超声造影肝脏影像报告和数据管理系统发展现状及临床应用进展

肝细胞癌(HCC)是我国乃至世界较为高发的恶性肿瘤，早期诊断及治疗是改善患者预后的关键。为了方便不同中心、不同专业医生间的沟通交流，美国放射学会于2016年发布第一版超声造影肝脏影像报告和数据管理系统(CEUS LI-RADS),对肝脏影像术语、技术、解释、报告及数据收集进行规定，同时对不同肝脏局灶性病变进行HCC的风险分层，在临床应用中逐渐展露出优势。本文就CEUS LI-RADS的发展现状及临床应用进展进行综述，认为应用CEUS LI-RADS对HCC高危人群肝脏局灶性病变进行临床管理具有巨大的潜在价值，而且相信在不久的将来CEUS LI-RADS适用人群和适应证将会不断扩展，更好的服务于临床。     

基于2018年版肝脏影像报告数据系统对比分析CT和MRI诊断肝细胞癌的效能*

目的 比较CT和MRI按照2018年版肝脏影像报告数据系统(LI-RADS)诊断肝细胞癌(HCC)的效能。方法 2017年9月～2020年7月四川省肿瘤医院诊治的有HCC高危因素的72例患者(HCC 53例、非HCC恶性肿瘤10例、良性病变9例),接受CT和MRI检查。根据2018年版LI-RADS定义的影像学征象和分类法则,对所有病灶进行分类,采用kappa一致性检验两种检查方法的分类结果,以组织病理学检查结果为金标准,比较CT和MRI诊断HCC的ROC曲线下面积(AUC),计算LR-5类诊断HCC的敏感性和特异性。结果 CT和MRI的LI-RADS分类结果一致性较好,kappa值为0.693【(95%CI:0.545～0.841),P＜0.001】;两种检查方法诊断HCC的AUC分别为0.827(95%CI: 0.708～0.946)和0.856(95%CI: 0.761～0.952),差异无统计学意义(P＞0.05);以LR-5为阳性,MRI诊断HCC的敏感性为81.1%(43/53),显著高于CT诊断的66.0%(35/53),差异有统计学意义(P＜0.05);CT和MRI诊断HCC的特异性分别为78.9%(15/19)和89.5%(17/19),差异无统计学意义(P＞0.05);在LI-RADS定义的主要征象中,MRI对强化包膜的显示率为40.3%,显著高于CT的5.5%(P＜0.001)。结论 基于肝脏影像报告数据系统,CT和MRI诊断HCC有相当高的效能,而MRI诊断肝细胞癌的敏感性高于CT,特别在显示强化病灶包膜方面优于CT。     

超声造影肝脏影像报告与数据系统分类标准在M类病变中的应用及进展

肝细胞癌(HCC)和非HCC肝恶性肿瘤在发病机制、生物学行为等方面存在显著差异,超声造影肝脏影像报告与数据系统(CEUS LI-RADS)中M类的存在为两者鉴别提供了新思路。本文介绍了CEUS LI-RADS分类标准在M类病变中的诊断应用情况及进展,认为应用CEUS LI-RADS可以帮助鉴别HCC和非HCC恶性肿瘤,但未来仍需进一步的改进和完善。     

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*

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。     

超声造影判断乙型肝炎肝硬化患者肝内占位性病变性质价值研究

目的 探讨应用超声造影(CEUS)肝脏影像报告与数据系统(LI-RADS)对乙型肝炎肝硬化患者肝内占位性病变性质的诊断价值。方法 2020年1月～2022年1月我院诊治的乙型肝炎肝硬化伴有肝内占位性病变患者521例,均进行肝穿刺病理学活检术和CEUS检查,应用LI-RADS对病灶进行分类诊断。应用MedCalc1 5.1统计学软件绘制受试者工作特征并计算曲线下面积(AUROC)判断LI-RADS的诊断效能。结果 在521例存在肝内占位性病变的乙型肝炎肝硬化患者中,经病理学检查诊断HCC者96例,局灶性结节性增生(FNHL)150例,血管瘤162例,肝囊肿63例,局灶性脂肪肝50例;经CEUS检查和LI-RADS评估,发现I类病变248例(血管瘤145例,肝囊肿63例,局灶性脂肪肝40例),II类病变140例(均为FNHL),III类病变22例(FNHL者18例,HCC者4例),IV类病变39例(FNHL者6例,血管瘤7例,HCC 26例),V类病变72例(FNHL者6例,HCC者66例);LI-RADS诊断V类病变的AUROC为0.84(95%CI:0.78～0.89),其灵敏度、特异...     

