基于钆塞酸二钠增强MRI 2017版与2018版肝脏影像报告与数据系统分类标准对肝硬化背景下肝细胞癌诊断效能的对照研究

目的基于钆塞酸二钠(Gd-EOB-DTPA)增强MRI, 比较2017版肝脏影像报告与数据系统(LI-RADS v2017)与2018版(LI-RADS v2018)分类标准对肝硬化背景下肝细胞癌(HCC)的诊断效能。方法回顾性收集2015年10月至2020年5月于南通大学附属南通第三医院行Gd-EOB-DTPA检查的213例肝硬化高危结节患者, 共246个病灶。由2名放射科医师根据LI-RADS v2017和v2018分类标准, 对MRI主要征象进行分析评估后对病灶分别进行分类。以术后病理或随访结果为金标准, 分别以LR-5和LR-4+LR-5为诊断HCC的标准, 计算LI-RADS v2017和v2018诊断HCC的灵敏度、特异度、准确度, 两者的比较采用McNemar检验或Fisher确切概率法。结果 246个病灶中, HCC 165个, 非HCC恶性病变31个, 良性病变50个。由于LI-RADS v2018中阈值增长和LR-5分类标准修订和简化, 共38个(15.4%, 38/246)病灶分类发生调整。LI-RADS v2017中84.6%(33/39)满足阈值增长的病变v2...     

LI-RADS v2018 MR辅助征象对肝细胞癌的诊断价值研究

目的:分析2018版肝脏影像报告和数据系统(LI-RADS,LR)中辅助征象对LR分类的影响及其对肝细胞癌(HCC)的诊断价值。方法:回顾性分析2009-2018年在本院经病理或影像学随访证实并行肝脏MRI增强检查的181例肝脏病变患者的临床、病理和影像资料。共217个肝内病灶,包括HCC146个、非HCC的恶性肿瘤16个和良性病变55个。所有病例的MR图像由3位医师共同读片并达成一致意见。计算并比较仅采用主要征象或主要征象联合辅助征象对HCC的诊断效能及其权重。结果:当以LR-4+LR-5为标准诊断HCC时,采用主要征象联合辅助征象对HCC的诊断效能略高于仅采用主要征象(约登指数0.71 vs.0.62,P=0.013)。在倾向为HCC的辅助征象中,结中结与HCC的相关性最大[诊断比值比(DOR)=4.68,95%CI:1.36~16.08],病灶含脂征象次之(DOR=2.93,95%CI:1.41~6.06)。在倾向恶性非HCC特异的辅助征象中,扩散受限(DOR=8.81,95%CI:4.13~18.82)与HCC的相关性最强,T 2WI上轻~中度高信号次之(DOR=8.17;95%CI:3.84~17.39)。结论:在HCC高危患者的MRI诊断中,应用LI-RADS v2018主要征象联合辅助征象有助于提高HCC的诊断效能。     

肝脏影像报告及数据系统（LI-RADS）2018版更新解读

【摘要】肝脏影像报告及数据系统（LI-RADS）是一个由美国放射学院（ACR）发布的肝脏影像检查规范及诊断分类系统,对肝细胞癌（HCC）高风险人群的影像检查技术、征象描述术语、诊断报告及数据收集进行了详细介绍和规范化要求。自2011年第一版LI-RADS发布以来,ACR分别于2013、2014、2017及2018年对该系统进行了更新。LI-RADS v2018针对超阈值生长和LR-5分类标准进行了修订和简化,随后又发布了详细的使用手册。本文将对LI-RADS v2018中CT及MRI部分相关内容的更新进行介绍。     

