging(MRI)are considered to be most useful tools for at-risk patients or patients with inadequate US.Liver biopsy is still used for diagnosis and prognosis of HCC in specific nodules that cannot be definitely characterized as HCC by imaging.Recently the American College of Radiology designed the Liver Imaging Reporting and Data System(LI-RADS),which is a comprehensive system for standardized interpretation of CT and MRI liver examinations that was first proposed in 2011.In 2018,it was integrated into the American Association for the Study of Liver Diseases guidance statement for HCC.LI-RADS is designed to ensure high sensitivity,precise categorization,and high positive predictive value for the diagnosis of HCC and is applied to“highrisk populations”according to specific criteria.Most importantly LI-RADS criteria achieved international collaboration and consensus among liver experts around the world on the best practices for caring for patients with or at risk for HCC.

Differentiating malignant and benign focal liver lesions in children using CEUS LI-RADS combined with serum alpha-fetoprotein

BACKGROUND Contrast-enhanced ultrasound(CEUS)can be used to diagnose focal liver lesions(FLLs)in children.The America College of Radiology developed the CEUS liver imaging reporting and data system(LI-RADS)for standardizing CEUS diagnosis of FLLs in adult patients.Until now,no similar consensus or guidelines have existed for pediatric patients to improve imaging interpretation as adults.AIM To evaluate the performance of CEUS LI-RADS combined with alpha-fetoprotein(AFP)in differentiating benign and malignant FLLs in pediatric patients.METHODS Between January 2011 and January 2021,patients≤18 years old who underwent CEUS for FLLs were retrospectively evaluated.The following criteria for diagnosing malignancy were proposed:Criterion I considered LR-4,LR-5,or LRM lesions as malignancies;criterion II regarded LR-4,LR-5 or LR-M lesions with simultaneously elevated AFP(≥20 ng/mL)as malignancies;criterion III took LR-4 Lesions with elevated AFP or LR-5 or LR-M lesions as malignancies.The sensitivity,specificity,accuracy and area under the receiver operating characteristic curve(AUC)were calculated to determine the diagnostic value of the aforementioned criteria.RESULTS The study included 63 nodules in 60 patients(mean age,11.0±5.2 years;26 male).There were no statistically significant differences between the specificity,accuracy,or AUC of criterion II and criterion III(95.1%vs 80.5%,84.1%vs 87.3%,and 0.794 vs 0.902;all P>0.017).Notably,criterion III showed a higher diagnostic sensitivity than criterion II(100%vs 63.6%;P<0.017).However,both the specificity and accuracy of criterion I was inferior to those of criterion II and criterion III(all P<0.017).For pediatric patients more than 5 years old,the performance of the three criteria was overall similar when patients were subcategorized by age when compared to all patients in aggregate.CONCLUSION CEUS LI-RADS combined with AFP may be a powerful diagnostic tool in pediatric patients.LR-4 with elevated AFP,LR-5 or LR-M lesions is highly suggestive of malignant tumors.

阈值增长对肝细胞癌的诊断效能

目的:探讨肝脏影像报告和数据系统2018版(LI-RADS v2018)中的主要征象阈值增长(TG)对肝细胞癌(HCC)的诊断效能。方法:回顾性分析首诊、随访均行MRI检查,且首诊病灶为LI-RADS 2~4类的肝硬化患者215例。记录TG出现率及LI-RADS分类调整情况。对TG不作为及作为主要征象的病灶分别进行LI-RADS分类。通过计算诊断优势比(DOR)确定TG与HCC诊断的相关性。以术后病理或临床诊断为金标准,以LI-RADS 5类为诊断HCC的标准,分别计算TG不作为及作为主要征象的诊断效能。结果:215例患者共253个病灶,其中HCC 157个、非HCC恶性肿瘤21个、良性病变75个。HCC中TG的出现率为32.5%(51/157),TG与HCC显著相关,DOR值为5.29(95%CI 2.39~11.75)(P<0.001)。当TG不作为主要征象时,51个HCC分类为LI-RADS 3类15个、LI-RADS 4类6个、LI-RADS 5类28个、LI-RADS M类2个。当TG作为主要征象时,21个HCC分类发生调整,其中15个LI-RADS 3类上调至LI-RADS 5类[最大径10~19 mm+非环状动脉期高强化(APHE)],6个LI-RADS 4类上调至LI-RADS 5类(最大径10~19 mm+非环状APHE+强化包膜1个,最大径≥20 mm+非环状APHE 5个)。以LI-RADS 5类为标准诊断HCC,TG作为主要征象与不作为主要征象相比,敏感度(75.2%vs.61.8%,P<0.001)、准确率(83.0%vs.75.5%,P<0.001)更高,特异度(95.8%vs.97.9%,P=0.683)相似。结论:TG与HCC显著相关,TG作为LI-RADS v2018中的主要征象之一可提高HCC(尤其表现为非环状APHE+TG)的诊断敏感度和准确率。