超声造影在射频消融治疗常规超声不显示原发性肝细胞癌中的临床应用价值

背景手术切除是目前临床治疗肝癌的首选方法,对于无法手术切除的患者,射频消融(radiofrequency ablation,RFA)治疗为其提供了一种重要的治疗手段.实施RFA需借助于影像学方法的引导,通常采用超声、电子计算机断层扫描(computed Tomography, CT)或磁共振成像(magnetic resonance imaging, MRI).CT引导具有射线辐射, MRI引导不适用于心脏起搏器植入、血管支架植入、心脏换瓣等患者,而超声引导具有无辐射、简便、灵活等优点被广泛应用于临床,成为一种引导肝肿瘤RFA的理想有效影像学手段.目的探讨超声造影(contrast-enhanced ultrasound, CEUS)在RFA治疗常规超声不显示原发性肝细胞癌(hepatocellular carcinoma, HCC)中的临床应用价值.方法选取常规超声不显示而增强MRI(contrast-enhanced MRI,CEMRI)显示并经穿刺活检病理确诊的52例HCC患者作为研究对象,共75个肿瘤.所有患者均行CEUS检查并在CEUS引导下行RFA治疗,术后行CEMRI以及CEUS评估治疗效果.结果术前CEUS对常规超声不显示HCC的检出率与CEMRI比较,差异无统计学意义(P0.05);术前HCC的开始增强时间、达峰时间明显短于邻近正常肝组织,而峰值强度明显高于邻近正常肝组织,差异具有统计学意义(P0.05);术后CEUS判定HCC完全消融的准确率与CEMRI比较,差异无统计学意义(P0.05);患者术后血清甲胎蛋白水平较术前明显下降,差异有统计学意义(P0.05).结论 CEUS能有效发现并准确定位常规超声不显示HCC从而引导RFA治疗,能为临床评估RFA疗效提供一种可靠的影像学方法,具有一定临床价值.     

基于超声造影LI-RADS特征的肝细胞癌微血管侵犯列线图模型的构建及验证

目的 基于肝细胞癌(HCC)患者的超声造影(CEUS)肝脏成像报告和数据系统(LI-RADS)特征建立预测微血管侵犯(MVI)的列线图模型并进行验证。方法 选取2017年1月—2020年7月在江苏大学附属武进医院确诊的HCC患者共262例,按照1∶1比例随机分为建模组和验证组各131例,以术后镜下病理结果确诊MVI,其中建模组MVI 70例和验证组MVI 56例。采用超声造影评估两组的LI-RADS特征。两组间计量资料比较采用独立样本t检验;两组间计数资料比较采用χ²检验。采用单因素和多因素Logistic回归分析筛选建模组MVI的危险因素;绘制受试者工作特征曲线(ROC曲线),计算模型预测MVI的曲线下面积(AUC),评估预测准确度;应用决策曲线分析模型的一致性,比较模型预测MVI的校正曲线与标准曲线的离散度。结果 建模组与验证组患者的临床资料和CEUS检查结果比较,差异均无统计学意义(P值均>0.05)。单因素分析显示,与MVI阴性患者相比,MVI阳性患者血清AFP水平显升高,肿瘤直径增大,LI-RADS显示LR-5“后出”和LR-M“先出”增多,LI-...     

