【摘要】 目的：探讨MRI肝脏影像报告和数据系统（MRv2018）与超声肝脏影像报告和数据系统（CEUS v2017）对肝细胞癌（HCC）的诊断效能差异。方法：前瞻性收集2019年8月至2021年7月间在丽水市中心医院就诊的153例HCC高危风险患者（173例病灶）的超声增强造影和磁共振增强检查资料，评估肝内病灶的影像特征和CEUS v2017与MR v2018类别，以病理或临床诊断为标准将病灶分为HCC组（119例）、其他肝脏恶性肿瘤（OM）组（20例）、良性病变组（34例）。采用Mann-Whitney U检验比较MR v2018与CEUS v2017的LIRADS分类结果差异，χ2检验比较MR v2018与CEUS v2017分类标准诊断HCC或OM的灵敏度、特异度和准确度差异。结果：MR v2018与CEUS v2017评估中HCC与OM的LI-RADS分类结果差异均无统计学意义（Z=-0.363、-1.705,P=0.717、0.088）。MR v2018与CEUS v2017中以LR-5标准诊断HCC的灵敏度均为63.9%(76/119)，特异度分别为98.1%(53/54)和92.6%(50/54)，准确度分别为74.6%(129/173)和72.8%(126/173)；以LR-4联合LR-5(LR-4/5)标准诊断HCC的灵敏度分别为74.8%(89/119)和84.9%(101/119)，特异度分别为94.4%(51/54)和70.4%(38/54)，准确度分别为80.9%(140/173)和80.3%(139/173)；以LR-M标准诊断OM的灵敏度分别为90.0%(18/20)和70.0%(14/20)，特异度分别为87.6%(134/153)和90.8%(139/153)，准确度分别为87.9%(152/173)和88.4%(153/173)；两套系统在LR-4/5标准的特异度对比中MR v2018要显著高于CEUS v2017，差异有统计学意义（P=0.001）。结论：MR v2018与CEUS v2017的LR-5标准诊断HCC、LR-M标准诊断OM均具有相近的诊断效能；而LR-4/5标准在诊断HCC的特异度方面MR v2018要高于CEUS v2017。更多还原

【Abstract】 Objective:To compare the difference between magnetic resonance imaging (MRI) Liver Imaging Reporting and Data System (LI-RADS) version 2018 and contrast-enhanced ultrasound (CEUS) LI-RADS version2017 in diagnostic efficacy for hepatocellular carcinoma (HCC).Methods:We prospectively collected the data of 153 high-risk patients (173 lesions) with HCC from August 2019 to July 2021 in Lishui Central Hospital of Zhejiang Province,and evaluated the imaging characteristics of all intrahepatic lesions.Moreover,the classifications of all intrahepatic lesions by MRI LI-RADS v2018 and CEUS LI-RADS v2017 were obtained.Based on the pathological or clinical diagnosis,all lesions were divided as HCC group (119 cases),other malignancy (OM) group (20 cases) and benign lesion group (34 cases).The sensitivity,specificity and accuracy of MRI LI-RADS v2018 and CEUS LI-RADS v2017 for the diagnosis of HCC or OM were calculated.The Mann-whitney U test was used to compare the classification results between MRI LI-RADS v2018 and CEUS LI-RADS v2017.Results:Regarding the classification results of HCC or OM,there was no statistical difference between MRI LI-RADS v2018 and CEUS LI-RADS v2017 (Z=-0.363,-1.705;P=0.717,0.088).In applications of MRI LI-RADS v2018 and CEUS LI-RADS v2017,the LR-5 criterion for the diagnosis of HCC had respective sensitivity of 63.9%and 63.9%,specificity of 98.1%and 92.6%,accuracy of 74.6%and 72.8%.The joint criterion of LR-4 and LR-5 for the diagnosis of HCC showed respective sensitivity of 74.8%and 84.9%,specificity of 94.4%and 70.4%,accuracy of 80.9%and 80.3%.Besides,the LR-M criterion for the diagnosis of OM showed respective sensitivity of 90.0%and 70.0%,specificity of 87.6%and 90.8%,accuracy of 87.9%and 88.4%.Among all,the MR v2018 result was significantly higher than the CEUS v2017 in regarding the specificity of LR-4/5 criteria for the diagnosis of HCC,showing statistical difference (P=0.001).Conclusion:Both the LR-5and LR-M criteria of MRI LI-RADS v2018 and CEUS LI-RADS v2017 have similar diagnostic efficacy for HCC and OM,with MR v2018 significantly higher than that of the CEUS v2017 in comparison of the specificity by LR-4/5 criteria for the diagnosis of HCC.更多还原