增强MRI采用LI-RADS v2018对肝细胞癌的诊断效能

目的:探讨增强MRI采用2018版肝脏影像报告和数据系统(LI-RADS)在高危人群中对肝细胞癌(HCC)的诊断效能。方法:回顾性分析本院2017年至2022年经病理证实的69例HCC患者,并且行MRI增强检查。基于LI-RADS v2018,对每个病灶MRI图像的主要/辅助征象进行评价及LI-RADS分类。以病理结果为金标准,评价增强MRI采用LI-RADS v2018对HCC的诊断效能。采用组内相关系数(ICC)评价阅片者的一致性。结果:3位阅片者间LI-RADS分类的ICC值为0.782(95%可信区间0.713~0.841)。基于LI-RADS v2018,以LR-5为诊断标准,MRI阅片者1诊断HCC的敏感度、特异度和准确率分别为83.9%、70.4%和79.8%;阅片者2分别为80.6%、74.1%和78.7%;阅片者3分别为80.6%、77.8%和79.8%。以LR-4联合LR-5为诊断标准,阅片者1诊断HCC的敏感度、特异度和准确率分别为93.5%、63.0%和84.3%,阅片者2分别为90.3%、66.7%和83.1%,阅片者3分别为91.9%、66.7%和84.3%。结论:基于LI-RADS v2018,增强MRI在高危人群中诊断HCC具有较高的诊断价值。

Systematic Training of Liver Imaging Reporting and Data System Magnetic Resonance Imaging v2018 can Improve the Diagnosis of Hepatocellular Carcinoma for Different Radiologists

Background and Aims:Liver imaging reporting and data system(LI-RADS)provides standardized lexicon and categorization for diagnosing hepatocellular carcinoma(HCC).However,there is limited knowledge about the effect of LI-RADS training.We prospectively explored whether the systematic training of LI-RADS v2018 on magnetic resonance imaging(MRI)can effectively improve the diagnostic performances of different radiologists for HCC.Methods:A total of 20 visiting radiologists and the multiparametric MRI of 70 hepatic observations in 61 patients with high risk of HCC were included in this study.The LI-RADS v2018 training procedure included three times of thematic lectures(each lasting for 2.5 h)given by a professor specialized in imaging diagnosis of liver,with an interval of a month.After each seminar,the radiologists had a month to adopt the algorithm into their daily work.The diagnostic performances and interobserver agreements of these radiologists adopting the algorithm for HCC diagnosis before and after training were compared.Results:A total of 20 radiologists(male/female,12/8;with an average age of 36.75±4.99 years)were enrolled.After training,the interobserver agreements for the LI-RADS category for all radiologists(p=0.005)were increased.The sensitivity,specificity,positive predictive value,negative predictive value,and coincidence rate of all radiologists for HCC diagnosis before and after training were 43%vs.54%,86%vs.88%,74%vs.81%,62%vs.67%,and 65%vs.71%,respectively.The diagnostic performances of all radiologists(p<0.001)showed improvement after training.Conclusions:The systematic training of LI-RADS can effectively improve the diagnostic performances of radiologists with different experiences for HCC.