多排螺旋CT三期增强与3.0T MR多期动态增强扫描诊断肝细胞癌的价值分析*

目的 探讨3.0T MR多期动态增强扫描与多排螺旋CT三期增强扫描诊断肝细胞癌的价值。方法 2015年9月~2017年9月我院收治的98例肝占位患者,分别行MRI和CT增强扫描检查,采用Kappa检验分析三名医师诊断评分之间的一致性,采用受试者工作特征曲线（ROC）并计算曲线下面积（AUC）判断影像学检查指标的诊断效能。结果 在98例肝占位患者中,病理学检查诊断HCC 86例,再生结节10例,嗜酸性肉芽肿2例;在86例HCC患者中,存在97个病灶,其中32个病灶<1.0 cm;在32个<1.0 cm的HCC病灶中, MRI动态增强扫描发现31个（96.9%）,而多排螺旋CT增强扫描仅发现26个（81.3%,P<0.05）,其余65个超过1.0 cm 的病灶均被两种扫描方法发现和诊断;ROC曲线分析发现,MRI动态增强扫描和多排螺旋CT增强扫描诊断HCC的AUC分别为0.962和0.824,两者相比具有显著性差异（t=3.106,P<0.05）,MRI动态增强扫描诊断HCC的敏感性、特异性和准确性分别为99.0%、91.0%和96.2%,显著优于多排螺旋CT增强扫描检查（分别为93.8%、72.0%和85.3%,x²=19.587,P<0.05)。结论 3.0T MR多期动态增强扫描能够更清晰地反映HCC病灶的细微形态特点和强化特征,对于诊断小HCC的价值优于CT增强扫描。     

基于LI-RADS分类标准的超声造影技术对肝细胞癌诊断的可行性研究

目的基于肝脏影像报告和数据管理系统(LI-RADS)分类标准的超声造影(CEUS)技术对肝细胞癌诊断的可行性。方法连续收集2016年6月至2019年6月期间我科收治入院肝细胞癌高危患者。疾病诊断符合2015年版原发性肝癌规范化病理诊断指南。超声造影剂为SonoVue(Bracco公司,意大利)。采用2017年版CEUS LI-RADS分类标准。本次研究以病理结果作为诊断金标准,LI-RADS 1类(LR-1)及LI-RADS 2类(LR-2)为阴性结果,LI-RADS 3类(LR-3)、LI-RADS 4类(LR-4)及LI-RADS 5类(LR-5)为阳性结果。绘制ROC曲线,计算诊断指标。结果纳入患者74例,男性52例,女性22例,平均年龄(54.2±11.4)岁。共检出病灶86个,病灶直径0.6至9.2 cm,平均直径(2.6±1.4)cm。病理结果包括原发性肝细胞癌(72个),胆管细胞癌(3个),局灶性结节增生(6个),肝血管瘤(3个)及炎性病变(2个)。CEUS LI-RADS分类中LR-1 4个,LR-2 5个,LR-3 16个,LR-4 25个,LR-5 36个。ROC曲线下面积为0.86(0.80～0.91),基于LI-RADS分类标准的CEUS技术对原发性肝细胞癌诊断指标如下:准确度94.2%(81/86),敏感度100%(72/72),特异度64.3%(9/14),阳性预测值93.5%(72/77),阴性预测值100%(9/9)。当不考虑LR-3分类时,调整后的诊断指标如下:准确度97.1%(68/70),敏感度100%(59/59),特异度81.8%(9/11),阳性预测值96.7%(59/61),阴性预测值100%(9/9)。结论基于LI-RADS分类标准的超声造影检查能够对原发性肝细胞癌作出较好的诊断效能,具有临床可行性。     

基于超声造影的LI-RADS应用进展

美国放射学会(American College of Radiology,ACR)2011年首次发布肝脏影像报告和数据管理系统,其科学性与实用性随着版本不断更新而逐渐提升,尤其在辅助高危人群肝脏结节的定性、分期及预后评估方面发挥着重要作用.2016年ACR发布了基于超声造影的肝脏影像报告和数据管理系统(contrast...     

LI-RADS 4 or 5 categorization may not be clinically relevant for decision-making processes: A prospective cohort study

