目的 分析基于(CT)的(LI-RADS)分类对肝细胞肝癌(HCC)的诊断价值。方法 选自2018年6月~2021年12月收治的HCC患者162例,所有患者均经手术或穿刺得行病理学检查,手术或穿刺前接受CT扫描,记录不同阅片者对2018年版LI-RADS(LI-RADS v 2018)...目的 分析基于(CT)的(LI-RADS)分类对肝细胞肝癌(HCC)的诊断价值。方法 选自2018年6月~2021年12月收治的HCC患者162例,所有患者均经手术或穿刺得行病理学检查,手术或穿刺前接受CT扫描,记录不同阅片者对2018年版LI-RADS(LI-RADS v 2018)分类的评估一致性,分析LI-RADS v 2018分类对162例HCC高危人群病灶判断情况,使用一致性检验评估LI-RADS v 2018对HCC的诊断效能。结果 一致性检验显示,2名阅片者对LIRADS v 2018分类的判断一致性较高,Kappa系数为0.903(P <0.001)。162例HCC高危人群共检出193个病灶,其中经病理学检查诊断有156个HCC病灶,LI-RADS v 2018分类中LR-1与LR-2未见HCC病灶,其他类型均有HCC病灶。以LR-5、LR-4+LR-5、LR-4+LR-5+LR-TIV诊断HCC均有较高应用价值(P <0.05),但LR-4+LR-5+LR-TIV对HCC诊断价值最高,与病理学检查的Kappa系数为0.464。结论 基于CT的LI-RADS v 2018分类对HCC诊断价值较高,以LR-4+LR-5+LR-TIV分类作为标准诊断HCC,具有良好诊断效能。展开更多
目的探讨超声造影肝脏影像报告与数据系统(liver imaging reporting and data system, LI-RADS)对肝细胞癌(hepatocellular carcinoma, HCC)的诊断效能,评估其在HCC诊断中的应用价值。方法选取2018年9月-2020年6月于蚌埠市第三人民医院...目的探讨超声造影肝脏影像报告与数据系统(liver imaging reporting and data system, LI-RADS)对肝细胞癌(hepatocellular carcinoma, HCC)的诊断效能,评估其在HCC诊断中的应用价值。方法选取2018年9月-2020年6月于蚌埠市第三人民医院就诊的具有HCC高危因素患者150例共163个肝脏局灶性病变的超声造影资料,由4名具有5年以上肝脏超声造影经验的医师按照超声造影常规法标准和LI-RADS分类法标准分为2组,分别对163个病灶进行诊断。以病理结果为金标准,计算敏感性、特异性、阳性预测值、阴性预测值、诊断符合率,绘制ROC曲线比较2组的诊断效能。结果 163个病灶经病理证实HCC为122个,非HCC恶性病变16个,良性病变25个。常规法诊断HCC符合率为87.1%(142/163),曲线下面积(AUC)为85.7%。LI-RADS分类法中LR-5类诊断HCC特异性最高(95.1%)但敏感性偏低(72.1%),若将LR-4+LR-5类诊断为HCC,其敏感性(98.4%,120/122)、特异性(82.9%,34/41)、诊断符合率(94.5%,154/163)及AUC(90.6%)均高于常规法。分类法诊断准确性优于常规法,二者差异具有统计学意义(χ^(2)=4.654,P=0.031)。结论超声造影LI-RADS分类标准可以提高HCC诊断符合率,具有较高的诊断价值。展开更多
Hepatocellular carcinoma(HCC)is the most common primary liver malignancy and the second leading cause of cancer-related deceases worldwide.Early diagnosis is essential for correct management and improvement of prognos...Hepatocellular carcinoma(HCC)is the most common primary liver malignancy and the second leading cause of cancer-related deceases worldwide.Early diagnosis is essential for correct management and improvement of prognosis.Proposed for the first time in 2011 and updated for the last time in 2017,the Liver Imaging-Reporting and Data System(LI-RADS)is a comprehensive system for standardized interpretation and reporting of computed tomography(CT)and magnetic reso-nance imaging(MRI)liver examinations,endorsed by the American College of Radiology to achieve congruence with HCC diagnostic criteria in at-risk populations.Understanding its algorithm is fundamental to correctly apply LI-RADS in clinical practice.In this pictorial review,we provide a guide for beginners,explaining LI-RADS indications,describing major and ancillary features and eventually elucidating the diagnostic algorithm with the use of some clinical examples.展开更多
