| Objective:Based on CEUS LI-RADS v2017,(1)to evaluate the reliability analysis of CEUS LI-RADS diagnosis within and between radiologists with different levels of CEUS diagnostic experience,and to propose methods to improve the consistency of CEUS LIRADS classification diagnosis;(2)to verify the effectiveness of the proposed modified LR-M in the diagnosis of different sizes of LR-M hepatic nodules,and to select the modified LR-M criteria with good diagnostic efficacy;(3)to construct a new improved LR-M standard by combining the previously screened effective and improved LR-M method with serum alpha-fetoprotein(AFP)to improve the diagnostic efficiency of LRM.Methods:Firstly,this study retrospectively analyzed the contrast-enhanced ultrasound data and clinicopathological data of 169 consecutive adult patients at high risk of HCC who were admitted to our hospital from August 2021 to September 2021 and received contrast-enhanced ultrasound to analyze the consistency of CEUS LI-RADS diagnoses within and between ultrasound diagnostician observers of different seniority.Three radiologists with different levels independently studied the diagnostic criteria of CEUS LI-RADS v2017,and performed CEUS LI-RADS nodule classification at baseline time and 2 weeks after the initial assessment and forgetting the previous nodule classification,respectively.In addition,one month after independently learning,the same 169 highrisk HCC nodules were classified by same radiologists with different levels at baseline time and one month later,respectively,after forgetting the previous classification of nodules and receiving rapid learning of "simple typical CEUS LI-RADS v2017 classification feature image".Inter-and intra-observer reliability was assessed for three radiologists using intraclass correlation coefficient(ICC)analysis.Secondly,this study retrospectively analyzed data from 2299 consecutive adult patients at high risk of HCC who were admitted to our hospital from 2019 to 2021 and underwent contrast-enhanced ultrasound.Finally,261 cases of LR-M lesions were selected and included in this study according to CEUS LI-RADS v2017 criteria,to verify the diagnostic efficacy of existing improved LR-M diagnostic methods in different sizes of LR-M liver nodules,and to construct new improved LR-M diagnostic criteria based on well-screened improved LR-M diagnostic methods combined with AFP.Four proposed modified LR-M criteria were included in this study.The diagnostic performances of the four modified LR-M methods were assessed in LR-M nodules of different sizes by the area under the receiver operating characteristic curve(AUC).Results:First,among the 169 HCC high-risk patient data used for consistency analysis,3were LR-1,13 were LR-2,27 were LR-3,29 were LR-4,29 were LR-M,32 were LR-5,21 were LR-TIV,and 16 were LR-NC.After independent study,ICC between three radiologists was 0.797(95%CI: 0.748-0.840),indicating good reliability;intragroup ICC for residents was 0.671(95%CI: 0.579-0.746);intragroup ICC for attending doctor was 0.788(95%CI:0.723-0.839);intragroup ICC for associate chief physician was 0.835(95%CI:0.783-0.876).After unified learning of simple typical CEUS LIRADS feature images,ICC between three radiologists was 0.952(95%CI:0.938-0.963);intragroup ICC for residents was 0.815(95%CI:0.757-0.860);intragroup ICC for attending doctor was 0.862(95%CI:0.817-0.896);intragroup ICC for associate chief physician was 0.913(95%CI:0.884-0.935).The 261 patients with LR-M observations included 166 HCCs and 95 non-HCCs.Elevated AFP was observed in 112 patients,including 61.4%(102/166)of HCC patients and 10.5%(10/95)of non-HCC patients.The patients with HCC with increased AFP was significantly higher than that without HCC(P < 0.001).A total of 133 nodules were<30 mm and defined as group A,78 nodules were 30 – 50 mm in size and defined as group B,and 50 nodules were >50 mm and defined as group C.In group A,B and C,there were 51,35 and 26 patients with elevated AFP,among which 58.5%(48/82),60.7%(34/56)and 71.4%(20/28)of HCC patients had elevated AFP,respectively.The AUCs between criterion I,II,III,and IV were not significantly different in all LR-M nodules.The AUCs of the ROC curves between criterion I,II,III,and IV were not significantly different in group A.However,the AUC of criterion IV was significantly higher than that of criterion I and III in group B,and the AUCs of criterion I and criterion III were both not significant in group B;the AUC of criterion IV was not significant in group C.Based on the diagnostic effectiveness of the four proposed modified LR-M criteria in the diagnosis of LR-M nodules of different sizes,the modified LR-M criteria II was selected to combinate with AFP to construct a new modified LR-M diagnostic method.The sensitivity,specificity and AUC of the new modified LR-M criteria were 75.9%,92.6% and 0.843(95%CI: 0.793-0.885)in 261 patients with LR-M observations.The specificity of the new modified LR-M criteria was significantly higher than that of the proposed criteria I,II,III and IV;The AUC of the new modified LR-M criteria was significantly higher than those of I,II,III,IV and AFP in total LR-M nodules.In group A,the AUC of the new modified LR-M criteria was significantly higher than those of I,II,III,IV and AFP;In group B,the AUC of the new modified LR-M criteria was significantly higher than those of I,II,III;In group C,the AUC of the new modified LR-M criteria was significantly higher than those of III and IV.Conclusion:(1)Radiologists with different levels of CEUS diagnostic experience showed good inter-and intra-observer reliability in CEUS LI-RADS v2017 classification diagnosis,and the reliability increased to varying degrees with the improvement of diagnostic experience.Compared with independently learning CEUS LI-RADS v2017 guidelines,unified and simplified of CEUS LI-RADS typical signs images can effectively improve the reliability of diagnosis among radiologists with different experience.(2)The modified LR-M method could moderate the detection effectiveness in differentiating HCC from other lesions.According to tumor size,the selection of appropriate modified LR-M diagnostic criteria could effectively improve the diagnostic performance of LRM.(3)Compared with the existing modified LR-M criteria,the new modified LR-M criteria combined with serum AFP can effectively further improve the diagnostic performance of LR-M and reduce the proportion of HCC in LR-M nodules. |
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