基于LI-RADS v2018及MRI特征对肝细胞癌CK19表达的风险预测及预后评估

目的 探讨2018版肝脏影像报告和数据系统(Liver Imaging Reporting and Data System version 2018,LI-RADS v2018)对肝细胞癌(hepatocellular carcinoma,HCC)细胞角蛋白19(cytokeratin 19,CK19)表达的术前预测及预后评估的价值。材料与方法 回顾性分析220例术前接受MRI检查并经病理证实为HCC患者的临床、病理及影像资料,包括CK19阳性组59例,CK19阴性组161例。将患者按7∶3比例分为训练集和验证集。通过单因素与多因素logistic回归分析确定CK19阳性表达HCC的独立预测因素并构建列线图评分模型。采用受试者工作特征(receiver operating characteristic,ROC)曲线分析模型诊断效能,绘制校准曲线、决策曲线评价模型的校准性能和临床适用性。计算患者的列线图得分并进行高低风险分组,采用Kaplan-Meier生存曲线分析比较不同亚组患者的总体、早期及晚期无复发生存率。结果 晕状强化(OR=3.432,P=0.045)、环形动脉期高强化(OR=32.073,P=0.017)、靶样扩散受限(OR=12.941,P=0.006)、不光滑肿瘤边缘(OR=4.590,P=0.014)及肝胆期肿瘤-肝实质相对增强比(the relative enhancement ratio,RER)(OR=0.014,P=0.023)是CK19阳性表达HCC的独立预测因素。预测模型在训练集和验证集的曲线下面积(area under the curve,AUC)分别为0.884(95%CI:0.823~0.930)、0.748(95%CI:0.625~0.846),校准曲线、决策曲线显示模型的校准性能和临床适用性较好。CK19阳性与阴性组的总体无复发生存率、高与低风险组的总体、早期及晚期无复发生存率之间均存在显著差异(P<0.05)。结论 晕状强化、环形动脉期高强化、靶样扩散受限结合不光滑肿瘤边缘、肝胆期增强定量参数可对HCC的CK19表达进行术前风险预测,并有助于评估HCC术后复发。

MRI特征评分模型预测增殖型肝细胞癌

目的观察MRI特征评分模型预测增殖型肝细胞癌(HCC)的价值。方法回顾性分析241例经病理证实HCC患者,包括90例增殖型HCC、151例非增殖型HCC;采用单因素及多因素logistic回归分析比较组间临床及基于2018版肝脏影像报告和数据系统评估的MRI表现,筛选增殖型HCC的独立预测因素,根据其权重赋分并构建评分模型。绘制受试者工作特征(ROC)曲线,计算曲线下面积(AUC),评估模型预测效能;根据评分最佳截断值将患者分为高、低增殖风险亚组,比较组间及亚组间无复发生存(RFS)率和早期RFS率。结果MRI显示肿瘤晕状强化、动脉期环形高强化、瘤内血管、大量病灶实质低强化及边缘不规则均为增殖型HCC的独立预测因素(OR=3.287、2.362、4.542、2.997、2.379,P均<0.05),分别赋分7、5、9、7、5分,总分0~33分;以之建立的评分模型预测增殖型HCC的AUC为0.818。以9分为最佳截断值进行判断,高、低增殖风险分别为97例及144例。组间、亚组间RFS率及早期RFS率差异均有统计学意义(P均<0.05)。结论MRI特征评分模型可有效预测增殖型HCC。