Aim:We sought to identify predictors of progression of an indeterminate observation(LI-RADS 3)to hepatocellular carcinoma(LI-RADS 5).Methods:Imaging reports with LI-RADS(LR)assignments were identified among patients a...Aim:We sought to identify predictors of progression of an indeterminate observation(LI-RADS 3)to hepatocellular carcinoma(LI-RADS 5).Methods:Imaging reports with LI-RADS(LR)assignments were identified among patients at the University of Washington,2013-2017.Patients with an LR3 lesion and follow-up scan within 1 year of LR3 lesion date were included(n=313).Features of interest were abstracted from chart review.Survival analyses employing interval censoring were performed,with variables potentially predictive of LR3 progression identified in univariate analyses.Backwards elimination(P<0.05)was used to obtain the final multivariate model.Results:20.4%of LR3 lesions progressed to LR5;73%remained LR3,8%LR4.The cohort was predominantly male(61%),Caucasian(54%),older than 55(63%).47%had a history of hepatitis C virus(HCV),33%with alcohol abuse,not mutually exclusive.Alpha-fetoprotein(AFP)at the time of LR3 scan was low if available(39%with AFP<5,29%unknown).CT was the most common exam(56%).Men(HR=2.0,P=0.02),earlier scan year(HR=0.47 per year,P<0.0001),and older age(HR=1.48,P=0.03),appeared as predictors of LR progression in the final model.HCV and alcohol use were more common among men but did not appear to explain the difference in LR progression by sex.Conclusion:Our analysis is an early exploration of characteristics that may predict the risk of progression of an LR3 observation to hepatocellular carcinoma.Future efforts may allow for risk stratification to identify high-risk indeterminate lesions that may benefit from earlier intervention or more frequent surveillance.展开更多
肝脏是肿瘤好发部位之一,恶性肿瘤多见,以原发性肝癌和肝转移瘤为主。肝细胞癌(hepatocellular carcinoma,HCC)是肝癌的主要组织学亚型,占全球原发性肝癌的80%以上,是全球癌症相关死亡的第四大常见原因。在肝脏成像报告和数据系统(Liver...肝脏是肿瘤好发部位之一,恶性肿瘤多见,以原发性肝癌和肝转移瘤为主。肝细胞癌(hepatocellular carcinoma,HCC)是肝癌的主要组织学亚型,占全球原发性肝癌的80%以上,是全球癌症相关死亡的第四大常见原因。在肝脏成像报告和数据系统(Liver Imaging Reporting and Data System,LI-RADS)中,已经确定了几个有利于诊断HCC的辅助特征,其中之一是病灶内脂肪的存在。瘤内脂肪被认为与HCC的肿瘤分级及预后密切相关,含脂肪HCC往往有更好的预后。也有研究发现瘤内脂肪含量对于不同肿瘤有一定的鉴别意义。化疗是目前针对肿瘤患者最有效和应用最广泛的治疗方案之一,而脂肪变性是化疗后肝损伤的首要表现形式,因此肝脏脂肪定量可以用于肿瘤患者化疗后肝损伤评估。随着肝癌肝移植标准的更新,扩大了受者人群。中国肝移植注册中心数据显示,2018至2020年国内肝移植年平均约6000例。肝脂肪变性被认为是预测移植后供肝损伤最重要的预后组织学参数。展开更多