前瞻性将肝脏影像报告和数据管理系统(LI-RADS)应用于钆塞酸二钠增强MR成像的诊断准确性

目的前瞻性评价LI-RADS(2014版)分类标准在钆塞酸二钠增强MRI临床应用中的诊断效能。方法回顾性分析2014年1月—12月行肝脏钆增强MRI检查的143例初治高危病人的前瞻性影像报告,并对202例肝脏病灶进行了LI-RADS分类。统计分析了LI-RADS分类对肝细胞癌(HCC)和肝脏恶性肿瘤的诊断效能。结果 29例LR-4中20例(69.0%),75例LR-5中73例(97.3%)以及全部5例LR-5V(100%)病灶病理结果为HCC,剩余2例(2.7%)LR-5病灶为混合性肝细胞胆管细胞癌,13例LR-M病灶中10例(76.9%)为HCC。LR-5/5V对HCC的敏感度和特异度分别为60.5%和97.3%,纳入LR-M后敏感度增加(68.2%,P=0.002),但特异度降低,其差异无统计学意义(93.2%,P=0.154)。LR-5/5V/M对诊断肝脏恶性肿瘤的敏感度为68.9%,特异度为100.0%。结论 LI-RADS(2014版)成功应用于临床钆塞酸二钠增强MRI。LR-5/5V对诊断HCC特异性最高,但多数LR-M观察结果也为HCC,并有相当一部分非HCC恶性肿瘤被分为LR-4或LR-5。     

基于磁共振图像比较LI-RADS 2018版与2017版的诊断效果

目的 比较LI-RADS 2018版和2017版的MRI诊断效果。方法 选取115例肝细胞肝癌患者，包括121个肝脏局灶病变。由3位MRI诊断医师独自分析、分别根据LI-RADS 2018和2017进行LR分类，再做统计分析。结果当LR-5作为预测指标时，LI-RADS 2018与2017版相比，敏感性（63.1%vs. 53.8%），阴性预测值（69.2%vs. 64.3%）和准确性（78.5%vs. 73.4%），约登指数（0.595vs. 0.502）；当LR-4/5为预测指标时，MRI诊断HCC的诊断价值差异无统计学意义（P>0.05）。2017版中7个LR-4病灶在2018版中分类为LR-5。结论 LI-RADS 2018版诊断性能优于2017版，具有更高的敏感性，阴性预测值和准确性。当LR-5为肝细胞肝癌的预测因子时，2018版的修订主要影响LR分类。     

MRI纹理分析和LI-RADS分类鉴别诊断肝硬化小肝癌与不典型增生结节的价值比较

【摘要】目的：比较MRI纹理分析和LI-RADS分类在鉴别肝硬化小肝癌（sHCCs）与不典型增生结节（DNs）中的价值。方法：回顾性分析2015年10月－2018年4月在本院经手术或穿刺活检病理证实的65例肝硬化结节患者的临床资料和术前MRI资料。共78个肝硬化结节（≤3cm）,56个为sHCCs,22个为DNs。由两位放射科医师采用盲法共同分析肝硬化结节的MRI征象,并根据LI-RADS（LR）v2018标准对结节进行分级。采用MaZda软件在横轴面T2WI上于病灶最大层面沿病灶边缘手工勾画ROI,提取病灶的纹理特征,联合Fisher系数、交互信息及分类错误概率+平均相关系数三种纹理选择方法筛选出30个最佳特征子集。采用logistic回归分析筛选关键纹理特征,并构建影像组学标签。采用ROC曲线评估LR-5类、LR-4+LR-5类和影像组学标签鉴别2种病变的诊断效能。结果：LR-5类、LR-4+LR-5类和影像组学标签诊断良、恶性肝硬化结节的ROC曲线下面积（AUC）分别为0.750（95% CI:0.645~0.885）、0.851（95% CI:0.739~0.962）和0.970（95% CI:0.947~0.993）。与LR-4+LR-5类相比,影像组学标签能显著提高诊断特异度（77.3% vs. 95.5%,P=0.031）和符合率（88.5% vs. 96.2%,P=0.023）,两者之间诊断敏感度的差异无统计学意义（92.9% vs. 96.4%,P=0.397）。结论：MRI纹理分析在鉴别肝硬化小肝癌与增生结节方面较LI-RADS分类具有更优的诊断效能。     