多参数磁共振成像联合LI-RADS分级标准对肝硬化再生结节与小肝癌的诊断价值及临床意义

目的探讨多参数磁共振成像(Mp-MRI)联合肝脏影像报告和数据管理系统(LI-RADS)分级标准对肝硬化再生结节与小肝癌(SHCC)的诊断价值及临床意义。方法选取2019年3月至2023年3月我院直径≤3 cm的肝脏结节患者86例(132个结节),根据手术病理结果将肝硬化再生结节38例(54个结节)记为良性组,SHCC 48例(78个结节)记为恶性组。比较2组LI-RADS分级和Mp-MRI参数[增强率(ER)、平均强化时间(MET)、最大上升斜率(MSI)、最大下降斜率(MSD)、表观扩散系数(ADC)、脂肪分数(FF)],分析其诊断价值。结果经LI-RADS分级标准诊断,132个结节中共检出阳性76个,阴性56个,其中假阳性10个,假阴性12个;恶性组ER、MET、MSI、ADC低于良性组,FF、MSD高于良性组(P<0.05);受试者操作特征(ROC)曲线分析结果显示,Mp-MRI参数联合LI-RADS分级标准诊断肝硬化再生结节与SHCC的曲线下面积(AUC)为0.946(95%CI:0.892~0.977),约登指数为0.811,灵敏度为88.46%,特异度为92.59%,优于各Mp-MRI参数及LI-RADS分级单独诊断;恶性组不同病理分级结节LI-RADS分级比较,差异有统计学意义(P<0.05);ER、MET、MSI、ADC在高分化结节中最高,中分化结节次之,低分化结节最低,FF、MSD在低分化结节最高,中分化结节次之,高分化结节最低(P<0.05);Spearman相关性分析结果显示,LI-RADS分级、ER、MET、MSI、ADC与SHCC病理分级呈正相关,FF、MSD与SHCC病理分级呈负相关(P<0.05)。结论Mp-MRI参数联合LI-RADS分级标准诊断肝硬化再生结节与SHCC的价值可靠,且能为临床评估SHCC病理分级提供参考依据。

术前MRI特征对肝细胞癌血管包绕肿瘤团簇及微血管侵犯的评估

目的探讨基于术前钆塞酸二钠增强MRI的2018版肝脏影像报告和数据系统(LI-RADS v2018)及其他影像特征同时预测肝细胞癌(HCC)血管包绕肿瘤团簇(VETC)及微血管侵犯(MVI)的价值,进一步构建预测模型并评估模型风险分层能力。方法回顾性纳入接受根治性肝切除术的232例HCC病人。根据VETC和MVI状态将HCC病人分为VETC及MVI均阳性组46例[VM(+)组]和VETC或MVI阴性组186例[非VM(+)组]。采用多因素Logistic回归分析确定VM(+)HCC的独立预测因素并构建联合模型。采用受试者操作特征(ROC)曲线评估单一预测因素及联合模型的预测效能,并计算ROC曲线下面积(AUC)、敏感度、特异度。通过DeLong检验比较单一预测因素及联合模型间AUC的差异。选择AUC最高的预测因素或模型进行生存分析,基于ROC曲线的最大约登指数设定预测概率截断值,将HCC病人分为高、低风险组。使用Kaplan-Meier生存曲线评估高与低风险组、VM(+)与非VM(+)组之间的无复发生存期(RFS)及早期复发(ER)风险。结果多因素Logistic回归分析显示,肿瘤最大径、动脉期瘤周强化及肝胆期瘤周低信号是VM(+)HCC的独立预测因素,联合上述3个因素构建的联合模型的AUC、敏感度及特异度分别为0.792、80.4%、74.2%。Delong检验显示联合模型预测VM(+)HCC的AUC高于各单一预测因素(均P<0.05)。Kaplan-Meier生存分析表明VM(+)组较非VM(+)组的RFS更短、ER风险更高,高风险组较低风险组病人的RFS更短、ER风险更高(P<0.05)。结论基于肿瘤最大径、动脉期瘤周强化及肝胆期瘤周低信号的联合模型可用于VM(+)HCC的术前预测。VETC及MVI同时存在与HCC病人切除术后ER风险增加及RFS降低相关。

