肝脏病灶大小及肝细胞癌分化程度对超声造影肝脏影像报告与数据管理系统分类诊断的影响北大核心CSCD

目的分析肝脏病灶大小和肝细胞癌(HCC)分化程度对超声造影肝脏影像报告与数据管理系统(CEUS LI-RADS)分类诊断的影响。方法回顾性分析698例接受超声造影(CEUS)的肝脏局灶性病变(FLL)患者,根据肝脏病灶最大径(T)分为T<3 cm、3 cm≤T<5 cm和T≥5 cm组;根据HCC分化程度将其分为高、中及低分化组。观察不同大小肝脏病灶、不同分化程度HCC间CEUS LI-RADS分类的差异;以病理诊断为金标准,计算CEUS LI-RADS分类诊断不同大小HCC(以LR-5类为HCC)的效能。结果698例中,恶性682例,包括599例HCC及83例其他恶性病变,良性病变16例;其中T<3 cm 182例,3 cm≤T<5 cm 208例,T≥5 cm组308例;HCC中,高分化组32例,中分化组346例,低分化组221例。T<3 cm、3 cm≤T<5 cm和T≥5 cm病灶中,根据最终病理诊断,LR-1类均为良性病变,LR-4类中HCC占比依次为85.71%(18/21)、100%(10/10)及100%(2/2);HCC在LR-5类中的占比依次为98.37%(121/123)、95.36%(144/151)及94.50%(206/218),在LR-M类中的占比依次为54.55%(18/33)、39.13%(18/46)及69.77%(60/86)。高、中、低分化HCC组中,LR-5类占比分别为78.13%(25/32)、81.79%(283/346)和73.76%(163/221);LR-M类在低分化HCC组中的占比高于高、中分化组(P均<0.05)。以LR-5类为标准诊断HCC,CEUS LI-RADS针对T<3 cm、3 cm≤T<5 cm和T≥5 cm病灶分类诊断HCC的敏感度分别为76.10%(121/159)、83.72%(144/172)和76.87%(206/268),特异度分别为91.30%(21/23)、80.56%(29/36)和70.00%(28/40)。结论肝脏病灶大小及HCC分化程度均对CEUS LI-RADS分类诊断具有一定影响。

Influence of liver lesion size and differentiation degree of hepatocellular carcinoma on classification of contrast-enhanced ultrasound liver imaging reporting and data management system

Objective To explore the influence of liver lesion size and differentiation degree of hepatocellular carcinoma (HCC) on classification of contrast-enhanced ultrasound liver imaging reporting and data management system (CEUS LIRADS). Methods Data of 698 patients with focal liver lesions (FLL) who underwent contrast-enhanced ultrasound (CEUS) were retrospectively analyzed. According to the maximum diameter (T) of lesions, the patients were divided into T < 3 cm, 3 cm T < 5 cm and T 5 cm groups. Meanwhile, patients with HCC were divided into high, medium and low differentiation groups according to the degrees of differentiation. CEUS LI-RADS classification of different sized liver lesion and different degree differentiation were observed. Taken pathological diagnosis as the gold standards, the diagnostic performance of CEUS LI-RADS for HCC with different size was calculated. Results Among 698 patients, malignant lesions were confirmed pathologically in 682 cases, including 599 cases of HCC and 83 cases of other malignant lesions, while benign liver lesions were proved in 16 cases. There were 182, 208 and 308 cases in T < 3 cm group, 3 cm T < 5 cm group and T 5 cm group, respectively. Among 599 HCC patients, 32 were found with high, 346 with medium and 221 with low differentiation HCC, respectively. In T < 3 cm, 3 cm T < 5 cm and T 5 cm groups, all LR-1 lesions were benign ones, and the proportion of HCC of LR-4 category was 85. 71 % (18/21), 100% (10/10) and 100% (2/2), of LR-5 category was 98. 37% (121/123), 95.36% (144/151) and 94. 50% (206/218), of LR-M category was 54. 55% (18/33), 39.13% (18/46) and 69.77% (60/86), respectively. In high, medium and low differentiation HCC groups, the proportion of LR-5 category lesion was 78. 13% (25/32), 81. 79% (283/346) and 73. 76% (163/221), respectively. The proportion of poorly differentiated HCC of LR-M category was higher than of high and medium HCC (both P < 0. 05). The sensitivity of CEUS LI-RADS for HCC (LR-5 category as HCC) in T < 3 cm, 3 cm T < 5 cm and T 5 cm groups was 76. 10% (121/159), 83. 72% (144/172) and 76. 87% (206/268), and the specificity was 91. 30% (21/23), 80. 56% (29/36) and 70. 00% (28/40), respectively. Conclusion Both the size of liver lesion and the differentiation degree of HCC had certain influence on CEUS LI-RADS classification. © 2022 Editorial Board of Chinese Journal of Medical Imaging Technology. All rights reserved.