| This study compare the diagnostic value of CEUS and MRI liver imaging reporting and data system(LI-RADS)v2018 in classifying focal liver lesions(FLLs)among high-risk patients with hepatocellular carcinoma(HCC),as well as the diagnostic efficacy of CEUS LI-RADS and European CEUS guidelines in the differential diagnosis of benign and malignant FLLs.A total of 158 patients with high-risk HCC,with 172 lesions,who underwent CEUS in the Ultrasound Department of Shenzhen Third People’s Hospital from August 2020 to July 2022 were selected as the research objects.The lesions were independently classified and diagnosed in sequence according to the classification criteria of CEUS LI-RADS v2017,CT/MRI LI-RADS v2018,and European CEUS guidelines,and the independent blind method was used to read the image,with pathological diagnosis or clinical diagnosis results used as the diagnostic reference criteria.The area under the ROC curve(AUC)values of CEUS LI-RADS,MRI LI-RADS and European CEUS guidelines were analyzed and calculated using the Receiver Operating Characteristic(ROC)curve.The sensitivity,specificity,positive predictive value(PPV),negative predictive value(NPV),and accuracy of CEUS LR-5 and MRI LR-5 in diagnosing HCC were also calculated,along with the sensitivity,specificity,PPV,NPV,and accuracy of CEUS LR-5+LR-M and European CEUS guidelines in diagnosing liver malignant tumors.Furthermore,the consistency between the observation methods was analyzed using the Kappa test.A total of 172 lesions were included in this study,of which 87 lesions were classified as LR-5 by CEUS,81 lesions were classified as LR-5 by MRI,and 71 lesions were confirmed as HCC by reference standard.The consistency between CEUS LI-RADS and MRI LI-RADS in the classification of FLLs was moderate,and the difference was statistically significant(Kappa=0.602,P < 0.001).The AUC values were 0.851(95%CI:79.0%-91.3%)and 0.871(95%CI: 81.4%-92.8%),respectively.However,the difference was not statistically significant(Z=1.130,P= 0.259).The sensitivity of CEUS LR-5 and MRI LR-5 in diagnosing HCC was 97.18%(95%CI: 90.2%-99.7%)which was significantly higher than that of MRI(92.96%,95% CI: 84.3%-97.7%),with a p-value of 0.002.The specificity of CEUS was 82.18%(95% CI: 73.3%-89.1%),which was slightly lower than that of MRI(85.15%,95% CI: 76.7%-91.4%),with a p-value of 0.012.The diagnostic accuracy of CEUS and MRI were both 88.37%,with a 95%CI of 84.0%-93.7% and 83.3%-93.2%,respectively.The PPV of CEUS was79.31%(95% CI: 69.3%-87.3%),which was slightly lower than that of MRI(81.48%,95% CI: 71.3%-89.2%).The NPV of CEUS was 97.65%(95% CI: 91.8%-99.7%),which was higher than that of MRI(94.51%,95%CI: 87.6%-98.2%).Ninety-four lesions were classified as LR-5+LR-M by CEUS,91 lesions were diagnosed as liver malignancy by European CEUS guidelines,and 82 lesions were confirmed as liver malignancy by reference standards.The consistency between CEUS LI-RADS and European CEUS guidelines in the classification of FLLs was very good,with a kappa value of 0.895 and a p-value of < 0.001.The AUC values were 0.926(95%CI:88.2%-97.0%)and 0.880(95%CI: 82.4%-93.6%),respectively,and the difference was not statistically significant(Z=0.374,P= 0.709).Taking LR-5 and LR-M lesions as positive results,the sensitivity of CEUS LR-5+LR-M and European CEUS guidelines in diagnosing liver malignant tumors was 98.78%(95%CI: 93.4%-99.9%)and 92.68%(95%CI:84.8%-97.3%),respectively,with a p-value of ≤ 0.001.The specificity of CEUS LR-5+LR-M was 85.56%(95%CI: 76.6%-92.1%),which was slightly higher than that of European CEUS guidelines(83.33%,95%CI: 74.0%-90.4%),with a p-value of 0.258.The diagnostic accuracy of CEUS LR-5+LR-M was 91.86%(95% CI: 86.7%-95.5%),which was higher than that of European CEUS guidelines(87.79%,95% CI:82.6%-92.8%).The PPV of CEUS LR-5+LR-M was 86.17%(95% CI:77.5%-92.4%),which was slightly higher than that of European CEUS guidelines(83.52%,95% CI: 74.3%-90.5%),while the NPV of CEUS LR-5+LR-M was 98.72%(95% CI: 93.1%-99.9%),which was higher than that of European CEUS guidelines(92.59%,95% CI:84.6%-97.2%).The results of this study show that there are differences in the classification of lesions between CEUS LI-RADS and MRI LI-RADS,with only moderate consistency.However,the diagnostic performance of CEUS LI-RADS and CEUS LI-RADS for the detection of HCC is comparable,with a higher sensitivity observed for CEUS LI-RADS.Additionally,the consistency between CEUS LI-RADS and European CEUS guidelines is excellent,but there are differences in the classification results between the two methods.Despite this,the diagnostic performance of CEUS LI-RADS is comparable to that of European CEUS guidelines for the diagnosis of liver malignant tumors,with a higher sensitivity observed for CEUS LI-RADS.In the case of liver lesions such as inflammatory lesions,it is appropriate to refer to the diagnostic criteria of European CEUS guidelines to classify lesions using CEUS LI-RADS. |
PDF Full Text Request