基于2018年版肝脏影像报告数据系统对比分析CT和MRI诊断肝细胞癌的效能*

目的 比较CT和MRI按照2018年版肝脏影像报告数据系统(LI-RADS)诊断肝细胞癌(HCC)的效能。方法 2017年9月～2020年7月四川省肿瘤医院诊治的有HCC高危因素的72例患者(HCC 53例、非HCC恶性肿瘤10例、良性病变9例),接受CT和MRI检查。根据2018年版LI-RADS定义的影像学征象和分类法则,对所有病灶进行分类,采用kappa一致性检验两种检查方法的分类结果,以组织病理学检查结果为金标准,比较CT和MRI诊断HCC的ROC曲线下面积(AUC),计算LR-5类诊断HCC的敏感性和特异性。结果 CT和MRI的LI-RADS分类结果一致性较好,kappa值为0.693【(95%CI:0.545～0.841),P＜0.001】;两种检查方法诊断HCC的AUC分别为0.827(95%CI: 0.708～0.946)和0.856(95%CI: 0.761～0.952),差异无统计学意义(P＞0.05);以LR-5为阳性,MRI诊断HCC的敏感性为81.1%(43/53),显著高于CT诊断的66.0%(35/53),差异有统计学意义(P＜0.05);CT和MRI诊断HCC的特异性分别为78.9%(15/19)和89.5%(17/19),差异无统计学意义(P＞0.05);在LI-RADS定义的主要征象中,MRI对强化包膜的显示率为40.3%,显著高于CT的5.5%(P＜0.001)。结论 基于肝脏影像报告数据系统,CT和MRI诊断HCC有相当高的效能,而MRI诊断肝细胞癌的敏感性高于CT,特别在显示强化病灶包膜方面优于CT。

Computed tomography and magnetic resonance imaging in the diagnosis of patients with hepatocellular carcinoma based on liver imaging report data system v2018

Objective This study aimed to compare the efficacy of computed tomography (CT) and magnetic resonance imaging (MRI) in the diagnosis of patients with hepatocellular carcinoma (HCC) based on liver imaging report data system (LI-RADS) v2018. Methods We performed a retrospective study in 72 patients with high risk of HCC (proven pathologically HCC in 53, non-HCC malignant tumors in 10 and benign lesions in 9), and all patients underwent CT and MRI scan between September 2017 and July 2020. Two independent radiologists assigned a LI-RADS category for all hepatic foci in consensus. The intraclass agreement for the LI-RADS category between CT and MRI was evaluated by using Kappa statistic. The area under receiver operating characteristic curve (AUC) was analyzed for diagnostic accuracy of LI-RADS v2018. Results The intraclass agreement for the LI-RADS category between CT and MRI was substantial, and the kappa value was 0.693 (95% CI: 0.545-0.841), P＜0.001]; the AUCs of the two modalities were 0.827 (95% CI: 0.708-0.946) and 0.856 (95% CI: 0.761-0.952), respectively, without significant difference(P＞0.05); the sensitivities of CT and MRI in diagnosing HCC based on the LR-5 were significantly different, while the specificities of CT and MRI were comparable; among the major features defined by LI-RADS, the display rate of enhanced capsule of tumors by MRI was 40.3%, significantly higher than 5.5% by CT (P ＜0.001). Conclusion Based on the LI-RADS v2018, the CT and MRI show a considerable efficacy in diagnosing patients with HCC, and the sensitivity of MRI is high with obvious presentation of enhanced capsule of tumors.