基于钆塞酸二钠增强MRI高度异型增生结节分类对2018版LI-RADS诊断效能的影响

目的 在肝细胞癌(HCC)高危因素背景下，探讨基于钆塞酸二钠(Gd-EOB-DTPA)增强MRI高度异型增生结节(HGDN)分类处理对2018版肝脏影像报告与数据系统(LI-RADS)诊断效能的影响。方法 回顾性分析2015年1月至2021年12月在桂林医学院附属医院放射科，行Gd-EOB-DTPA增强MRI检查并术后经病理诊断的169例HCC高风险患者，共192个肝结节。两名放射科医师独立评估患者的影像征象，根据2018版LI-RADS分类标准将结节分类，统计分析LR-4/5、LR-5的诊断效能。为HGDN增加一个新分类LR-DN,将病理结果为HGDN的结节分类为LR-DN,其他结节分类不变，重新统计LR-4/5、LR-5的诊断效能。结果 2018版LI-RADS分类LR-4/5、LR-5的灵敏度、特异度、准确率分别为92.81%、56.41%、85.42%和82.35%、79.49%、81.77%。新增LR-DN分类后，LR-4/5、LR-5的灵敏度无变化，特异度分别为87.18%、92.31%,准确率分别为91.67%、84.38%。结论 Gd-EOB-DTPA增强MRI结合20...     

肝脏影像报告和数据系统(LI-RADS)中 MRI辅助特征的解读

增强MRI是临床常用的对肝细胞癌(HCC)进行准确诊断和分期的无创性检查方法。HCC的典型表现为动脉期明显强化和门静脉/平衡期廓清,但直径20 mm的结节常表现为非典型的强化模式。肝脏影像报告和数据系统(LI-RADS)描述了一些影像辅助特征来帮助诊断,包括非特异性恶性特征(轻至中度T_2高信号、DWI扩散受限、病灶中乏脂、病灶中乏铁、直径增加小于阈值生长和晕环状强化)及HCC特异性征象(病灶内含脂、结节中结节、马赛克结构和出血)。现就上述MRI影像辅助特征进行详细阐述。     

2018版MRI肝脏影像报告和数据系统对≤3 cm肝细胞癌与其他肝脏原发恶性肿瘤的鉴别诊断价值

目的:探讨2018版MRI肝脏影像报告和数据系统（LI-RADS v2018）对≤3 cm肝细胞癌（HCC）与其他肝脏原发恶性肿瘤（OM）的鉴别诊断价值。方法:回顾性分析2014年9月至2019年9月间浙江省丽水市中心医院、丽水市遂昌人民医院经手术病理证实且病灶长径≤3 cm的95例原发肝癌患者资料,根据病理结果分别归...     

基于LI-RADS添加辅助MRI征象鉴别不典型肝细胞癌与肝内胆管细胞癌

目的:探讨基于2018版肝脏影像报告和数据系统(LI-RADS)添加MRI辅助征象对不典型肝细胞癌(HCC)与肿块型肝内胆管细胞癌(ICC)的鉴别诊断价值,明确Gd-EOB-DTPA增强MRI鉴别LR-M患者中HCC和ICC的可靠影像学特征。方法:回顾性搜集2017年6月-2022年8月在本院行Gd-EOB-DTPA增强MRI检查的LR-M类肝脏肿瘤患者的病例资料。其中,不典型HCC 42例,ICC 56例。基于2018版LI-RADS中主要MRI征象和添加辅助MRI征象对不典型HCC与ICC的影像表现进行比较。采用多元logistic回归分析筛选出诊断HCC的独立影响因素。基于LI-RADS中诊断HCC的主要MRI征象建立HCC诊断模型(模型A)并分析其诊断效能,在模型A的基础上添加辅助征象建立HCC诊断模型(模型B)并分析其诊断效能,采用DeLong检验比较模型A和模型B的AUC的差异。结果:不典型HCC与ICC血清甲胎蛋白(AFP)和CA-199的差异具有统计学意义(P<0.001;P=0.008),强化包膜(P=0.001)、病灶内出血(P=0.040)、脂质沉积(P=0...     

