目的 在肝细胞癌(HCC)高危因素背景下,探讨基于钆塞酸二钠(Gd-EOB-DTPA)增强MRI高度异型增生结节(HGDN)分类处理对2018 版肝脏影像报告与数据系统(LI-RADS)诊断效能的影响.方法 回顾性分析2015 年1 月至2021 年12 月在桂林医学院附属医院放射科,行Gd-EOB-DTPA增强MRI检查并术后经病理诊断的169 例HCC高风险患者,共192 个肝结节.两名放射科医师独立评估患者的影像征象,根据2018 版LI-RADS分类标准将结节分类,统计分析LR-4/5、LR-5 的诊断效能.为HGDN增加一个新分类LR-DN,将病理结果为HGDN的结节分类为LR-DN,其他结节分类不变,重新统计LR-4/5、LR-5 的诊断效能.结果 2018 版LI-RADS分类LR-4/5、LR-5 的灵敏度、特异度、准确率分别为92.81%、56.41%、85.42%和82.35%、79.49%、81.77%.新增LR-DN分类后,LR-4/5、LR-5 的灵敏度无变化,特异度分别为 87.18%、92.31%,准确率分别为 91.67%、84.38%.结论 Gd-EOB-DTPA增强MRI结合2018 版LI-RADS对小肝癌(sHCC)的诊断效能较高,新增LR-DN分类可以提高LI-RADS分类对sHCC的诊断效能,同时加强临床对HGDN的分类管理、随访及诊疗策略.

目的 探讨2018版肝脏影像报告与数据系统(LI-RADS)钆塞酸二钠(Gd-EOB-DTPA)增强MRI肝胆期低信号对小肝癌(sHCC)的诊断价值.方法 回顾性分析行Gd-EOB-DTPA增强MRI检查的157例具有肝癌高危风险患者.2名放射科医师采用双盲法分析患者的影像资料,分别记录每一个肝结节的主要征象和辅助征象,根据2018版LI-RADS诊断表将结节分类为LR-3、LR-4、LR-5,统计分析各征象以及LR-4/LR-5分类对sHCC的诊断效能.以肝胆期低信号作为调整LR-3、LR-4分类的主要征象,在新诊断模型下将每一个LR-3、LR-4分类的肝结节重新分类,重新统计分析新诊断模型LR-4/LR-5对sHCC的诊断效能.结果 2名医师评估的肝胆期低信号诊断sHCC的敏感度、特异度和准确度分别为98.66％、72.22％、95.81％,阳性预测值为96.71％;2名医师评估的LR-4/LR-5诊断sHCC的敏感度、特异度与准确度分别为93.29％、66.67％、90.42％,阳性预测值为95.86％.将肝胆期低信号作为调整LR-3、LR-4分类的主要征象时,新诊断模型下2名医师重新评估的LR-4/LR-5诊断sHCC的敏感度、特异度与准确度分别为99.33％、61.11％、95.21％,阳性预测值为95.48％.结论 Gd-EOB-DTPA增强MRI结合2018版LI-RADS诊断sHCC的效能较高,肝胆期低信号可以提高LI-RADS分类诊断sHCC的敏感度和准确度.

Objective To develop and validate a radiomic nomogram for individualized prediction of hepatocellular carcinoma (HCC) in HBV cirrhosis patients based on baseline magnetic resonance imaging examinations and clinical data. Methods 364 patients with HBV cirrhosis from five hospitals were assigned to the training, internal validation, external validation-1 or external validation-2 cohort. All patients underwent baseline magnetic resonance image (MRI) scans and clinical follow-up within three-year time. Clinical risk factors and MRI-based features were extracted and analyzed. The radiomic signatures were built using the radiomics-score (Rad-score) that calculated for each patient as a linear weighted combination of selected MRI-based features. Prognostic performances of the clinical and radiomic nomograms were evaluated with Cox modeling in the training and validation cohorts. Results Eighteen features were selected for inclusion in the Rad-score prognostic model. The radiomic signature from multi-sequence MRI yielded a concordance index (C-index) of 0.710, 0.681, 0.632 and 0.658 in the training, internal validation, external validation-1, external validation-2 cohorts, respectively. Sex and Child-Turcotte-Pugh (CTP) class were the most prognostic clinical risk factors in univariate Cox proportional hazards analyses. The radiomic combined nomogram that integrated the radiomic signature with the clinical factors yielded a C-index of 0.746, 0.710, and 0.641 in the training, internal validation, and external validation-1 cohorts, respectively, which was an improvement over either the clinical nomogram or radiomic signature alone. Conclusion We developed an MRI-based radiomic combined nomogram with good discrimination ability for the individualized prediction of HCC in HBV cirrhosis patients within three-year time.

目的 探讨MR DWI的ADC值及标准化ADC值在不同Gleason评分(GS)前列腺癌中的诊断价值.方法 回顾性分析84例前列腺癌患者,所有患者均经手术取得病理结果 ,术前进行常规MRI及DWI扫描,分别测量前列腺癌组织及前列腺正常外周带ADC值,计算得出标准化ADC值(标准化ADC值=ADC癌灶/ADC外周带),以术后病理结果 为金标准,分别比较ADC值及标准化ADC值对不同GS前列腺癌的诊断效能.结果 84例前列腺癌患者中,根据GS将患者分为3组:GS<7分13例,GS=7分32例,GS>7分39例,3组患者ADC值分别为(0.805±0.040)×10-3 mm2/s,(0.680±0.245)×10-3 mm2/s,(0.533±0.015)×10-3 mm2/s,GS<7分和GS>7分2组之间及GS=7分和GS>7分2组之间ADC值差异有统计学意义(P<0.05).3组患者标准化ADC值分别为(0.653±0.021)×10-3 mm2/s,(0.486±0.014)×10-3 mm2/s,(0.385±0.009)×10-3 mm2/s,GS<7分和GS>7分2组之间及GS=7分和GS>7分2组之间的标准化ADC值差异有统计学意义(P<0.05).ADC值与标准化ADC值均可对GS<7分和GS>7分及GS=7分和GS>7分进行鉴别;绘制ROC曲线结果 显示,标准化ADC值敏感度、特异度均高于ADC值(GS<7分vs GS>7分:100％、100％vs 92.3％、89.7％;GS=7分vs GS>7分:78.1％、87.2％vs 62.5％、84.6％),两者ROC曲线之间差异有统计学意义(P<0.05).结论 ADC值对不同GS前列腺癌具有较高的诊断效能,标准化ADC值的诊断价值更为显著,具有较高的敏感度与特异度.

肝细胞癌(HCC)临床诊断的准确性直接关系到病人的临床治疗决策与预后.美国放射学院(ACR)于2011年发布了肝脏影像报告和数据系统(LI-RADS)的首个版本,旨在将HCC征象术语标准化、诊断与治疗预后报告以及影像数据资料收集标准化.随着临床对LI-RADS指南的不断研究、实践,以及LI-RADS征象新证据的出现,ACR于2018年更新并发布了新版LI-RADS指南.本文主要综述LI-RADS主要征象及根据主要征象的LI-RADS分类在HCC诊断及预后中的临床应用价值.