超声造影肝脏影像报告与数据系统调整分类在≤ 5 cm肝细胞癌中的诊断价值

doi:10.3969/j.issn.1006-5725.2026.07.009

Abstract

Abstract:

Objective To explore the application value of the modified Contrast-Enhanced Ultrasound Liver Imaging Reporting and Data System （CEUS LI-RADS） in the diagnosis of hepatocellular carcinoma （HCC） with the diameter of ≤ 5 cm. Methods A retrospective analysis was performed on contrast-enhanced ultrasound （CEUS） data from 461 liver nodules in high-risk HCC patients， with pathological results serving as the gold standard. The nodules were classified according to the 2017 CEUS Liver Imaging Reporting and Data System （LI-RADS） and then modified based on the following two criteria：（1） nodules with arterial phase hyper-enhancement and a washout time of 45-60 s were re-classified as LR-5；（2） If LR-4 and LR-M nodules were combined with positive alpha-fetoprotein （AFP） or des-gamma-carboxy prothrombin （DCP）， they were re-judged as LR-5. The diagnostic efficacy of LR-5 before and after modification was compared. Results Among 379 HCC lesions， after modification， the proportion of HCC cases classified as LR-M decreased from 32.70% to 4.70% （χ2 = 97.367， P < 0.001）. In the overall group， the ≤ 3 cm group， the 3-5 cm group， the 0-2 cm group， and the 2-3 cm group of the tumor maximum diameter， the modified classification significantly improved the sensitivity ［（92.61%， 92.41%， 93.33%， 90.30%， 95.04%） vs. （62.27%， 61.24%， 65.56%， 58.79%， 64.46%）］， accuracy ［（90.5%， 89.52%， 91.84%， 87.78%， 91.60%） vs. （62.38%， 60.38%， 67.35%， 58.89%， 63.36%）］， and the area under the curve value （AUC）［（0.766， 0.742， 0.842， 0.752， 0.726） vs. （0.630， 0.586， 0.765， 0.594， 0.572）］. The positive predictive value （PPV） was more than 96%. Conclusions The modified CEUS LI-RADS classification significantly enhanced the sensitivity， accuracy， and AUC of ≤ 5 cm HCC diagnosis without compromising the PPV. The same applies to ≤ 2 cm HCC diagnosis， which would provide more reliable evidence for clinical decision-making.

Key words: contrast-enhanced ultrasound, liver imaging reporting and data system, hepatocellular carcinoma, modified classification

CLC Number:

R445.1

Lihong CHEN,Huichun CHEN,Siyi FENG. Application of modified contrast-enhanced ultrasound Liver Imaging Reporting and Data System in diagnosis of ≤5cm hepatocellular carcinoma[J]. The Journal of Practical Medicine, 2026, 42(7): 1177-1182.

Figures/Tables 4

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References 20

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指标	HCC(n = 379)	非HCC恶性病灶(n = 49)	良性病灶(n = 33)	HCC vs.非HCC恶性病灶		HCCvs.良性病灶
指标	HCC(n = 379)	非HCC恶性病灶(n = 49)	良性病灶(n = 33)	χ2值	P值	χ2值	P值
动脉期增强方式				1.513	0.219	7.497	0.006
高增强	363	45	28
环状增强	15	4	3
等增强	1	0	2
开始廓清时间				16.166	<0.001	2.060	0.151
＜ 60 s	115	29	14
≥ 60 s	254	0	15
无廓清	10	20	4
AFP/DCP				8.320	0.004	67.015	<0.001
阳性	283	27	2
阴性	96	22	31
调整前LI-RADS
LR-3	1	0	1
LR-4	18	1	5
LR-5	236	28	12
LR-M	124	30	15
调整后LI-RADS
LR-3	1	0	1
LR-4	9	1	5
LR-5	351	33	13
LR-M	18	15	14

肿瘤最大径分组		灵敏度/%	特异度/%	PPV/%	NPV/%	准确度/%	AUC（95%CI）
总体组(n = 412)	调整前	62.27	63.64	95.16	12.80	62.38	0.630（0.543 ~ 0.716）
	调整后	92.61	60.61	96.43	41.67	90.05	0.766（0.680 ~ 0.852）
	Z/χ2值	-99.869	0.064	0.605	19.828	87.000	-7.106
	P值	< 0.001	0.800	0.437	< 0.001	< 0.001	< 0.001
≤3 cm组(n = 314)	调整前	61.24	56.00	94.14	11.11	60.83	0.586（0.483 ~ 0.689）
	调整后	92.41	56.00	96.06	38.89	89.52	0.742（0.641 ~ 0.842）
	Z/χ2值	-78.691	0.000	0.895	-15.112	-70.933	-11.413
	P值	< 0.001	1.000	0.344	< 0.001	< 0.001	< 0.001
3 ~ 5 cm组(n = 98)	调整前	65.56	87.50	98.33	18.42	67.35	0.765（0.633 ~ 0.897）
	调整后	93.33	75.00	97.67	50.00	91.84	0.842（0.679 ~ 1.000）
	Z/χ2值	-21.263	-0.410	-0.076	-4.727	-18.092	-1.143
	P值	< 0.001	0.522	0.782	0.030	< 0.001	0.253
0 ~ 2 cm组(n = 180)	调整前	58.79	60.00	94.17	11.69	58.89	0.594（0.460 ~ 0.728）
	调整后	90.30	60.00	96.13	36.00	87.78	0.752（0.621 ~ 0.882）
	Z/χ2值	-43.182	0.000	-0.533	-7.676	-36.828	8.687
	P值	< 0.001	1.000	0.465	0.006	< 0.001	< 0.001
2 ~ 3 cm组(n = 134)	调整前	64.46	50.00	93.98	10.20	63.36	0.572（0.404 ~ 0.741）
	调整后	95.04	50.00	95.93	45.45	91.60	0.726（0.561 ~ 0.890）
	Z/χ2值	-36.173	0.000	-0.363	-8.037	-31.009	-7.372
	P值	< 0.001	1.000	0.547	0.005	< 0.001	< 0.001

Application of modified contrast-enhanced ultrasound Liver Imaging Reporting and Data System in diagnosis of ≤5cm hepatocellular carcinoma

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