Differentiation of Atypical Hepatocellular Carcinoma from Focal Nodular Hyperplasia: Diagnostic Performance of Contrast-enhanced US and Microflow Imaging
Differentiation of Atypical Hepatocellular Carcinoma from Focal Nodular Hyperplasia: Diagnostic Performance of Contrast-enhanced US and Microflow Imaging
复制标题
非典型肝细胞癌与局灶性结节性增生的鉴别：对比增强超声和微流成像的诊断性能。
DOI：
10.1148/radiol.14140911
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发表时间：
2015-06-01
期刊：
影响因子：
19.7
通讯作者：
Lu, Ming-De
中科院分区：
文献类型：
--
作者：
Li, Wei;Wang, Wei;Lu, Ming-De
目的：探讨超声造影（CE）和微流成像（MF）在鉴别非典型肝细胞癌（HCC）和局灶性结节性增生（FNH）中的诊断价值。材料和方法：获得机构审查委员会批准，并放弃知情同意。共纳入103例患者，平均年龄43.9岁，年龄17 ~ 75岁；38例HCC患者和65例FNH患者行CE - US，分析血管结构模式（VAP）和到达时间参数（ATP）图像。住院医师和工作放射科医师独立回顾性地审查CE US、VAP和ATP图像。采用chi(2)检验和logistic回归分析，在CE US和MF图像上识别FNH或HCC的具体特征。为了比较有或没有MF成像的CE US的诊断性能，分配了四组标准：(a)常规CE US单独，(b) VAP和CE US， (c) ATP成像和CE US，以及(d)所有三种方法的组合。分析住院医师和工作放射科医师的敏感性、特异性、准确性和受者工作特征曲线下面积。使用Cohen kappa统计来评估工作人员和住院放射科医生之间CE - US和MF成像特征的一致性。结果：在两组中，与常规CE - US征象的大多数检出率相比，MF成像提供了显著的改善。对于放射科工作人员，标准组3 （AUC = 0.873, P < 0.05）和标准组4 （AUC = 0.887, P < 0.05）的AUC显著高于标准组1 （AUC = 0.835）的AUC。对于住院放射科医师而言，标准3和标准4的特异性（71%和69% vs 25%， P < 0.01）和准确性（78%和79% vs 50%， P < 0.01）显著高于标准1。此外，标准组2 （AUC = 0.728, P < 0.05）、标准组3 （AUC = 0.823, P < 0.01）和标准组4 （AUC = 0.857, P < 0.01）的AUC均显著高于标准组1 （AUC = 0.667）。结论：与常规CE US相比，MF成像可以更有效地描述特异性特征，并在非典型HCC与FNH的鉴别诊断中提供更高的诊断性能，特别是在住院放射科医生使用时。(c) rsna, 2015
Purpose: To evaluate diagnostic performance of contrast-enhanced (CE) ultrasonography (US) and microflow (MF) imaging in differentiation of atypical hepatocellular carcinoma (HCC) from focal nodular hyperplasia (FNH).Materials and Methods: Institutional review board approval was obtained, and informed consent was waived. A total of 103 patients (mean age, 43.9 years; age range, 17-75 years) were included; 38 patients with HCC and 65 with FNH underwent CE US, and vascular architecture pattern (VAP) and arrival time parametric (ATP) images were analyzed. Resident and staff radiologists independently and retrospectively reviewed CE US, VAP, and ATP images. chi(2) test and logistic regression analysis were applied to identify specific features of FNH or HCC on CE US and MF images. To compare diagnostic performance of CE US with or without MF imaging, four sets of criteria were assigned: (a) routine CE US alone, (b) VAP and CE US, (c) ATP imaging and CE US, and (d) all three methods in combination. Sensitivity, specificity, accuracy, and area under the receiver operating characteristic curve (AUC) of resident and staff radiologists were analyzed. Cohen kappa statistic was used to assess agreement of CE US and MF imaging features between staff and resident radiologists.Results: MF imaging offered significant improvements over most detection rates achieved with routine CE US signs in both groups. For staff radiologists, AUCs from criteria sets 3 (AUC = 0.873, P < .05) and 4 (AUC = 0.887, P < .05) were significantly higher than AUC from criteria set 1 (AUC = 0.835). For resident radiologists, specificity (71% and 69% vs 25%, P < .01) and accuracy (78% and 79% vs 50%, P < .01) of criteria sets 3 and 4 were significantly higher than those of criteria set 1. Moreover, AUCs for criteria sets 2 (AUC = 0.728, P < .05), 3 (AUC = 0.823, P < .01), and 4 (AUC = 0.857, P < .01) were significantly higher than those for criteria set 1 (AUC = 0.667).Conclusion: When compared with routine CE US, MF imaging can more effectively depict specific features and offers improved diagnostic performance in the differentiation of atypical HCC from FNH, especially when used by resident radiologists. (C) RSNA, 2015