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。

Application of the LI-RADS CT classification for the diagnosis of hepatocellular carcinoma

Objective:To evaluate the application value of liver imaging reporting and data system (LI-RADS)CT classification in the diagnosis of hepatocellular carcinoma (HCC).Methods:158 patients at high risk of HCC who underwent CT examination were enrolled.All the CT images were analyzed and the lesions were categorized into 5 scales according to the LI-RADS.The diagnostic results of MRI LI-RADS were compared with the results of clinical objective diagnosis. Results:179 lesions were detected in all 158 patients,including 167 lesions were diagnosed as LI-RADS category 1~5.Of 167 lesions,48 lesions in category 1 or 2 were benign lesions proved by clinical data (negative predictive value 100%).Of the four lesions in category 3,there was no HCC.Of the six lesions in category 4,there were 2 HCCs (positive predictive value 75%).Of 109 lesions in category 5,there were 103 HCCs (positive predictive value 100%).The area underneath the ROC curve (AUC)was 0.89 with statistic significance (P<0.001).If hepatic lesions in category 1 and 2 were considered as negative and lesions in category 3~5 considered as positive,the accuracy,sensitivity,specificity,positive predictive value (PPV)and negative predictive value (NPV)of the LI-RADS classification for the diagnosis of HCC were 91.6%,100%, 77.4%,88.2% and 100% respectively.If lesions in category 1 and 2 were considered as negative,lesions in category 4~5 were considered as positive and lesions in category 3 were excluded,the accuracy,sensitivity,specificity,PPV and NPV of the LI-RADS classification for diagnosis of HCC were 93.9%,100%,82.8%,91.3% and 100% respectively.Conclusion:LI-RADS CT classification provides strong validity for the diagnosis of HCC,and is very useful to improve the accuracy of CT reports.