European Radiology:因为这一征象,我们改良了LI-RADS!

2021-12-28 shaosai MedSci原创

肝脏成像报告和数据系统(LI-RADS)是一个综合评估系统,主要目的是规范成像结果的词汇、解释和报告,以提高影像科内部与各科室之间高危肝细胞癌(HCC)诊断相关的解析及交流。

肝脏成像报告和数据系统(LI-RADS)是一个综合评估系统,主要目的是规范成像结果的词汇、解释和报告,以提高影像科内部与各科室之间高危肝细胞癌(HCC)诊断相关的解析及交流。LI-RADS v2017重新定义了LR-M类别,可能的或明确的恶性肿瘤,但并不具有HCC的特异性影像学表现。这种更新的LR-M类别标准是为了保留LR-5类别对HCC的最高特异性。同时,LR-M类别被分为靶或非靶肿块[1]。"靶样外观 "是指肿瘤至少具有以下一种影像学特征:边缘动脉期高强化(APHE)、周边廓清、中心延迟强化、靶样限制、靶样平衡期(TP)或肝胆期(HBP)外观。靶样外观大多表现为肝内胆管细胞癌(ICC),但也可能与合并肝细胞-胆管癌(cHCC-CC)或不典型HCC有关,这通常需要额外的检查进一步确诊。

使用Gd-EOB-DTPA增强磁共振成像(MRI)在识别HBP中的小HCC以及根据OATP的表达程度预测HCC方面很有价值,特别是在肝移植的情况下尤为显著。为了证实HBP成像的好处,目前所有的指南都采用了Gd-EOB-DTPA MRI作为HCC的一线诊断成像手段

近日,发表在European Radiology杂志的一项研究定义了一个改良后的LI-RADS分类强调增强包膜的存在而靶样外观,并在细胞外对比剂(ECA)-MRI和HBA-MRI中单独比较其诊断性能LR-M类病变的准确诊断及术前评估提供更有力的参考依据

本研究招募了198名患有慢性肝病的参与者(161名男性;平均年龄56.3岁),每位患者均在手术前接受了ECA-MRI和HBA-MRI扫描。两位评审员对LI-RADS分类(v2018)进行了分配。我们定义了一个 "改良的LR-5类别",强调增强包膜(MLR-5C)而特征,并将同时具有靶外观和增强包膜的肿瘤归类为HCC而不是LR-M。我们比较了传统的LI-RADS和改良的LI-RADS标准对两种MRI的诊断性能。 

共分析了258个肝脏结节(194个HCC,43个良性病变,21个非HCC恶性肿瘤;中位数大小,19毫米)。根据传统的LI-RADS,47个(18.2%)结节(31个HCC和16个非HCC恶性肿瘤)被归类为LR-M。与LR-5标准相比,MLR-5C标准显示出更高的敏感性(ECA-MRI,76.6%对67.0%;HBA-MRI,60.4%对56.3%;两者的P<0.05),同时保持高特异性(ECA-MRI,93.8%对98.4%;HBA-MRI,95.3%对98.4%;两者P>0.05)。使用LR-5C标准,ECA-MRI表现出比HBA-MRI更高的敏感性(76.6% vs. 60.4%,p < 0.001)和相似的特异性(93.8% vs. 95.3%,p > 0.99)。 

 a, b 在使用细胞外对比剂后的轴动脉相和延迟图像上,35mm大小的肿块(箭头)显示厚边动脉增强(APHE),然后是非周边的廓清。c-f 给予Gd-EOB-DTPA后,在轴动脉期、门静脉期、3分钟平衡期和肝胆期图像上,波浪形边缘的肿瘤(箭头)在门静脉期显示厚边APHE,然后是非外周性廓清,在肝胆期显示靶特征。在门静脉期和过渡期可见增强的包膜(箭头)。两位观察者最初将该肿瘤归类为LR-M。两位观察者在两个MRI上都将肿瘤重新归类为LR-5C。

本研究建立了一个改良的LI-RADS标准,强调增强包膜的意义,与传统的LI-RADS相比,该标准在HCC影像诊断中显示出更高的敏感性,同时保持了较高的特异性。ECA-MRI和HBA-MRI都有这种提高的诊断表现,尽管ECA- MRI比HBA-MRI表现更好。

原文出处

Ji Hye Min,Jong Man Kim,Young Kon Kim,et al.A modified LI-RADS: targetoid tumors with enhancing capsule can be diagnosed as HCC instead of LR-M lesions.DOI:10.1007/s00330-021-08124-0

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    2022-02-22 zhanfl
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    2022-11-28 江川靖瑶
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    2022-04-18 feather89
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    2022-12-10 仁医06

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