文摘目的 分析基于(CT)的(LI-RADS)分类对肝细胞肝癌(HCC)的诊断价值。方法 选自2018年6月~2021年12月收治的HCC患者162例,所有患者均经手术或穿刺得行病理学检查,手术或穿刺前接受CT扫描,记录不同阅片者对2018年版LI-RADS(LI-RADS v 2018)分类的评估一致性,分析LI-RADS v 2018分类对162例HCC高危人群病灶判断情况,使用一致性检验评估LI-RADS v 2018对HCC的诊断效能。结果 一致性检验显示,2名阅片者对LIRADS v 2018分类的判断一致性较高,Kappa系数为0.903(P <0.001)。162例HCC高危人群共检出193个病灶,其中经病理学检查诊断有156个HCC病灶,LI-RADS v 2018分类中LR-1与LR-2未见HCC病灶,其他类型均有HCC病灶。以LR-5、LR-4+LR-5、LR-4+LR-5+LR-TIV诊断HCC均有较高应用价值(P <0.05),但LR-4+LR-5+LR-TIV对HCC诊断价值最高,与病理学检查的Kappa系数为0.464。结论 基于CT的LI-RADS v 2018分类对HCC诊断价值较高,以LR-4+LR-5+LR-TIV分类作为标准诊断HCC,具有良好诊断效能。
文摘目的 探讨超声造影(CEUS)LI-RADS鉴别诊断最大径≤3 cm肝脏局灶性病变(FLLs)良恶性的临床价值。方法 选取我院收治的FLLs患者82例,均行常规超声及CEUS检查。采用Kappa检验分析CEUS LI-RADS及常规超声诊断结果与病理诊断结果的一致性;绘制受试者工作特征(ROC)曲线分析CEUS LI-RADS及常规超声鉴别FLLs良恶性的诊断效能,并进一步探讨CEUS LI-RADS鉴别不同大小FLLs良恶性的诊断效能。结果 82例FLLs患者经病理确诊为良性病变3例,恶性病变79例。CEUS LI-RADS鉴别诊断FLLs良恶性的准确率为96.34%(79/82);CEUS LI-RADS与病理诊断结果的一致性(Kappa=0.738)高于常规超声与病理诊断结果的一致性(Kappa=0.394),差异有统计学意义(P<0.05)。ROC曲线分析显示,CEUS LI-RADS鉴别诊断FLLs良恶性的AUC(0.821)大于常规超声(0.783),差异有统计学意义(P<0.05)。CEUS LI-RADS鉴别诊断最大径≥2~3 cm、1~2 cm及<1 cm FLLs良恶性的准确率分别为94.74%、91.18%、70.00%,其诊断最大径≥2~3 cm FLLs的准确率高于最大径<1 cm FLLs,差异有统计学意义(P=0.023);CEUS LI-RADS鉴别诊断最大径1~2 cm、≥2~3 cm FLLs良恶性的AUC(0.917、0.972)均大于最大径<1 cm FLLs(0.667),差异均有统计学意义(均P<0.05)。结论 CEUS LI-RADS可有效判断FLLs恶性风险,且其对最大径1~2 cm、≥2~3 cm FLLs良恶性的鉴别诊断价值高于最大径<1 cm FLLs。
文摘目的探讨超声造影肝脏影像报告与数据系统(liver imaging reporting and data system, LI-RADS)对肝细胞癌(hepatocellular carcinoma, HCC)的诊断效能,评估其在HCC诊断中的应用价值。方法选取2018年9月-2020年6月于蚌埠市第三人民医院就诊的具有HCC高危因素患者150例共163个肝脏局灶性病变的超声造影资料,由4名具有5年以上肝脏超声造影经验的医师按照超声造影常规法标准和LI-RADS分类法标准分为2组,分别对163个病灶进行诊断。以病理结果为金标准,计算敏感性、特异性、阳性预测值、阴性预测值、诊断符合率,绘制ROC曲线比较2组的诊断效能。结果 163个病灶经病理证实HCC为122个,非HCC恶性病变16个,良性病变25个。常规法诊断HCC符合率为87.1%(142/163),曲线下面积(AUC)为85.7%。LI-RADS分类法中LR-5类诊断HCC特异性最高(95.1%)但敏感性偏低(72.1%),若将LR-4+LR-5类诊断为HCC,其敏感性(98.4%,120/122)、特异性(82.9%,34/41)、诊断符合率(94.5%,154/163)及AUC(90.6%)均高于常规法。分类法诊断准确性优于常规法,二者差异具有统计学意义(χ^(2)=4.654,P=0.031)。结论超声造影LI-RADS分类标准可以提高HCC诊断符合率,具有较高的诊断价值。
文摘Hepatocellular carcinoma(HCC)is the most common primary liver malignancy and the second leading cause of cancer-related deceases worldwide.Early diagnosis is essential for correct management and improvement of prognosis.Proposed for the first time in 2011 and updated for the last time in 2017,the Liver Imaging-Reporting and Data System(LI-RADS)is a comprehensive system for standardized interpretation and reporting of computed tomography(CT)and magnetic reso-nance