CT LI-RADS v2018专项培训提高医师对肝脏局灶病变诊断效能的研究

目的:探讨肝脏影像报告和数据系统(LI-RADS)v2018专项培训对提升医师对肝细胞癌(HCC)高危人群肝脏局灶性病变的征象评估及分类的准确性的价值。方法:回顾性收集首都医科大学附属友谊医院行肝脏增强CT扫描的HCC高危患者,最终共纳入63例患者的70个病灶,其中有27个HCC病变,15个非HCC恶性病变和28个良性病变。18位不同年资的影像诊断医师参加CT LI-RADS v2018专项培训。受试医师在参加培训前后分别独立判读入组病灶图像并记录结果,包括对入组病灶的LI-RADS主要征象及支持HCC的辅助征象识别和LI-RADS分类。将病变分类为LR-5即可诊断HCC,计算受试医师在LI-RADS培训前后评估LI-RADS主要征象及支持HCC的辅助征象和诊断HCC的敏感度、特异度、阳性预测值、阴性预测值、阳性似然比、阴性似然比及准确率并计算受试者操作特征(ROC)曲线下面积(AUC)。采用非参数检验比较培训前后对LI-RADS主要征象和支持HCC的辅助征象评估效能及HCC的诊断效能。结果:培训后受试医师对LI-RADS的主要征象及支持HCC的辅助征象的识别效能均较培训前有提升(P值均<0.05),其中对非边缘性廓清、强化包膜以及辅助征象中的无强化包膜识别效能提升较为显著。培训前后受试医师对HCC诊断的敏感度、特异度、阳性预测值、阴性预测值和准确率分别为45.9%、80.9%、60.1%、70.4%、67.4%和55.8%、91.0%、79.5%、76.6%、77.4%(P值均<0.05)。结论:CT LI-RADS专项培训能提升医师对HCC高危人群肝局灶病变的征象评估及诊断能力,其专项培训具有确切的推广意义和价值。

基于临床资料、超声造影LI-RADS联合异常凝血酶原的肝癌微血管侵犯列线图模型的构建及验证

目的基于临床资料、超声造影肝脏影像报告和数据系统(LI-RADS)联合异常凝血酶原前体蛋白(PIVKA-Ⅱ)的肝癌微血管侵犯(MVI)列线图模型的构建,并对所构建的列线图模型进行验证。方法选取2019年1月至2023年12月该院收治的312例肝癌患者作为研究对象,按照2∶1分为建模集组(208例)和验证集组(104例)。以单因素和多因素Logistic回归分析肝癌MVI的影响因素,采用R3.6.1软件绘制肝癌MVI预测列线图模型;以预测风险能力指数(C-index)、校准曲线、受试者工作特征(ROC)曲线评价列线图模型的预测能力,以决策曲线评价列线图模型的临床效用。结果建模集组与验证集组MVI发生率分别为32.21%(67/208)、27.88%(29/104),建模集组与验证集组年龄、性别、体质量指数等基线资料及MVI发生情况比较,差异均无统计学意义(P>0.05)。单因素分析结果显示,建模集组中MVI组中国肝癌分期为Ⅱ~Ⅲ期患者占比及甲胎蛋白水平均高于无MVI组,差异均有统计学意义(P<0.05);建模集组中MVI组肿瘤最大径大于无MVI组,LI-RADS分级为5级患者占比及PIVKA-Ⅱ水平均高于无MVI组,差异均有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,甲胎蛋白水平升高、肿瘤最大径增大、LI-RADS分级为5级患者占比较高、PIVKA-Ⅱ水平升高均为肝癌MVI的独立危险因素(P<0.05)。预测肝癌MVI的列线图模型的C-index为0.936(95%CI:0.894~0.965),区分度良好。Bootstrap内部验证和外部验证结果显示,列线图模型在建模集和验证集中的一致性指数分别为0.859、0.840。ROC曲线分析结果显示,列线图模型预测肝癌MVI的AUC为0.936,高于单独的甲胎蛋白(0.839)、肿瘤最大径(0.792)、LI-RADS分级(0.705)、PIVKA-Ⅱ(0.813)。决策曲线分析结果显示,当建模集高风险阈值为0.00~0.93、验证集高风险阈值为0.00~0.78时该列线图模型具有较好的临床净收益。结论甲胎蛋白、肿瘤最大径、LI-RADS分级和PIVKA-Ⅱ与肝癌MVI均有关,均可作为肝癌MVI的联合预测因子,可提高术前诊断肝癌MVI的效能,为临床肝癌的诊断和治疗提供客观准确的决策支持。

Liver imaging reporting and data system and CT/MRI diagnosis of hepatocellular carcinoma

The Liver Imaging Reporting and Data System(LI-RADS)is a comprehensive and robust system which provides an algorithmic approach to stratify the probability of hepatocellular carcinoma(HCC)for each observation found in patients at risk for HCC.LI-RADS uses a standardized terminology and approach to improve communication between the radiologist and clinicians.LI-RADS version 2018 is noteworthy for its adoption by the American Association for the Study of Liver Disease into its HCC practice guidance.This manuscript provides an overview of the history of LI-RADS,reviews the Computed tomography/magnetic resonance imaging diagnostic algorithm,highlights the key diagnostic criteria for each category,and discusses the advantage of incorporating LI-RADS in clinical practice.

