肝硬化相关铁沉积结节的LI-RADS MRI分类诊断及随访价值

目的基于肝脏影像报告和数据系统(LI-RADS)2018版分类标准,探讨MRI在肝硬化相关铁沉积结节(SN)的评分及随诊价值。方法回顾性分析本院54例肝硬化患者合并SN(167个病灶)的MRI随访资料,随访时长7~56个月,平均21.4个月。首诊LI-RADS评分,LI-RADS 2类105个,LI-RADS 3类56个,LI-RADS 4类6个,且未进行过活检、手术等治疗。记录随访期间病灶影像改变及LI-RADS分类调整情况。采用Kaplan-Meier曲线分析LI-RADS 2、LI-RADS≥3类SN上调至LI-RADS 5的累积发生率,并采用Log-Rank检验比较。结果105个LI-RADS 2类SN中,3个上调至LI-RADS 5,1个上调至LI-RADS 4,3个上调至LI-RADS 3;56个LI-RADS 3类SN中,4个上调至LI-RADS 5,2个上调LI-RADS 4;6个LI-RADS 4类SN中,2个上调至LI-RADS 5。9个SN演变为HCC中,均表现为病灶内铁廓清、T2WI信号的增高以及富血供转变。SN进展至LI-RADS 5的累积发生率为5.4%,其中LI-RADS≥3类病变上调至LI-RADS 5的累积发生率较LI-RADS 2类稍高,差异有统计学意义(P<0.05),12、24、36个月进展至LI-RADS 5的累积发生率LI-RADS≥3类SN分别为1.6%、8.1%、9.7%,LI-RADS 2类SN分别为0、1.0%、1.9%。结论约5.4%的SN转归为明确的HCC,其中LI-RADS≥3类病灶较LI-RADS 2类高,铁廓清、T2WI信号增高及富血供转变为SN多步癌演变重要的过程。

Category Diagnosisand Follow-up of Cirrhotic Siderotic Nodules Depending on MRI Liver Imaging Reporting and Data System

Objective To evaluate the category diagnosis and prognosis of cirrhotic siderotic nodules based on MRI liver imaging reporting and Data system(LI-RADS)version 2018.Methods The retrospective study included 54 patients with 167 cirrhotic siderotic nodules,the mean follow-up period was 21.4 months(range,7-56 months).Among all the lesions,105 were LR-2,56 were LR-3 and 6 were LR-4.The imaging features and category modifications were recorded for each lesion.The incidence for upgrade to LR-5 of LR-2 and LR≥3 siderotic nodules were analyzed by Kaplan-Meier curve.Log-Rank test was used to compare the results.Results Among 105 index LR-2 lesions,3 were upgraded to LR-5,1 upgraded to LR-4,3 upgraded to LR-3.Among 56 index LR-3 lesions,4 were upgraded to LR-5 and 2 were upgraded to LR-4.Among 6 index LR-4 lesions,2 were upgraded to LR-5.9 siderotic nodules of progression to HCC showed iron clearance,hyperintense on T2WI and hypervascular transformation during follow-up periods.The cumulative incidence of siderotic nodules up-regulated to LR-5 was 5.4%.The cumulative incidence of LR≥3 siderotic nodules at 12,24,36 months to LR-5 was 1.6%、8.1%、9.7%,and LR-2 lesions was 0、1.0%、1.9%(P<0.05).Conclusion Approximately 5.4%of siderotic nodules were upgraded to definite HCC.Iron clearance,hyperintense signal on T2WI and increased hypervascularity on the follow-up MRI indicated the multi-phase malignant transformation.