imaging(MRI)liver examinations,endorsed by the American College of Radiology to achieve congruence with HCC diagnostic criteria in at-risk populations.Understanding its algorithm is fundamental to correctly apply LI-RADS in clinical practice.In this pictorial review,we provide a guide for beginners,explaining LI-RADS indications,describing major and ancillary features and eventually elucidating the diagnostic algorithm with the use of some clinical examples.
文摘Aim:We sought to identify predictors of progression of an indeterminate observation(LI-RADS 3)to hepatocellular carcinoma(LI-RADS 5).Methods:Imaging reports with LI-RADS(LR)assignments were identified among patients at the University of Washington,2013-2017.Patients with an LR3 lesion and follow-up scan within 1 year of LR3 lesion date were included(n=313).Features of interest were abstracted from chart review.Survival analyses employing interval censoring were performed,with variables potentially predictive of LR3 progression identified in univariate analyses.Backwards elimination(P<0.05)was used to obtain the final multivariate model.Results:20.4%of LR3 lesions progressed to LR5;73%remained LR3,8%LR4.The cohort was predominantly male(61%),Caucasian(54%),older than 55(63%).47%had a history of hepatitis C virus(HCV),33%with alcohol abuse,not mutually exclusive.Alpha-fetoprotein(AFP)at the time of LR3 scan was low if available(39%with AFP<5,29%unknown).CT was the most common exam(56%).Men(HR=2.0,P=0.02),earlier scan year(HR=0.47 per year,P<0.0001),and older age(HR=1.48,P=0.03),appeared as predictors of LR progression in the final model.HCV and alcohol use were more common among men but did not appear to explain the difference in LR progression by sex.Conclusion:Our analysis is an early exploration of characteristics that may predict the risk of progression of an LR3 observation to hepatocellular carcinoma.Future efforts may allow for risk stratification to identify high-risk indeterminate lesions that may benefit from earlier intervention or more frequent surveillance.
文摘肝脏是肿瘤好发部位之一,恶性肿瘤多见,以原发性肝癌和肝转移瘤为主。肝细胞癌(hepatocellular carcinoma,HCC)是肝癌的主要组织学亚型,占全球原发性肝癌的80%以上,是全球癌症相关死亡的第四大常见原因。在肝脏成像报告和数据系统(Liver Imaging Reporting and Data System,LI-RADS)中,已经确定了几个有利于诊断HCC的辅助特征,其中之一是病灶内脂肪的存在。瘤内脂肪被认为与HCC的肿瘤分级及预后密切相关,含脂肪HCC往往有更好的预后。也有研究发现瘤内脂肪含量对于不同肿瘤有一定的鉴别意义。化疗是目前针对肿瘤患者最有效和应用最广泛的治疗方案之一,而脂肪变性是化疗后肝损伤的首要表现形式,因此肝脏脂肪定量可以用于肿瘤患者化疗后肝损伤评估。随着肝癌肝移植标准的更新,扩大了受者人群。中国肝移植注册中心数据显示,2018至2020年国内肝移植年平均约6000例。肝脂肪变性被认为是预测移植后供肝损伤最重要的预后组织学参数。