超声甲状腺影像报告和数据系统在甲状腺结节诊治中的应用及进展

超声因其安全、无创、低价、方便等优点,成为甲状腺结节检测的首选方法,目前国内外有数个版本甲状腺影像报告和数据系统(Thyroid Imaging Reporting and Data System,TI-RADS)用于甲状腺结节恶性风险的分层管理。不同版本TI-RADS对同一甲状腺结节的分类及其是否需要进行细针穿刺活检(fine-needle aspiration biospy,FNAB)的建议存在差异。本文对各TI-RADS版本在甲状腺结节风险分层管理方面的应用、优势与局限性,以及其最新的研究进展进行了述评。

Mp-MRI、LI-RADS联合血清甲胎蛋白在肝硬化伴小肝癌诊断及疗效评估中的价值

目的探讨肝硬化伴小肝癌的多参数磁共振成像(Mp-MRI)、肝脏影像报告和数据管理(LI-RADS)系统影像特征,并分析联合血清甲胎蛋白的诊断及疗效评估价值。方法选取2020年5月至2022年1月张家口市第一医院收治的65例肝硬化伴小肝癌患者为研究组,另选取同期65例单纯肝硬化患者为对照组,均行Mp-MRI检查,获取Mp-MRI参数[表观扩散系数(ADC)、增强率、平均强化时间(MET)、最大上升斜率(MSI)、最大下降斜率(MSD)、脂肪分数],根据MRI检查进行LI-RADS分级,比较两组Mp-MRI参数、LI-RADS分级,检测血清甲胎蛋白;分析Mp-MRI、LI-RADS及血清甲胎蛋白对肝硬化伴小肝癌的诊断价值。研究组患者接受肝癌根治术治疗,术后6个月复查Mp-MRI、血清甲胎蛋白并进行LI-RADS分级,根据术后小肝癌是否复发分为复发组(n=21)、未复发组(n=44),比较两组术后6个月Mp-MRI参数、血清甲胎蛋白及LI-RADS分级,分析Mp-MRI、LI-RADS影像特征联合血清甲胎蛋白对肝硬化伴小肝癌患者的疗效评估价值。结果研究组的ADC、增强率、MET、MSI分别为(0.98±0.22)×10^(-3)mm^(2)/s、(67.51±10.75)%、(511.78±15.90)s、106.47±27.53,均低于对照组,MSD、脂肪分数及血清甲胎蛋白分别为113.59±30.06、(4.62±1.53)Hz、(257.24±64.33)ng/mL,均高于对照组,差异均有统计学意义(P<0.05)。研究组阳性(LR-4、LR-5)占比高于对照组,差异有统计学意义(P<0.05)。Mp-MRI参数、LI-RADS及血清甲胎蛋白联合诊断肝硬化伴小肝癌的ROC曲线AUC为0.927。术后6个月,复发组的ADC、增强率、MET、MSI分别为(1.01±0.12)×10^(-3)mm^(2)/s、(69.02±9.85)%、(511.54±11.34)s、113.41±15.77,均低于未复发组,MSD、脂肪分数及血清甲胎蛋白分别为110.36±12.08、(4.36±1.55)Hz、(239.57±40.17)ng/mL,均高于未复发组,差异均有统计学意义(P<0.05)。术后6个月Mp-MRI参数、LI-RADS及血清甲胎蛋白联合评估肝硬化伴小肝癌术后复发风险的ROC曲线AUC为0.924。结论肝硬化伴小肝癌的Mp-MRI、LI-RADS影像特征存在显著差异,Mp-MRI、LI-RADS联合血清甲胎蛋白对肝硬化伴小肝癌的诊断及疗效评估价值较高。

