摘要
Abstract
Objective:To compare the diagnostic performance of the 2017 version of the contrast-enhanced ultrasound:liver imaging reporting and data system(CEUS LI-RADS)classification,CEUS LI-RADS combined with tumor markers[carbohydrate antigen(CA)199,CA125,carcinoembryonic antigen(CEA),alpha fetoprotein(AFP),and protein induced by vitamin K absence/antagonist-II(PIVKA-II)],and CEUS LI-RADS classification with an adjusted early washout time from<60 s to<40 s in differentiating hepatocellular carcinoma(HCC)from non-HCC liver malignancies.
Methods:Patients who underwent CEUS for liver lesions at Hunan Provincial People's Hospital between 2018 and 2021 were retrospectively enrolled.CEUS LI-RADS classification was performed based on imaging characteristics.The cases were then reclassified after integrating tumor marker results and again reclassified by adjusting the early washout time criterion in CEUS LI-RADS from<60 s to<40 s,yielding three classification schemes in total.Using pathological diagnosis as the gold standard,the diagnostic performance of the three classification methods in distinguishing HCC from non-HCC liver malignancies was compared.
Results:1)When using CEUS LI-RADS combined with tumor markers and classifying LR-3,4,and 5;LR-4 and 5;and LR-5 alone as HCC-positive,significant differences were observed compared to the original CEUS LI-RADS classification(all P<0.05).Similarly,when using CEUS LI-RADS with an early washout time of<40 s and applying the same HCC-positive classification thresholds,the differences from the original classification were also statistically significant(all P<0.05).2)For non-HCC liver malignancies classified as LR-M,the diagnostic accuracy using CEUS LI-RADS alone was 50.00%,which improved to 80.00%when combined with tumor markers,and to 63.04%when using the<40 s early washout modification.3)The maximum Youden index occurred at the>LR-3 threshold(i.e.,LR-4 and 5 considered HCC-positive)for CEUS LI-RADS alone;at>LR-4(i.e.,LR-5 considered HCC-positive)for CEUS LI-RADS combined with tumor markers;and again at>LR-3 for the<40 s washout time-adjusted CEUS LI-RADS classification.
Conclusion:Combining CEUS LI-RADS with tumor markers significantly enhances diagnostic performance and shows strong consistency with pathologic results,with the LR-5 classification threshold offering the best diagnostic value for HCC.Adjusting the early washout time to<40 s also improves the diagnostic efficacy of CEUS LI-RADS in distinguishing between HCC and non-HCC liver malignancies.关键词
超声造影肝脏影像报告和数据系统/肝细胞癌/肝内胆管细胞癌/肿瘤标志物/早期廓清时间/诊断效能Key words
contrast-enhanced ultrasound:liver imaging reporting and data system/hepatocellular carcinoma/intrahepatic cholangiocarcinoma/tumor markers/early washout time/diagnostic efficacy
