应用肝脏影像报告与数据管理系统诊断肝细胞癌的价值研究*

doi:10.3969/j.issn.1672-5069.2020.01.027

摘要/Abstract

摘要： 目的探讨应用肝脏影像报告与数据管理系统(LI-RADS)诊断肝细胞癌(HCC)的价值,以规范化HCC的影像学诊断。方法对200例存在慢性乙型肝炎或/和肝硬化、酗酒、血清甲胎蛋白升高的HCC高风险人群行CT和MRI常规平扫和增强检查,依据LI-RADS v2017分级标准进行评定,由两名放射科医师进行盲法评定,1个月后,再由同一名医生进行再次评定,评估两次评定的同一性。在LI-RADS分级中,LR-1、LR-2被看作是良性病变,LR-4、LR-5和LR-5TIV为恶性病变,以组织病理学检查作为诊断的金标准,计算LI-RADS诊断的敏感性、特异性和准确性。结果在200例肝脏病变患者,病理学检查诊断125例为HCC,27例为肝内胆管细胞癌,9例为肝转移癌,39例为良性病灶;运用LI-RADS分级,CT诊断17例为良性,151例为恶性,而MRI诊断17例为良性,169例为恶性;CT诊断两次评级的Kappa值为0.912 (P < 0.001),而MRI诊断图像的数据显示,两次评级的Kappa值为1.000 (P < 0.001),说明在MRI检查运用LI-RADS分级判断HCC的准确度比CT高;运用LI-RADS分级标准,CT诊断HCC的灵敏度、特异度和准确性分别为95.4%、81.2%和90.2%,而MRI诊断HCC的灵敏度、特异度和准确性分别为100%、85.4%和92.4%。结论在CT和MR检查中应用LI-RADS分级评估可以提高诊断HCC的准确度,且可重复性好。在CT检查评定分为LR-3的病变,可能为HCC,建议重新检查MRI或随访,而经MRI检查仍然评定为LR-3的病变则需要密切随访。

关键词: 肝细胞癌, 计算机体层扫描, 磁共振成像, 肝脏影像报告与数据管理系统, 诊断

Abstract: Objective To explore the liver imaging report and data management system (LI-RADS) in CT and MR imaging in diagnosis of patients with hepatocellular carcinoma (HCC). Methods 200 patients with high risk for HCC, such as chronic hepatitis B, cirrhosis, alcohol abuse and elevated serum alpha-fetoprotien levels were recruited and all patients underwent CT and MRI plain and enhancement scan. The imaging was evaluated according to the LI-RADS v2017 grading criteria. The evaluation was performed by two radiologists, and the consistency of one doctor was evaluated one month later. In LI-RADS grading, LR-1 and LR-2 were considered benign lesions, while LR-4, LR-5, and LR-5TIV were malignant lesions. The results of pathology were acted as gold standard of diagnosis. Finally, the sensitivity, specificity, and accuracy of LI-RADS diagnosis were calculated. Results We enrolled 200 patients, and all finished CT and MRI; the histopathological examination showed that there were 125 patients with HCCs, 27 with intrahepatic cholangiocarcinomas, 9 with metastasis, and 39 with benign lesions; by LI-RADS classification, 17 cases were diagnosed as benign, and 151 cases as malignant by CT scan, while 17 cases were diagnosed as benign, and 169 cases as malignant by MRI; in CT diagnosis, the Kappa value was 0.912 (P<0.001), while the data of MR diagnosis showed the Kappa value was 1.000 (P<0.001), indicating that the diagnostic accuracy by using LI-RADS grading in MR examination was superior to that of CT scan; by LI-RADS grading standard, the sensitivity, specificity and accuracy of CT scan were 95.4%, 81.2% and 90.2%, while those of MRI were 100%, 85.4% and 92.4%. Conclusion The LI-RADS based on CT and MRI has a very good repeatability and high accuracy in the evaluation of HCC, the possibility for HCC is quite greater in CT-evaluated LR-3 lesions, thus, Gd-DTPA enhancement of MRI is firmly recommended for such patients. We suggest that the patients with LR-3 lesions by MRI scan should be regularly followed-up.

Key words: Hepatocellular carcinoma, CT, MRI, Liver imaging report and data management system, Diagnosis

石莹莹, 王元喜. 应用肝脏影像报告与数据管理系统诊断肝细胞癌的价值研究^*[J]. 实用肝脏病杂志, 2020, 23(1): 98-101.

Shi Yingying, Wang Yuanxi. Application of liver imaging report and data management system in diagnosis of hepatocellular carcinoma in CT and MR examinations[J]. Journal of Practical Hepatology, 2020, 23(1): 98-101.

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应用肝脏影像报告与数据管理系统诊断肝细胞癌的价值研究^*

Application of liver imaging report and data management system in diagnosis of hepatocellular carcinoma in CT and MR examinations

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