ACR CEUS LI-RADS和WFUMB-EFSUMB标准对高危人群肝细胞癌诊断价值的对比研究

目的比较美国放射学会超声造影肝脏影像报告和数据系统（ACR CEUS LI-RADS）和世界超声医学和生物学联合会-欧洲超声医学和生物学联合会（WFUMB-EFSUMB）肝脏超声造影指南对于高危人群肝细胞癌（HCC）的诊断效能。 方法回顾性分析2018年3月至2020年12月在浙江大学医学院附属第二医院就诊的HCC高危患者319例（334个病灶），按照ACR CEUS LI-RADS 2017版和WFUMB-EFSUMB肝脏造影指南分类标准对334个病灶的超声造影视频进行判读，以手术或穿刺活检组织学病理、临床诊断及随访结果为参考标准，分析ACR CEUS LI-RADS各分级类别对HCC的诊断效能。分别计算ACR CEUS LI-RADS LR-5类和WFUMB-EFSUMB标准诊断HCC的敏感度、特异度、准确性、阳性预测值、阴性预测值及受试者操作特征（ROC）曲线下面积，采用χ²检验及DeLong's检验进行诊断效能比较。计算两者联合诊断HCC的ROC曲线下面积，并分别与2种诊断标准的ROC曲线下面积进行比较。 结果本研究纳入的334个肝脏病灶，按照ACR CEUS LI-RADS分类，LR-5类病灶114个，LR-4类病灶25个，LR-3类病灶12个，LR-M类病灶162个，每个分类诊断HCC的阳性预测值分别为93.9%、40.0%、16.7%、24.7%。ACR CEUS LI-RADS LR-5类标准与WFUMB-EFSUMB标准诊断HCC的敏感度分别为66.9%、83.8%，特异度分别为96.0%、73.0%，差异均具有统计学意义（χ²=25.037、38.025，P均＜0.001）；2种标准诊断准确性比较（82.0% vs 78.1%），差异无统计学意义（χ²=1.352，P=0.245）；2种标准诊断HCC的ROC曲线下面积分别为0.814、0.784，差异无统计学意义（P=0.161）。两者联合诊断的ROC曲线下面积为0.857，与ACR CEUS LI-RADS LR-5类及WFUMB-EFSUMB标准比较，差异具有统计学意义（P=0.001、＜0.001）。 结论ACR CEUS LI-RADS和WFUMB-EFSUMB标准对高危人群HCC的诊断均具有较高的价值。ACR CEUS LI-RADS LR-5类标准和WFUMB-EFSUMB标准诊断HCC的效能类似。然而，2种标准在提供诊断信息时存在差异，ACR CEUS LI-RADS LR-5类标准的诊断特异度更高，而WFUMB-EFSUMB标准的诊断敏感度更高，2种标准在一定程度上可以互补。

Comparison between ACR CEUS LI-RADS and WFUMB-EFSUMB for diagnosing hepatocellular carcinoma in high-risk patients

ObjectiveTo compare the diagnostic value of the American College of Radiology contrast-enhanced ultrasound liver imaging reporting and data system (ACR CEUS LI-RADS) and the World Federation for Ultrasound in Medicine and Biology-European Federation of Societies for Ultrasound in Medicine and Biology (WFUMB-EFSUMB) guidelines for hepatocellular carcinoma (HCC) in high-risk patients. MethodsFrom March 2018 to December 2020, 319 patients (334 lesions) with a high risk of HCC at the Second Affiliated Hospital Zhejiang University School of Medicine were analyzed. CEUS videos of 334 lesions were interpreted according to the CEUS LI-RADS 2017 edition and WFUMB-EFSUMB classification criteria. Using surgery or biopsy histopathology, clinical diagnosis, and follow-up results as reference standards, the diagnostic efficacy of each classification of ACR CEUS LI-RADS for HCC was analyzed. The sensitivity, specificity, accuracy, positive predictive value, negative predictive value, and area under the ROC curve of ACR CEUS LI-RADS LR-5 and WFUMB-EFSUMB criteria in the diagnosis of HCC were calculated and compared by the chi-square test and DeLong's test. The area under the ROC curve of the combined diagnosis was also calculated and compared with that of either of them. ResultsOf the 334 liver lesions included, according to the ACR CEUS LI-RADS classification, there were 114 nodules in LR-5 category, 25 in LR-4, 12 in LR-3, and 162 in LR-M; their positive predictive values for the diagnosis of HCC were 93.9%, 40.0%, 16.7%, and 24.7%, respectively. The sensitivity and specificity of ACR CEUS LI-RADS LR-5 and WFUMB-EFSUMB in the diagnosis of HCC were 66.9% vs 83.8% and 96.0% vs 73.0%, respectively, and the differences were statistically significant (χ²=25.037 and 38.025; P＜0.001). There was no significant difference in the diagnostic accuracy of the two criteria (82.0% vs 78.1%, χ²=1.352, P=0.245). The areas under the ROC curve were 0.814 and 0.784, respectively, and the difference was not statistically significant (P=0.161). The area under the ROC curve of the combined diagnosis of the two was 0.857, which was significantly higher than that of either of them (P=0.001 and <0.001, respectively). ConclusionBoth ACR CEUS LI-RADS and WFUMB-EFSUMB criteria have high diagnostic value for HCC in high-risk patients. The diagnostic efficacy of ACR CEUS LI-RADS LR-5 and WFUMB-EFSUMB is similar. However, the information provided by the two criteria is different, with ACR CEUS LI-RADS LR-5 having a higher specificity and WFUMB-EFSUMB having a higher sensitivity. The two criteria can complement each other to a certain extent.