Introduction and objectivesThe liver imaging reporting data system (LI-RADS) for hepatocellular carcinoma (HCC) was proposed to standardize and enhance consensus of reporting. However, clinical utility of LI-RADS has not been evaluated in Latin America. We therefore sought to compare LI-RADS categories with histopathology findings in liver transplant (LT) explants in a regional center.Materials and methodsProspective cohort study conducted between 2012 and 2018 in a single center from Argentina including patients with HCC listed for LT. LI-RADS definitions were applied to magnetic resonance images (MRI) or computed tomography (CT) abdominal scans at time of listing and at final pre-LT reassessment and compared to explant pathology findings; specifically, major nodule (NOD1).ResultsOf 130 patients with HCC listed for LT (96.1% with cirrhosis and 35.6% with hepatitis C virus infection), 72 underwent LT. Overall, 65% had imaging HCC diagnosis based on MRI (n = 84), 26% with CT (n = 34) and 9% (n = 12) with both methods. Among LT patients with pre-transplant imaging at our institution (n = 42/72), 69% of the NOD1 were LR-5, 21% LR-4 and 10% LR-3. Definite HCC diagnosis was 50% in LR-3 NOD1 (CI 18–90); none presented microvascular invasion. In LR-4 NOD1, HCC was confirmed in 89% (CI 59–98), of which 11% showed microvascular invasion; whereas in LR-5 NOD1 77% (CI 64–87) had confirmed HCC, 17% with microvascular invasion.ConclusionsLI-RADS was useful to standardize reports; however, no significant differences were observed between LR-4 and LR-5 HCC probability when compared to explant pathology.     

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 “high-risk 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.     

Differentiation of intrahepatic cholangiocarcinoma from hepatocellular carcinoma in high-risk patients: a predictive model using contrast-enhanced ultrasound

AIM To develop a contrast-enhanced ultrasound(CEUS)predictive model for distinguishing intrahepatic cholangiocarcinoma(ICC) from hepatocellular carcinoma(HCC) in high-risk patients.METHODS This retrospective study consisted of 88 consecutive high-risk patients with ICC and 88 high-risk patients with HCC selected by propensity score matching between May 2004 and July 2016. Patients were assigned to two groups, namely, a training set and validation set, at a 1:1 ratio. A CEUS score for diagnosing ICC was generated based on significant CEUS features. Then, a nomogram based on the CEUS score was developed, integrating the clinical data. The performance of the nomogram was then validated and compared with that of the LR-M of the CEUS Liver Imaging Reporting and Data System(LI-RADS).RESULTS The most useful CEUS features for ICC were as follows: rim enhancement(64.5%), early washout(91.9%), intratumoral vein(58.1%), obscure boundary of intratumoral non-enhanced area(64.5%), and marked washout(61.3%, all P 0.05). In the validation set, the area under the curve(AUC) of the CEUS score(AUC = 0.953) for differentiation between ICC and HCC was improved compared to the LI-RADS(AUC = 0.742)(P 0.001). When clinical data were added, the CEUS score nomogram was superior to the LI-RADS nomogram(AUC: 0.973 vs 0.916, P = 0.036, Net Reclassification Improvement: 0.077, Integrated Discrimination Index: 0.152). Subgroup analysis demonstrated that the CEUS score model was notably improved compared to the LIRADS in tumors smaller than 5.0 cm(P 0.05) but not improved in tumors smaller than 3.0 cm(P 0.05).CONCLUSION The CEUS predictive model for differentiation between ICC and HCC in high-risk patients had improved discrimination and clinical usefulness compared to the CEUS LIRADS.     

Contrast-enhanced ultrasound: Improving the preoperative staging of hepatocellular carcinoma and guiding individual treatment

