张炜 石才够 蓝中凯 黄志武 张步林

【摘要】 目的 探討超声造影在CT/MRI诊断为LIRADS4（LR4）类结节的诊断价值。

方法 收集2019年1月至2020年12月期间经CT/MRI诊断为LR4类结节的72例患者，一共90个结节，进行超声造影检查，利用肝脏影像和数据报告系统（LIRADS）对结节重新分类，以手术或者活检病理诊断为“金标准”，分析超声造影对这类结节的诊断价值。

结果 90个CT/MRI诊断为LR4的结节中，CEUS与CE CT/MRI在诊断模式及一致性上，有64个（71.11%）动脉相为高增强，24个（26.67%）等增强，2个环状增强（2.22%），延迟期无廓清38个（42.22%），轻度廓清50个（55.56%），显著廓清2个（2.22%）。CEUS与CT/MRI在动脉期表现的一致性是44.44%，在门脉期表现的一致性是73.33%，在延迟期表现的一致性是97.78%，40例（62.50%，40/64）在再次CEUS检查时动脉期呈高增强，2例环状增强，早期廓清（2个，LRM），延迟期廓清（34个，LR5），无廓清（6个，LR4）;重新使用CEUS LIRADS分类后，升级为LR5 38个，LRM 2个，降级为LR3 18个;其中LR3类结节HCC 4个（22.22%），良性14个;LR4类结节32个，HCC 20个（62.50%），良性12个;LR5类结节38个，均为HCC（100.00%）;LRM类结节2个，均为HCC（100.00%）;90个CT/MRI提示LR4类结节 HCC 63个，占71.11%;重新分类为LR3、LR4、LR5、LRM的结节中，其诊断效能显示，准确性分别为：17.70%、37.78%、71.11%、31.11%;敏感性分别为：6.25%、31.25%、59.38%、3.13%;特异性分别为：46.15%、53.50%、100.00%、100.00%;阳性预测值分别为：22.22%、62.50%、100.00%、100.00%;阴性预测值分别为：16.67%、24.14%、50.00%、29.55%。

结论 在CT/MRI诊断为LR4的结节中增加超声造影分类，能明显提高诊断HCC的特异性、敏感性及准确性。

【关键词】 CT;MRI;LR4;超声造影

中图分类号：R445. 文献标志码： DOI：10.3969/j.issn.10031383.2021.06.006

Diagnostic value of contrastenhanced ultrasound on LIRADS4 nodules categorized by CT/MRI

ZHANG Wei， SHI Caigou， LAN Zhongkai， HUANG Zhiwu， ZHANG Bulin▲

（Department of Medical Ultrasound， Liuzhou People's Hospital， Liuzhou 545006， Guangxi， China）

【Abstract】 ObjectivTo investigate the diagnostic value of contrastenhanced ultrasound （CEUS） in the diagnosis of LIRADS4 （LR4） nodules categorized by CT/MRI.

Methods From January 2019 to December 2020， 72 patients with LR4 nodules diagnosed by CT/MRI in our hospital （including 90 nodules） were collected for contrastenhanced ultrasound examination. Liver imaging reporting and data system （LIRADS） was used to reclassify the nodules， and surgery or biopsy pathological diagnosis were taken as the "gold standard". In addition， the diagnostic value of contrastenhanced ultrasound in such nodules was analyzed.

Results Among 90 nodules diagnosed as lR4 by CT/MRI， in the diagnostic mode and consistency oCEUS and CE CT/MRI， 64 nodules （71.11%） had high enhancement in arterial phase， 24 nodules （26.67%） had equal enhancement， 2 nodules （2.22%） had annular enhancement， 38 nodules （42.22%） had no clearance in delayed phase， 50 nodules （55.56%） had mild clearance， and 2 nodules （2.22%） had significant clearance. The consistency of CEUS and CT/MRI was 44.44% in arterial phase， 73.33% in portal phase and 97.78% in delayed phase. 40 cases （62.50%， 40/64） showed high enhancement in arterial phase in reexamine of CEUS， 2 cases showed annular enhancement， 2 nodules showed early clearance （LRM）， 34 nodules showed delayed clearance （LR5） and 6 nodules showed no clearance （LR4）. After reusing CEUS LIRADS classification， 38 nodules were upgraded to LR5， and 2 nodules to LRM， and 18 nodules were downgraded to LR3; among LR3 nodules， 4 （22.22%） were HCC， and 14 were benign; of 32 LR4 nodules， 20 （62.5%） were HCC， and 12 were benign; among 38 LR5 nodules， all of them were HCC （100%）; among 2 LRM nodules， all of which were HCC （100%）; CT/MRI showed that there were 63 HCC among 90 LR4 nodules， accounting for 71.11%; among the nodules reclassified as LR3， LR4， LR5， LRM， the diagnostic efficiency showed that the accuracy was 17.70%， 37.78%， 71.11%， and 31.11%， respectively; the sensitivity was 6.25%， 31.25%， 59.38%， and 3.13%， respectively; the suggestibility was 46.15%， 53.50%， 100.00%， and 100.00%， respectively; the positive predictive value was 22.22%， 62.50%， 100.00%， and 100.00%， respectively; and the negative predictive value was 16.67%， 24.14%， 50.00%， and 29.55%， respectively.

Conclusion In the CT/MRI diagnosis of LR4 nodules， adding contrastenhanced ultrasound classification can significantly improve the specificity， sensitivity and accuracy of diagnosis of HCC.

【Key words】 CT; MRI; LR4; CEUS

肝细胞肝癌（HCC）是全世界癌症死亡最主要的原因之一[1]，患有慢性肝炎、长期饮酒所致肝硬化等高危因素的患者是HCC风险的高危患病人群，最初美国放射学会（ACR）提出肝脏影像报告和数据系统（LIRADS，LR）的计算方法来规范CT/MRI对高风险患者进行肝癌的监控[2]，但是……