| 摘要: |
| 目的：研究超声造影LI-RADSv2017分类标准对提高肝超声造影初学者预测肝局灶性病变（focal liver lesion，FLL）为肝细胞肝癌（hepatocellular carcinoma,HCC）等疾病的诊断能力的可行性。
方法：对 225个FLL的影像及临床资料进行回顾性分析。A组观察者（2名初学超声造影医师）和B组观察者（2名资深超声造影医师）分别用传统方法对病灶进行HCC及非HCC(包括常见良性病变及肝脏其他恶性肿瘤)诊断，之后A组参照超声造影 LI-RADS v2017对病灶进行分类。诊断金标准为组织病理学或临床诊断结果，分析A、B组诊断HCC的效能。结果：A、B组使用传统方法诊断HCC的准确性、灵敏度、特异度、阳性预测值和阴性预测值分别为：70.22%和89.33%、81.06%和96.21%、54.84%和79.57%、71.81%和86.99%、67.11%和93.67%，差异均有统计学意义（P＜0.05）。A组以LR-3、4、5类为HCC诊断标准可使灵敏度和阴性预测值提高至96.97%和92.45%，以LR-4、5类为标准可使准确性提高至84.00%，以LR-5类为标准特异度达90.32%，阳性预测值达91.35%，均高于传统方法诊断效能（P＜0.05）且特异度高于B组（P＜0.05）。结论：超声造影 LI-RADS分类标准对提高初学者正确预测肝癌高危人群中HCC的诊断效能有较好的指导作用，值得在临床工作中推广应用。 |
| 关键词: 肝细胞癌，肝局灶性病变，超声造影，肝脏影像报告和数据系统 |
| DOI： |
| 投稿时间：2021-06-30修订日期：2021-08-15 |
| 基金项目: |
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| The application value of contrast-enhanced ultrasound LI-RADS in the diagnosis of HCC for inexperienced CEUS physician |
| ZHENG Li-li,REN Xin-ping,ZHAN Wei-wei,XIA shu-jun |
| (Department of Ultrasound,Wuxi Branch of Ruijin Hospital Affiliated to Shanghai Jiaotong University Medical College) |
| Abstract: |
| Objective To investigate the feasibility of contrast-enhanced ultrasound(CEUS) Liver Imaging Reporting and Data System (LI-RADS) v 2017 in improving the diagnostic ability of inexperienced CEUS physician to predict focal liver lesion (FLL) as hepatocellular carcinoma (HCC) and other diseases. Methods The imaging and clinical data of 225 focal liver lesions were retrospectively analyzed. HCC and non-HCC (including common benign and Other Hepatic Malignancies，OM) were diagnosed by group A (Two inexperienced CEUS physicians)and B(Two senior CEUS physicians) using traditional methods respectively, and then each nodule was classified to a category according to CEUS LI-RADS v2017 by group A. The reference standard was based on histopathological or clinical diagnosis. The diagnostic efficacies of HCC by group A and B were analyzed .RESULTS The accuracy（AC）, sensitivity(SE), specificity(SP), positive predictive value(PPV) and negative predictive value(NPV) of HCC diagnosis using conventional methods in group A and B were:70.22% and 89.33%, 81.06% and 96.21%, 54.84% and 79.57%, 71.81% and 86.99%, 67.11% and 93.67%,respectively, with statistically significant differences (All P < 0.05).The diagnostic sensitivity and negative predictive value of group A were improved to 96.97% and 92.45% when using LR-3, 4 and 5 as the diagnostic criteria of HCC, the accuracy was improved to 84.00% when using LR-4 and 5 as the criteria, and the specificity and positive predictive value were improved to 90.32% and 91.35% when using LR-5 as the standard, all of which were higher than the diagnostic efficacy of traditional diagnostic methods (P < 0.05)and the specificity was higher than that of group B (P < 0.05).Conclusion The CEUS LI-RADS algorithm has a good guiding effect on improving the diagnostic efficiency of inexperienced CEUS physician in predicting HCC in patients at risk for hepatocellular carcinoma, and is worthy of promotion and application in clinical work. |
| Key words: hepatocellular carcinoma, focal liver lesion, contrast-enhanced ultrasound, LI-RADS |
