摘要
目的:探讨肝脏影像报告和数据系统(LI-RADS)v2018专项培训对提升医师对肝细胞癌(HCC)高危人群肝脏局灶性病变的征象评估及分类的准确性的价值.方法:回顾性收集首都医科大学附属友谊医院行肝脏增强CT扫描的HCC高危患者,最终共纳入63例患者的70个病灶,其中有27个HCC病变,15个非HCC恶性病变和28个良性病变.18位不同年资的影像诊断医师参加CT LI-RADS v2018专项培训.受试医师在参加培训前后分别独立判读入组病灶图像并记录结果,包括对入组病灶的LI-RADS主要征象及支持HCC的辅助征象识别和LI-RADS分类.将病变分类为LR-5即可诊断HCC,计算受试医师在LI-RADS培训前后评估LI-RADS主要征象及支持HCC的辅助征象和诊断HCC的敏感度、特异度、阳性预测值、阴性预测值、阳性似然比、阴性似然比及准确率并计算受试者操作特征(ROC)曲线下面积(AUC).采用非参数检验比较培训前后对LI-RADS主要征象和支持HCC的辅助征象评估效能及HCC的诊断效能.结果:培训后受试医师对LI-RADS的主要征象及支持HCC的辅助征象的识别效能均较培训前有提升(P值均＜0.05),其中对非边缘性廓清、强化包膜以及辅助征象中的无强化包膜识别效能提升较为显著.培训前后受试医师对HCC诊断的敏感度、特异度、阳性预测值、阴性预测值和准确率分别为45.9％、80.9％、60.1％、70.4％、67.4％和55.8％、91.0％、79.5％、76.6％、77.4％(P值均＜0.05).结论:CT LI-RADS专项培训能提升医师对HCC高危人群肝局灶病变的征象评估及诊断能力,其专项培训具有确切的推广意义和价值.
Abstract
Objective:To evaluate the effectiveness of CT liver imaging reporting and data sys-tem(LI-RADS)v2018 training in improving the accuracy of physician diagnosis and classification of focal liver lesions in high-risk populations for hepatocellular carcinoma(HCC).Methods:A total of 63 patients with 70 lesions,including 27 HCC lesions,15 non-HCC malignant lesions and 28 benign le-sions,who underwent liver enhanced CT scan in the Friendship Hospital Affiliated to Capital Medical University were retrospectively collected.Eighteen imaging diagnostic physicians with varying seniori-ty participated in the CT LI-RADS v2018 special training.Before and after the training,the participants independently interpreted the images of the enrolled lesions and recorded the results,including the main LI-RADS signs and auxiliary signs supporting HCC recognition and LI-RADS classification.The lesions were divided into LR-5 categories to diagnose HCC.The sensitivity,specificity,positive predic-tive value,negative predictive value,positive likelihood ratio,negative likelihood ratio and accuracy of the main signs and auxiliary signs of LI-RADS before and after LI-RADS training and the diagnosis of HCC were calculated,and the area under the ROC curve was calculated.Nonparametric test was used to compare the evaluation efficacy of LI-RADS main signs and auxiliary signs supporting HCC and the diagnostic efficacy of HCC before and after training.Results:After the training,the recognition efficien-cy of the primary LI-RADS signs and auxiliary signs supporting HCC was significantly improved com-pared to before the training(P＜0.05),with more significant improvement observed in the recognition efficiency of non-marginal clearance,enhanced capsule,and auxiliary signs of non-enhanced capsule.Be-fore and after the training,the sensitivity,specificity,positive predictive value,negative predictive value and accuracy of the diagnosis of HCC were 45.9％and 55.8％,80.9％and 91.0％,60.1％and 79.5％,70.4％and 76.6％,67.4％and 77.4％,respectively(P＜0.05).Conclusion:The special training of CT LI-RADS can improve the ability of doctors to evaluate and diagnose focal liver lesions in the high-risk population of HCC,and it has definite promotional significance and value.
基金项目
国家自然科学基金项目(61871276)
国家自然科学基金项目(62171298)
国家自然科学基金项目(82071876)
首都卫生发展科研专项(2018-2-2023)
北京市医院管理中心临床医学发展专项经费资助项目(ZYLX202101)
NETL
NSTL
万方数据