【摘要】 目的 探讨2018版肝脏影像报告和数据系统(LI-RADS v2018)在钆塞酸二钠(Gd-EOB-DTPA)增强MRI上诊断肝细胞肝癌(HCC)的效能。方法 回顾性收集行Gd-EOB-DTPA增强MRI并于1个月内取得病理结果的237例HCC(共282枚肝脏病灶)高风险人群的临床及影像资料。由2名放射科医师进行独立盲法阅片。根据LI-RADS v2018评估每个病灶的主要和辅助MRI征象,并对病灶分类。应用Kappa检验评估2名医师对病灶征象和分类判读的一致性。以病理结果为金标准计算以LR-5和LR-(4+5)分类诊断HCC的诊断效能,并比较2名医师诊断效能的一致性。结果 2名医师对病灶MRI征象和病灶分类的判读一致性较好,征象的平均Kappa值为0.684±0.169;分类的Kappa值为0.714。以LR-5为标准诊断HCC,医师1和医师2诊断的灵敏度、特异度、阳性预测值、阴性预测值、准确度和约登指数分别为80.8%和80.4%、87.9%和88.4%、95.2%和94.5%、60.4%和64.4%、82.6%和82.7%、0.687和0.688。以LR-(4+5)为标准诊断HCC,医师1和医师2诊断的灵敏度、特异度、阳性预测值、阴性预测值、准确度和约登指数分别为90.9%和91.6%、75.8%和79.1%、91.8%和91.6%、73.5%和79.1%、87.1%和88.0%、0.667和0.707。不同医师间诊断效能比较结果无统计学差异(P>0.05)。结论 LI-RADS v2018所描述的肝脏病灶的MRI征象有很好的诊断一致性,基于Gd-EOB-DTPA增强MRI应用LI-RADS v2018诊断HCC有较高的诊断效能,且不同医师间的一致性较好。更多还原

【Abstract】 Objective To explore the diagnostic performance of the liver imaging reporting and data system version 2018(LI-RADS v2018)for hepatocellular carcinoma(HCC) on gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid(Gd-EOB-DTPA) enhanced MRI.Methods The clinical and imaging data of 237 patients with high risk of HCC who underwent Gd-EOB-DTPA enhanced MRI,and be confirmed by pathological results within one month were retrospectively collected,and a total of 282 liver observations were obtained.Two independent radiologists blindly reviewed all of MRI.According to LI-RADS v2018,the major and ancillary MRI features of each observation were evaluated and then all observations were categorized based on them.The Kappa test was used to evaluate the consistency of the two radiologists in diagnosing the features of all observations.The diagnostic performance of LR-5 and LR-(4+5)in the diagnosis of HCC were calculated using the pathological results as the gold standard,and the consistency of the diagnostic performance between the two radiologists was compared.Results Two radiologists had good consistency in the interpretation of the MRI features and categories of the observations,while the average Kappa of features was 0.684±0.169,and the Kappa of categories was 0.714.Using LR-5 as the diagnostic criteria for HCC,the sensitivity,specificity,positive predictive value,negative predictive value,accuracy and Youden index of radiologists 1 and 2 were 80.8% and 80.4%,87.9% and 88.4%,95.2% and 94.5%.60.4% and 64.4%,82.6%and 82.7%,0.687 and 0.688,respectively.Using LR-(4+5) as the diagnostic criteria for HCC,the sensitivity,specificity,positive predictive value,negative predictive value,accuracy and Youden index of radiologists 1 and 2 were 90.9% and 91.6%,75.8% and79.1%,91.8% and 91.6%,73.5% and 79.1 %,87.1% and 88.0%,0.667 and 0.707,respectively.There was no significant difference in diagnostic performance between the different radiologists(P>0.05).Conclusion The MRI features of liver observations described by LI-RADS v2018 have good diagnostic consistency.Based on the Gd-EOB-DTPA enhanced MRI,the LI-RADS v2018has a high diagnostic performance for the diagnosis of HCC,and a good consistent among different radiologists.更多还原