Should Threshold Growth Be Considered a Major Feature in the Diagnosis of Hepatocellular Carcinoma Using LI-RADS?

ObjectiveBased on the Liver Imaging Reporting and Data System version 2018 (LI-RADS, v2018), this study aimed to analyze LR-5 diagnostic performance for hepatocellular carcinoma (HCC) when threshold growth as a major feature is replaced by a more HCC-specific ancillary feature, as well as the frequency of threshold growth in HCC and non-HCC malignancies and its association with tumor size.Materials and MethodsThis retrospective study included treatment-naive patients who underwent gadoxetate disodium-enhanced MRIs for focal hepatic lesions and surgery between January 2009 and December 2016. The frequency of major and ancillary features was evaluated for HCC and non-HCC malignancies, and the LR-category was assessed. Ancillary features that were significantly more prevalent in HCC were then used to either replace threshold growth or were added as additional major features, and the diagnostic performance of the readjusted LR category was compared to the LI-RADS v2018.ResultsA total of 1013 observations were analyzed. Unlike arterial phase hyperenhancement, washout, or enhancing capsule which were more prevalent in HCCs than in non-HCC malignancies (521/616 vs. 18/58, 489/616 vs. 19/58, and 181/616 vs. 5/58, respectively; p < 0.001), threshold growth was more prevalent in non-HCC malignancies than in HCCs (11/23 vs. 17/119; p < 0.001). The mean size of non-HCC malignancies showing threshold growth was significantly smaller than that of non-HCC malignancies without threshold growth (22.2 mm vs. 42.9 mm, p = 0.040). Similar results were found for HCCs; however, the difference was not significant (26.8 mm vs. 33.1 mm, p = 0.184). Additionally, Fat-in-nodule was more frequent in HCCs than in non-HCC malignancies (99/616 vs. 2/58, p = 0.010). When threshold growth and fat-in-nodule were considered as ancillary and major features, respectively, LR-5 sensitivity (73.2% vs. 73.9%, p = 0.289) and specificity (98.2% vs. 98.5%, p > 0.999) were comparable to the LI-RADS v2018.ConclusionThreshold growth is not a significant diagnostic indicator of HCC and is more common in non-HCC malignancies. The diagnostic performance of LR-5 was comparable when threshold growth was recategorized as an ancillary feature and replaced by a more HCC-specific ancillary feature.     

基于钆塞酸二钠增强MRI在LI-RADS v2018及LI-RADS v2017诊断肝细胞癌的对比研究

目的 探讨基于钆塞酸二钠(Gd-EOB-DTPA)增强MRI采用肝脏影像报告和数据系统2018版(LI-RADS v2018)诊断肝细胞癌(HCC)的效能,并与LI-RADS v2017进行对比研究.方法 回顾性分析2017年3月至2020年5月本院行Gd-EOB-DTPA增强MRI检查有病理结果的HCC高危患者.由三...     

Diagnostic Performance of 2018 KLCA-NCC Practice Guideline for Hepatocellular Carcinoma on Gadoxetic Acid-Enhanced MRI in Patients with Chronic Hepatitis B or Cirrhosis: Comparison with LI-RADS Version 2018