CEUS LI-RADS联合人工智能辅助决策模型对肝细胞癌的诊断价值评估

目的评估超声肝脏造影报告及数据管理系统(CEUS LI-RADS)联合人工智能辅助决策模型对肝细胞癌的诊断价值。方法选取88例肝细胞肿瘤患者,均通过CEUS LI-RADS评估肝细胞肿瘤的良性与恶性,根据CEUS LI-RADS结果采用人工智能辅助决策模型进行诊断,比较CEUS LI-RADS和人工智能辅助决策模型对肝细胞癌的单独诊断结果与联合诊断价值,并分析CEUS LI-RADS在不同病理特征肝细胞肿瘤诊断中的价值。结果CEUS LI-RADS联合人工智能辅助决策模型对肝细胞癌的诊断灵敏度、准确度高于单一方案诊断,漏诊率低于单一方案诊断,差异均具有统计学意义(P<0.05)。肝细胞肿瘤<5 cm的阳性患者和阴性患者CEUS LI-RADS分类LR-1~LR-3、LR-4、LR-5之间有显著差异(P<0.05)。肝细胞肿瘤≥5 cm阳性患者和阴性患者LR-1~LR-3、LR-5之间有显著差异(P<0.05)。不同分化程度肝细胞癌患者CEUS LI-RADS分类LR-3、LR-5之间有显著差异(P<0.05)。结论CEUS LI-RADS联合人工智能辅助决策模型对于肝细胞癌诊断准确度、灵敏度较高,可有效提高肝细胞癌诊断效能,降低漏诊率。

Hepatocellular carcinoma: Can LI-RADS v2017 with gadoxetic-acid enhancement magnetic resonance and diffusion-weighted imaging improve diagnostic accuracy?

BACKGROUND The Liver Imaging Reporting and Data System(LI-RADS), supported by the American College of Radiology(ACR), has been developed for standardizing the acquisition, interpretation, reporting, and data collection of liver imaging examinations in patients at risk for hepatocellular carcinoma(HCC). Diffusionweighted imaging(DWI), which is described as an ancillary imaging feature of LI-RADS, can improve the diagnostic efficiency of LI-RADS v2017 with gadoxetic acid-enhanced magnetic resonance imaging(MRI) for HCC.AIM To determine whether the use of DWI can improve the diagnostic efficiency of LIRADS v2017 with gadoxetic acid-enhanced magnetic resonance MRI for HCC.METHODS In this institutional review board-approved study, 245 observations of high risk of HCC were retrospectively acquired from 203 patients who underwent gadoxetic acid-enhanced MRI from October 2013 to April 2018. Two readers independently measured the maximum diameter and recorded the presence of each lesion and assigned scores according to LI-RADS v2017. The test was used to determine the agreement between the two readers with or without DWI. In addition, the sensitivity(SE), specificity(SP), accuracy(AC), positive predictive value(PPV), and negative predictive value(NPV) of LI-RADS were calculated.Youden index values were used to compare the diagnostic performance of LIRADS with or without DWI.RESULTS Almost perfect interobserver agreement was obtained for the categorization of observations with LI-RADS(kappa value: 0.813 without DWI and 0.882 with DWI). For LR-5, the diagnostic SE, SP, and AC values were 61.2%, 92.5%, and71.4%, respectively, with or without DWI; for LR-4/5, they were 73.9%, 80%, and75.9% without DWI and 87.9%, 80%, and 85.3% with DWI; for LR-4/5/M, they were 75.8%, 58.8%, and 70.2% without DWI and 87.9%, 58.8%, and 78.4% with DWI; for LR-4/5/TIV, they were 75.8%, 75%, and 75.5% without DWI and 89.7%,75%, and 84.9% with DWI. The Youden index values of the LI-RADS classification without or with DWI were as follows: LR-4/5: 0.539 vs 0.679; LR-4/5/M: 0.346 vs 0.467; and LR-4/5/TIV: 0.508 vs 0.647.CONCLUSION LI-RADS v2017 has been successfully applied with gadoxetate-enhanced MRI for patients at high risk for HCC. The addition of DWI significantly increases the diagnostic efficiency for HCC.