Diagnostic accuracy of imaging for liver cirrhosis compared to histologically proven liver cirrhosis
Diagnostic accuracy of imaging for liver cirrhosis compared to histologically proven liver cirrhosis
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DOI：
10.1159/000122595
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发表时间：
2008-01-01
期刊：
影响因子：
4.6
通讯作者：
Kojiro, Masamichi
中科院分区：
文献类型：
--
作者：
Kudo, Masatoshi;Zheng, Rong Qin;Kojiro, Masamichi
目的：通过与切除标本的组织病理学诊断结果进行比较，评价影像学检查（包括CT、MRI和US）对肝硬化诊断的准确性。材料与方法：对10个单位的142例复杂性肝癌（直径<3cm）手术治疗的慢性肝病患者的CT、MRI和US检查进行了多中心研究，由3名具有CT、MRI和US经验的放射科医生进行盲法审查。使用严重程度量表评估图像的五个成像参数（不规则或结节状肝脏表面、钝性肝脏边缘、肝脏实质异常、肝脏形态学改变和门脉高压症表现）。还计算了诊断成像印象评分。由三位病理学家独立地对切除的肝脏标本进行回顾，将患者在组织学上分为慢性肝炎（CH; n = 54）、肝硬化（LC; n = 71）和肝硬化前期（P-LC; n = 17）.将三种成像方法的结果与组织学诊断的结果进行比较，并进行多变量分析（逐步向前logistic回归分析）以确定肝硬化的独立预测体征。采用受试者工作特征曲线（ROC）分析比较CT、MRI和US对LC和早期肝硬化的诊断效能。结果如下：CT、MRI和US在LC与CH之间的5项影像学参数差异有统计学意义（P < 0.001），但US对门脉高压的表现差异无统计学意义。多因素分析显示，超声显示肝脏表面不规则或结节状、钝缘或形态学改变是肝硬化的最佳预测征象，而MRI和CT显示肝实质异常、门脉高压表现和肝脏形态学改变是肝硬化的最佳预测征象。CT对LC与CH的诊断准确性、敏感性和特异性分别为71.9%、77.1%和67.6%; MRI为67.9、67.5和68.3%，US为66.0、38.4（低于CT和MRI，p = 0.001）和88.8%（高于CT和MRI，p = 0.001）。根据影像学印象评分系统，CT的诊断准确性、敏感性和特异性分别为67.0%、84.3%和52.9%; MRI为70.3%、86.7%和53.9%; US为64.0%、52.4%（低于CT和MRI，p = 0.0001）和73.5%（高于CT和MRI，p < 0.003）。ROC曲线分析显示MRI和CT对LC的诊断略上级US，但无统计学差异。在病理诊断方面，超声、CT和MRI诊断肝硬化的阳性率分别为59.5%、46.7%和41.7%，三者之间无显著性差异。结论：超声、CT和MRI对LC的诊断有不同的独立预测指标。MRI和CT在预测肝硬化方面略上级US，尤其是在敏感性方面。无创性影像学技术在肝硬化的诊断中起着重要作用，尤其是在P- LC的评价中。版权所有（c）2008 S. Karger AG，巴塞尔。
Objective: To evaluate the diagnostic accuracy of liver cirrhosis by imaging modalities, including CT, MRI and US, compared to results obtained from histopathological diagnoses of resected specimens. Materials and Methods: CT, MRI and US examinations of 142 patients with chronic liver disease who underwent surgery for complicated hepatocellular carcinoma (< 3 cm in diameter) in 10 institutions were blindly reviewed in a multicenter study by three radiologists experienced in CT, MRI and US. The images were evaluated for five imaging parameters ( irregular or nodular liver surface, blunt liver edge, liver parenchymal abnormalities, liver morphological changes and manifestations of portal hypertension) using a severity scale. The diagnostic imaging impression score was also calculated. Patients were histologically classified into chronic hepatitis ( CH; n = 54), liver cirrhosis ( LC; n = 71) and pre- cirrhosis ( P- LC; n = 17) by three pathologists, independently, who reviewed the resected liver specimens. The results of the three imaging methods were compared to those from histological diagnoses, and a multivariate analysis ( stepwise forward logistic regression analysis) was performed to identify independent predictive signs of cirrhosis. The diagnostic efficacies for LC and early cirrhosis were also compared among CT, MRI and US using a receiver- operating characteristic ( ROC) curve analysis. Results: The differences in the five imaging parameters evaluated by CT, MRI and US between LC and CH were statistically significant ( p < 0.001) except for the manifestations of portal hypertension on US. Irregular or nodular surface, blunt edge or morphological changes in the liver were selected as the best predictive signs for cirrhosis on US whereas liver parenchymal abnormalities, manifestations of portal hypertension and morphological changes in the liver were the best predictive signs on MRI and CT by multivariate analysis. The predictive diagnostic accuracy, sensitivity and specificity in discriminating LC from CH based on the best predictive signs were 71.9, 77.1 and 67.6% by CT; 67.9, 67.5 and 68.3% by MRI, and 66.0, 38.4 ( lower than CT and MRI, p = 0.001) and 88.8% ( higher than CT and MRI, p = 0.001) by US. According to the imaging impression scoring system, diagnostic accuracy, sensitivity and specificity were 67.0, 84.3 and 52.9% by CT; 70.3, 86.7 and 53.9% by MRI, and 64.0, 52.4 ( lower than CT and MRI, p = 0.0001) and 73.5% ( higher than CT and MRI, p < 0.003) by US. ROC analysis showed that MRI and CT were slightly superior to US in the diagnosis of LC but no statistically significant difference was found between them. For the pathological diagnosis of P- LC, cirrhosis was diagnosed in 59.5, 46.7 and 41.7% of the P- LC cases by US, CT and MRI, respectively, with no significant difference among these methods. Conclusion: US, CT and MRI had different independent predictive signs for the diagnosis of LC. MRI and CT were slightly superior to US in predicting cirrhosis, especially regarding sensitivity. Noninvasive imaging techniques play an important role in the diagnosis of cirrhosis, especially in the evaluation of P- LC. Copyright (c) 2008 S. Karger AG, Basel.