ObjectiveTo evaluate the performance of the 2018 Korean Liver Cancer Association-National Cancer Center (KLCA-NCC) Practice Guidelines (hereafter, PG) for the diagnosis of hepatocellular carcinoma (HCC) using gadoxetic acid-enhanced MRI, compared to the Liver Imaging-Reporting and Data System (LI-RADS) version 2018 (hereafter, v2018).Materials and MethodsFrom January 2013 to October 2015, treatment-naïve hepatic lesions (≥ 1 cm) on gadoxetic acid-enhanced MRI in consecutive patients with chronic hepatitis B or cirrhosis were retrospectively evaluated. For each lesion, three radiologists independently analyzed the imaging features and classified the lesions into categories according to the 2018 KLCA-NCC PG and LI-RADS v2018. The imaging features and categories were determined by consensus. Generalized estimating equation (GEE) models were used to compare the per-lesion diagnostic performance of the 2018 KLCA-NCC PG and LI-RADS v2018 using the consensus data.ResultsIn total, 422 lesions (234 HCCs, 45 non-HCC malignancies, and 143 benign lesions) from 387 patients (79% male; mean age, 59 years) were included. In all lesions, the definite HCC (2018 KLCA-NCC PG) had a higher sensitivity and lower specificity than LR-5 (LI-RADS v2018) (87.2% [204/234] vs. 80.8% [189/234], p < 0.001; 86.2% [162/188] vs. 91.0% [171/188], p = 0.002). However, in lesions of size ≥ 2 cm, the definite HCC had a higher sensitivity than the LR-5 (86.8% [164/189] vs. 82.0 (155/189), p = 0.002) without a reduction in the specificity (80.0% [48/60] vs. 83.3% [50/60], p = 0.15). In all lesions, the sensitivity and specificity of the definite/probable HCC (2018 KLCA-NCC PG) and LR-5/4 did not differ significantly (89.7% [210/234] vs. 91.5% [214/234], p = 0.204; 83.5% [157/188] vs. 79.3% [149/188], p = 0.071).ConclusionFor the diagnosis of HCC of size ≥ 2 cm, the definite HCC (2018 KLCA-NCC PG) had a higher sensitivity than LR-5, without a reduction in specificity. The definite/probable HCC (2018 KLCA-NCC PG) had a similar sensitivity and specificity to that those of the LR-5/4.     

CT and MRI Liver Imaging Reporting and Data System Version 2018 for Hepatocellular Carcinoma: A Systematic Review With Meta-Analysis

PurposeThe aim of this study was to determine the diagnostic performance of the LR-5 category for hepatocellular carcinoma (HCC) and the pooled proportion of HCC in each Liver Imaging Reporting and Data System (LI-RADS) category with CT and MRI, using LI-RADS version 2018.MethodsThe MEDLINE, Embase, and Scopus databases were searched from inception to December 7, 2019, for studies reporting the diagnostic accuracy of LI-RADS version 2018 for HCC. Risk for bias and concerns regarding applicability were assessed using the Quality Assessment of Diagnostic Accuracy Studies–2 tool. Random-effects models were used to determine the summary estimates of the diagnostic performance of LR-5 and the pooled proportion of HCC for each LI-RADS category.ResultsFourteen studies were included in the final analysis, consisting of 2,708 observations with 1,841 HCCs. The pooled per-observation sensitivity and specificity of the LR-5 category for diagnosing HCC were 70% (95% confidence interval [CI], 61%-78%) and 91% (95% CI, 89%-93%), respectively. No HCCs were reported for LR-1 and LR-2. The pooled proportions of HCC were 31% (95% CI, 12%-50%) for LR-3, 64% (95% CI, 47%-80%) for LR-4, 95% (95% CI, 93%-96%) for LR-5, 54% (95% CI, 30%-77%) for LR-TIV, and 33% (95% CI, 21%-46%) for LR-M. The proportions of HCC were significantly different among the LI-RADS categories (P = .022).ConclusionsThe LR-5 category of LI-RADS version 2018 provided moderate sensitivity and high specificity for diagnosing HCC. Higher LI-RADS categories from LR-3 to LR-5 included greater proportions of HCC.     

Analysis of comparative performance of CEUS and CECT/MR LI-RADS classification: Can CEUS dichotomize LI-RADS indeterminate lesions on CT or MRI?

