CEUS与增强CT/MRI LI-RADS分类诊断小肝细胞癌应用研究*

doi:10.3969/j.issn.1672-5069.2025.05.029

摘要/Abstract

摘要： 目的比较超声造影(CEUS)与增强CT(CECT)/磁共振成像(MRI) 肝脏影像报告和数据系统(LI-RADS)分类诊断小肝细胞癌(sHCC)的价值。方法 2019年1月～2023年12月我院诊治的肝内小结节病灶患者102例,纳入患者肝内结节均≤1 cm,同时接受CEUS和CECT/MRI检查,应用LI-RADS系统分类,经穿刺活检或术后组织病理学检查诊断。结果在102例肝内病灶中,CEUS判定为LR3、LR4、LR5和LRM分别为11例、13例、67例和11例,与CECT/MRI判定的结果(分别为18例、20例、61例和3例)比,存在显著性差异(P=0.033);经组织病理学检查诊断sHCC者92例,混合性肝癌2例和肝硬化结节4例,局灶性增生性结节(FPN)4例;CEUS诊断的灵敏度、特异度和准确性分别为62.5%、98.9%和96.1%,与CECT/MRI诊断的75.0%、97.9%和96.1%比,无显著性差异(P＞0.05)。结论 CECT/MRI与CEUS均可应用于对肝内结节性病灶的性质判断。临床上,这些检查往往相互印证,以早期做出适当的诊断,帮助临床决策。

关键词: 小肝细胞癌, 超声造影, 增强CT, 磁共振成像, 肝脏影像报告和数据系统, 诊断

Abstract: Objective The aim of this study was to investigate diagnostic performance of contrast-enhanced ultrasonography(CEUS) and enhanced CT (CECT)/magnetic resonance imaging (MRI) liver image reporting and data system (LI-RADS) in the diagnosis of patients with small hepatocellular carcinoma (sHCC). Methods A total of 102 patients with intrahepatic space-occupying lesions (SOL) were encountered in our hospital between January 2019 and December 2023, and the patients enrolled all had SOL less than 1 cm. All patients underwent CEUS and CECT /MRI check-up, intrahepatic SOL were assorted based on LI-RADS, and diagnosis was determined by histo-pathological examination. Results Of 102 SOL, CEUS judged as LR3, LR4, LR5 and LRM in 11, 13, 67 and 11 cases, significantly different as compared to 18,20, 61 and 3 cases by CECT/MRI did(P=0.033); final diagnosis was made by pathological examination and showed sHCC in 92 cases and mixed liver cancer in 2 cases, and benign lesions in 8 cases, including cirrhotic nodules in 4 cases and focal proliferative nodule (FPN) in 4 cases; sensitivity, specificity and accuracy by CEUS were 62.5%, 98.9% and 96.1%, all not significantly different compared to 75.0%,97.9% and 96.1% by CECT/MRI (P＞0.05). Conclusion CECT/MRI and CEUS could help clinicians make an appropriate diagnosis early in patients with intrahepatic small SOL, and we recommend the LI-RADS for relatively correct diagnosis. For patients with intrahepatic SOL, the histo-pathological examination is never too important in clinical practice.

Key words: Hepatocellular carcinoma, Contrast-enhanced ultrasonography, Contrast- enhanced CT, Magnetic resonance imaging, Liver imaging reporting and data system, Diagnosis

李新, 梅文娟, 张昊月. CEUS与增强CT/MRI LI-RADS分类诊断小肝细胞癌应用研究^*[J]. 实用肝脏病杂志, 2025, 28(5): 755-758.

Li Xin, Mei Wenjuan, Zhang Haoyue. Contrast-enhanced ultrasonography and enhanced CT/MRI LI-RADS classification in the diagnosis of small hepatocellular carcinoma[J]. Journal of Practical Hepatology, 2025, 28(5): 755-758.

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CEUS与增强CT/MRI LI-RADS分类诊断小肝细胞癌应用研究^*

Contrast-enhanced ultrasonography and enhanced CT/MRI LI-RADS classification in the diagnosis of small hepatocellular carcinoma

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