AIM: To investigate the clinical role of contrast-enhanced ultrasound (CEUS) combined with contrast-enhanced computed tomography (CE-CT) or magnetic resonance imaging to improve the preoperative staging of hepatocellular carcinoma (HCC) and guide surgical decision-making.METHODS: Sixty-nine patients who underwent liver resection for HCC in our center were enrolled prospectively in the study. CEUS and CE-CT/MRI were performed before surgery. Intraoperative ultrasound (IOUS) was carried out after liver mobilization. Lesions depicted by each imaging modality were counted and mapped. To investigate the impact of tumor size on the study, we divided the patients into two groups, the “Smaller group”(S-group, ≤ 5 cm in diameter) and the “Larger-group” (L-group, > 5 cm in diameter). The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of CE-CT/MRI, CEUS, IOUS, CEUS+CE-CT/MRI and the tumor node metastasis staging of tumors were calculated and compared. Changes in the surgical strategy as a result of CEUS and IOUS were analyzed.RESULTS: One hundred and twenty-seven nodules, comprising 94 HCCs confirmed by histopathology and 33 benign lesions confirmed by histopathology and follow-up, were identified in 69 patients. The overall diagnostic sensitivity rates of CE-CT/MRI, CEUS, IOUS and CEUS+ CE-CT/MRI were 78.7%, 89.4%, 89.4% and 89.4%, respectively. There was a significant difference between CEUS + CE-CT/MRI and CE-CT/MRI (P = 0.046). Combining CEUS with CT or MRI increased, the diagnostic specificity compared with CT/MRI, CEUS and IOUS, and this difference was statistically significant (100%, 72.7%, 97.0%, and 69.7%, P = 0.004, P = 0.002, P = 0.002, respectively). The diagnostic accuracy was significantly higher for CEUS + CT/MRI compared with CT/MRI (92.1% vs 77.2%, P = 0.001). The TNM staging of tumors based on CEUS + CE-CT/MRI approximated to the final pathological TNM staging (P = 0.977). There was a significant difference in the accuracy of TNM staging when comparing CEUS + CE-CT/MRI with CE-CT/MRI (P = 0.002). Before surgery, strategies were changed in 15.9% (11/69) of patients as a result of CEUS. Finally, only 5.7% (4/69) of surgical strategies were changed because of IOUS findings. In the S-group, CEUS revealed 12 false positive lesions, including seven false positive lesions that were diagnosed by preoperative imaging examinations and five by IOUS. In contrast, in the L-group, IUOS revealed eight new malignant lesions; six of these lesions were true HCCs that were also identified by preoperative CEUS.CONCLUSION: CEUS combined with CT or MRI improves the accuracy of preoperative staging for hepatocellular carcinoma and may help to guide individualized treatment for patients with HCC. CEUS may better identify non-malignant lesions in patients with small tumors and discover new malignant lesions in patients with large tumors.     

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.     

Contrast-enhanced ultrasound in the diagnosis of nodules in liver cirrhosis

Contrast-enhanced ultrasound(CEUS)using microbubble contrast agents are useful for the diagnosis of the nodules in liver cirrhosis.CEUS can be used as a problem-solving method for indeterminate nodules on computed tomography(CT)or magnetic resonance imaging(MRI)or as an initial diagnostic test for small newly detected liver nodules.CEUS has unique advantages over CT and MRI including no renal excretion of contrast,real-time imaging capability,and purely intravascular contrast.Hepatocellular carcinoma(HCC)is characterized by arterial-phase hypervascularity and later washout(negative enhancement).Benign nodules such as regenerative nodules or dysplastic nodules are usually isoechoic or slightly hypoechoic in the arterial phase and isoechoic in the late phase.However,there are occasional HCC lesions with atypical enhancement including hypovascular HCC and hypervascular HCC without washout.Cholangiocarcinomas are infrequently detected during HCC surveillance and mostly show rimlike or diffuse hypervascularity followed by rapid washout.Hemangiomas are often found at HCC surveillance and are easily diagnosed by CEUS.CEUS can be effectively used in the diagnostic work-up of small nodules detected at HCC surveillance.CEUS is also useful to differentiate malignant and benign venous thrombosis and to guide and monitor the local ablation therapy for HCC.     

LI-RADS超声分类诊断肝脏占位性病变准确性分析

目的 探讨应用LI-RADS超声分类方法诊断肝脏占位性病变的准确性。方法 2018年1月～2019年9月我院经病理学检查诊断为肝脏占位性病变患者60例,均接受超声造影检查。按照LI-RADS分类方法,分别以LR-3(方法1)和LR-4a(方法2)作为为截断点,分析两种方法鉴别良恶性病变的效能。结果 在60例肝占位性病变患者中,综合诊断肝囊肿4例,肝血管瘤16例,肝脓肿8例,肝局灶性脂肪变9例,肝局灶性结节性增生9例,肝细胞癌8例,肝转移瘤6例;以病理学检查诊断为金标准,方法1诊断恶性病变22例,良性病变38例。方法 2诊断恶性病变14例,良性病变46例;方法1诊断的灵敏度、特异度和正确率分别为85.7%、78.2%和80.0%,而方法2则分别为78.6%、93.5%(P<0.05)和100.0%(P<0.05)。结论 采用LI-RADS 方法2分辨肝脏占位性病变的性质具有很高的准确性,其临床应用价值值得进一步研究。