PurposeTo study the comparative performance of contrast-enhanced ultrasound (CEUS) and contrast-enhanced CT or MRI (CECT/MR) in evaluating liver lesions using the LI-RADS guidelines.MethodsRetrospective analysis of radiology database from July 2010 to April 2017 revealed 228 patients who had CECT/MR and CEUS. Patients at risk of hepatocellular carcinoma (HCC), had contemporaneous CEUS and CECT/CEMR studies within 3 months and adequate follow up were included; reviewed (2 reviewers) and graded according to the 2017 CEUS and 2018 CECT/MR LI-RADS guidelines. Reference standard was multidisciplinary clinical decisions, histology or follow-up imaging.ResultsThe study cohort consisted of 45 patients with 46 lesions. HCC were significantly larger than non-malignant (mean sizes of 2.5 and 1.4 cm, respectively, p<0.001). Intraclass correlation coefficient for CEUS review (0.941) was higher than of CECT/MR review (0.643). Mean area-under-ROC curve (AUC) for CEUS (0.994) was significantly higher than of CECT/MR (0.760) for all lesions (p=0.01). For lesions scored LR-3 by CECT/MR, the AUC was significantly higher for CEUS (0.978) than CECT/MR (0.500) (p<0.001). Twenty-one (of 27) lesions, classified LR-3 or LR-4 by CECT/MR were upgraded by CEUS and 20 were found to be HCC. Six lesions that were LR-3 on both CECT/MR and CEUS were found to be non-malignant. There was good concordance for LR-5 lesions between both techniques.ConclusionCEUS is useful for reassessment of lesions with intermediate probability (LR-3) or probable for HCC (LR-4) on CECT/MR. Lesions upgraded by CEUS tend to be HCC. Lesions that remain LR-3 on CEUS tend to be non-malignant.     

LI-RADS CT分类标准对肝细胞癌的诊断效能评价

目的：探讨肝脏影像报告和数据管理系统（LI-RADS）CT分级诊断标准对肝细胞癌（HCC）的临床诊断价值。方法：回顾性分析158例肝癌高危患者肝脏病变患者的上腹部CT资料,并根据LI-RADS分类标准对病变进行分析评估,并与临床客观诊断结果进行比较。结果：158例患者的 CT 图像共发现179个肝内病灶,其中 LI-RADS 1～5类病灶共167个：1类和2类48个,临床客观诊断结果均为良性（阴性预测值为100％）;3类4个;4类6个,其中2个病灶的术后病理结果为 HCC（阳性预测值为33．3％）;5类109个,其中103例为 HCC（阳性预测值为94．5％）。受试者工作特征（ROC）曲线下面积为0．89（P＜0．001）。若将LI-RADS 1～2类病灶归为阴性,3～5类病灶归为阳性,LI-RADS对诊断肝癌的总符合率为91．6％（153／167）,检出 HCC 的敏感度为100％（105／105）,特异度为77．4％（48／62）,阳性预测值为88．2％（105／119）,阴性预测值为100％（48／48）。若将LI-RADS 3类病灶排除,1～2类病灶归为阴性,4～5类病灶归为阳性,LI-RADS对肝内已检出病灶的诊断符合率为93．9％（153／163）,检出 HCC 的敏感度为100％（105／105）,特异度为82．8％（48／58）,阳性预测值为91．3％（105／115）,阴性预测值为100％（48／48）。结论：LI-RADS分类标准对 HCC 的CT诊断具有很好的诊断效果,有利于提高CT诊断报告的准确性。     

