| ObjectivesThe purpose of this study was to explore the clinical value of contrast-enhanced ultrasound liver imaging reporting and data system(CEUS LI-RADS)classification in the diagnosis of hepatocellular carcinoma(HCC),and to provide theoretical support for the application of this classification method in practice.MethodFrom January 2016 to May 2018,82 HCC high-risk patients who underwent liver contrast-enhanced ultrasound in the department of ultrasound of the fifth affiliated hospital of zhengzhou university were selected.All patients were examined and diagnosed by the same physician with decades of experience in liver contrast-enhanced ultrasonography.The ultrasound data of 82 intrahepatic lesions of the 82 patients were retrospectively analyzed by two physicians with more than 5 years of experience in liver contrast-enhanced ultrasonography.All lesions were diagnosed clearly by histopathology or clinical criteria.The target lesions were classified according to the CEUS LI-RADS(v2017),and the final pathological or clinical diagnosis results were taken as the gold standard to judge the diagnostic efficiency of CEUS LI-RADS classification.Sensitivity,specificity,positive predictive value and negative predictive value were used to evaluate the diagnostic efficacy of CEUS LI-RADS classification criteria for HCC.Paired chi-square test was used to compare the accuracy of CEUS LI-RADS classification standard and the routine CEUS diagnostic method for the diagnosis of hepatocellular carcinoma(HCC).Results1.Compared with histopathological or clinical diagnosis results,40 out of 48 cases of HCC were correctly diagnosed by conventional CEUS diagnosis,with a diagnostic accuracy of 83.33%(40/48).Five benign nodules were misdiagnosed as HCC,including 1 case of hepatic abscess,1 case of hepatocellular adenoma,and 3 cases of cirrhotic nodules.There were 8 cases of missed diagnosis of HCC,including 1 case of focal nodular hyperplasia,1 case of hepatocellular adenoma,and 6 cases of regenerated nodules of cirrhosis.2.Compared with the gold standard,in CEUS LI-RADS classification criteria,36 cases of LR-5 type nodules were classified,including 34 cases of HCC,8 cases of LR-4 type nodules were classified,including 7 cases of HCC,25 cases of LR-3 type nodules were classified,including 7 cases of HCC.8 cases of LR-1 class nodules and 3 cases of LR-2 class nodules were confirmed as benign lesions.And 2 cases of LR-M type nodules were classified,including 1 case of cholangiocarcinoma and 1 case of liver abscess.The negative predictive values of LR-1 and LR-2 were 100.00%,and the positive predictive values of LR-3 to LR-5 HCC were increased gradually,which were 28.00%(7/25),87.50%(7/8)and 94.11%(34/36),respectively.The area under the subject's operating curve was 0.913(P<0.05),and the 95% confidence interval was 0.845~0.981.3.If LR-1 and LR-2 were negative and LR-3,LR-4 and LR-5 were positive,the sensitivity,specificity,positive predictive value and negative predictive value of this classification for HCC diagnosis were 100.00%,34.38%,69.57% and 100.00%,respectively.If LR-1 and LR-2 are negative,LR-4 and LR-5 are positive but LR-3 classification is excluded,the sensitivity,specificity,positive predictive value and negative predictive value of this classification for HCC are 100.00%,78.57%,93.18% and 100.00%,respectively.4.If LR-1 and LR-2 are negative and LR-4 and LR-5 are positive,the diagnostic accuracy of CEUS LR-RADS classification diagnostic method for HCC was 85.42%(41/48)and conventional diagnostic method was 83.33%(40/48).There was no significant statistical difference between the two(P>0.05),and they had good consistency(K=0.605).ConclusionCEUS LI-RADS classification has similar diagnostic efficacy to the conventional CEUS diagnosis method by senior physicians,but it is easier for junior physicians to grasp and obtain a more accurate diagnosis,so it can be recommended for clinical practice. |
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