Application Of CEUS LI-RADS Combined With Serological Parameters To The Diagnosis Of Focal Hepatic Lesion

Objective:To evaluate the effectiveness of the Contrast-enhanced ultrasound（CEUS）liver imaging reporting and data system（LI-RADS）on the classified diagnosis of patients with focal liver lesions and to investigate the diagnostic efficacy of CEUS LI-RADS on hepatocellular carcinoma（HCC）in single or combined serological parameters.Methods:The CEUS tests and laboratory examination of 202 patients with clearly clinically diagnosed focal liver lesions were retrospectively analyzed.First,liver lesions were graded according to CEUS LI-RADS,and then CEUS LI-RADS was combined with serological in single or combined serological parameters α-fetalprotein（AFP）,Carbohydrate antigen19-9（CA19-9）and hepatitis B surface antigen（HBs Ag）,respectively,to differentiate between benign and malignant liver lesions,HCC and other malignant tumors,HCC and Intrahepatic cholangiocarcinom（ICC）,and draw the curves of receiver operating characteristic（ROC）.The Area under the curve（AUC）and its diagnostic sensitivity,specificity,accuracy,positive predictive value and negative predictive value were calculated,and then compared and analyzedResults:1.The sensitivity,specificity,positive predictive value,negative predictive value and accuracy of CEUS LI-RADS in differential diagnosis of malignant lesions were99.2%,83.8%,86.2%,100% and 93.3%,respectively.Combined with serum AFP and HBs Ag,the specificity and AUC of malignant lesions increased to 94.6% and 0.977,respectively,sensitivity decreased to 92.2%.2.The sensitivity,specificity,accuracy,positive predictive value,negative predictive value of CEUS LI-RADS in differentiating HCC from other malignant lesions were86%,79.3%,83.4%,87.1% and 77.7%,respectively.After the combination of three serological indexes,the sensitivity decreased to 83.7%,the specificity and AUC increased to 92.7% and 0.914,and the accuracy increased to 87.1%.3.The sensitivity,specificity and AUC of CEUS LI-RADS in the differential diagnosis of HCC from ICC were 80.0%,80.7%,0.811.After the combination of three serological indexes,AFP,HBs Ag and CA19-9,the sensitivity,specificity and AUC were 84.0%,91.6% and 0.914,respectively.The positive predictive value and negative predictive value were 87.2%,72.1%and94.2%,77.9%,respectively.4.Using LR-3 as the index of benign and malignant stratified diagnosis,PPV and NPV were 86.2% and 100%,respectively,with accuracy of 90.1%,sensitivity of100% and specificity of 74.0%.The PPV,NPV accuracy,sensitivity and specificity of LR-4 and LR-5 were 89.2%,98.4%,92.6%,99.2%,80.5% and 90.2%,91.4%,90.6%,95.2%,83.1%,respectively.Conclusion:CEUS LI-RADS combined with serological indicators can improve the diagnostic efficiency and authenticity of CEUS for the pathological nature of focal hepatic lesions.Among all combinations,CEUS LI-RADS combined with AFP and HBs Ag has the best diagnostic effect in differentiating benign and malignant liver lesions.CEUS LI-RADS combined with AFP,HBs Ag and CA19-9 has the best diagnostic effect on HCC and non-HCC liver cancer,HCC and ICC.LR-4 as CEUS LI-RADS is the best stratification index for benign and malignant liver lesions.Objective:To evaluate the consistency of CEUS（Contrast-enhanced ultrasound）LIRADS（Liver imaging reporting and data system）in patients with hepatic focal lesions in different seniority groups.Methods:70 patients with focal liver lesions were randomly selected.The CEUS images of these patients were graded by CEUS LI-RADS when the low and high seniority doctors did not know the pathological results.Using pathology as the gold standard,the sensitivity,specificity,accuracy,positive predictive value and negative predictive value of CEUS LI-RADS in the diagnosis of hepatocellular carcinoma（HCC）were calculated among physicians of different seniority groups,high seniority groups and low seniority groups.The consistency of their diagnosis of focal liver lesions was compared（Kappa value）.Results:1、The Kappa value of CEUS LI-RADS in the diagnosis of hepatic focal lesions by two high-senior ultrasound diagnostic physicians was 0.743.The Kappa value of the low-seniority group was 0.693,showing strong consistency.The consistency of CEUS LI-RADS between the senior group and the junior group was strong,and the Kappa value was 0.656.2、When LR-3,LR-4 and LR-5 were used as diagnostic indicators of benign and malignant stratification in high and low seniority groups,the accuracy of LR-4 was highest in both high and low seniority groups（95.7% and 94.3%,respectively）,and the sensitivity and specificity were 100%,85% and 100%,80%,respectively.Conclusion:CEUS LI-RADS is a diagnostic standard for classifying focal liver lesions.The application of LR-4 as the index of benign and malignant liver stratification has the best effect.The consistency between observers is good and is less affected by operator experience,so it will be widely used in the future.