LI-RADS MRI分类标准对肝细胞癌的诊断效能

目的：探讨肝脏影像报告和数据管理系统（LI-RADS）MRI 分级诊断标准对肝细胞癌（HCC）的诊断价值。方法：回顾性分析88例肝脏病变患者的上腹部MRI资料,并根据LI-RADS分类标准对病变进行分析评估,并与临床客观诊断结果进行比较。结果：88例患者MRI共发现117个病灶,其中LI-RADS 1～5类病灶99个：1类和2类病灶25个,临床客观诊断结果均为良性（阴性预测值为100％）;3类病灶3个,其中1个为HCC（阳性预测值为33．3％）;4类病灶8个,其中5个为 HCC（阳性预测值为62．5％）;63个5类病灶中61个为 HCC（阳性预测值为96．8％）。受试者工作特征（ROC）曲线下面积为0．96（P＜0．001）。若将LI-RADS 1～2类病灶归为阴性,3～5类归为阳性,LI-RADS对诊断 HCC的总符合率为92．9％（92／99）,敏感度为100％（67／67）,特异度为78．1％（25／32）,阳性预测值为90．5％（67／74）,阴性预测值为100％（25／25）。若将LI-RADS 3类病灶排除,1～2类病灶归为阴性,4～5类病灶归为阳性,LI-RADS对 HCC的诊断符合率为94．8％（91／96）,敏感度为100％（66／66）,特异度为83．3％（25／30）,阳性预测值为93．0％（66／71）,阴性预测值为100％（25／25）。结论：LI-RADS分类标准对HCC的MRI诊断具有很好的诊断效果,有利于提高MRI诊断报告的准确性。     

肝硬化背景下肝细胞癌的CT动态增强表现：LI-RADS（2014版）定义征象的出现率

目的：分析肝硬化背景下肝细胞肝癌（HCC）的 CT 动态增强表现,探讨2014版肝脏影像报告及数据系统（LI-RADS）所定义的各种征象在图像中的出现率。方法：2008年12月－2014年8月共51例乙肝肝硬化患者行CT动态增强检查、且经病理证实有54个 HCC病灶。两位阅片者采用盲法独立进行阅片,根据LI-RADS标准,分析所有入组病例的动态增强CT图像,对每个病灶的主要征象（动脉期高强化、＂廓清＂表现、包膜）和次要征象（马赛克征、出血等）进行评估并计算其出现率。通过Kappa检验来分析两位阅片者所评估的各种征象的出现率的一致性。结果：对54个 HCC病灶的动脉期高强化、“廓清”表现和包膜这3个主要征象的出现率,两位阅片者的评估结果分别为：77．8％和75．9％、81．5％和81．5％、14．8％和18．5％,阅片者间的一致性（Kappa值）分别为0．636、0．755和0．468。所有次要征象的出现率均较低,以马赛克征的出现率最高,两位阅片者的评估结果分别为25．9％和11．1％,阅片者间的一致性（Kappa 值）为0．289。结论：基于LI-RADS的诊断标准,动态增强CT图像对乙肝肝硬化背景下的 HCC的主要征象显示较好,阅片者间的一致性较高;但其它征象的出现率较低及／或诊断一致性欠佳。     

Outcome of LR-3 and LR-4 observations without arterial phase hyperenhancement at Gd-EOB-DTPA-enhanced MRI follow-up

ObjectiveThe aim of this study was to retrospectively analyze the outcome of LR-3 and LR-4 without arterial phase hyperenhancement (APHE), and identify which features could predict LR-5 progression on serial Gd-EOB-DTPA-enhanced MRI follow-up.MethodsForty-nine cirrhotic patients with 55 LR-3 and 19 LR-4 without APHE were evaluated. Observations were classified as decreased, stable or increased in category at follow-up. Observation size and LI-RADS major and ancillary features were evaluated.ResultsSeventeen/fifty-five (31%) LR-3 and 8/19 (42%) LR-4 progressed to LR-5 at follow-up. Baseline LI-RADS major and ancillary features were not significantly different among LR-3 and LR-4. A diameter ≥ 10 mm significantly increased LR-5 progression risk of LR-3 (OR = 6.07; 95% CI: 0.12; 60.28]; P < .001). LR-4 with a diameter ≥ 10 mm more likely become LR-5 at follow-up (OR = 8.95; 95% CI: 0.73; 111.8; P = .083]).ConclusionLR-3 and LR-4 without APHE were often downgraded or remained stable in category on Gd-EOB-DTPA-enhanced MRI follow-up.