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OA

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 stan-dard.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 posi-tive alpha-fetoprotein(AFP)or des-gamma-carboxy prothrombin(DCP),they were re-judged as LR-5.The diag-nostic efficacy of LR-5 before and after modification was compared.Results Among 379 HCC lesions,after modi-fication,the proportion of HCC cases classified as LR-M decreased from 32.70％to 4.70％(x2=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 signifi-cantly 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.