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Radiology:LI-RADS是否也适用于儿童肝细胞癌的描述及诊断?

2021-04-29 shaosai MedSci原创

美国放射学院肝脏成像报告和数据系统(LI-RADS)提供了一个标准化报告模式,用于描述有发展为肝细胞肝癌(HCC)风险的成人CT和MRI发现。

美国放射学院肝脏成像报告和数据系统(LI-RADS)提供了一个标准化报告模式,用于描述有发展为肝细胞肝癌(HCC)风险的成人CT和MRI发现。尽管有共识性指南用于小儿肝脏恶性肿瘤的分期和成像,但可用于诊断小儿肝细胞肿瘤的标准化图像解释的信息还十分有限。最近成立的美国放射学会小儿LI-RADS工作组已经发布了对小儿肝细胞肿瘤影像学检查的共识性建议。目前由于小儿HCC十分罕见,占所有HCC病例的不足1%且在生物学上与成人HCC不同,因此有关这种癌症的知识十分有限。肝硬化是成人HCC的最常见的危险因素,而在北美只有约25%–40%的HCC患儿患有肝病。此外,儿童HCC的易感条件不同于成人,HCC患儿通常患有例如酪氨酸血症和胆汁淤积性疾病等遗传性代谢疾病或范科尼贫血等遗传性癌症易感性疾病。

LI-RADS 2018版标准特别声明不适用于18岁以下、患有先天性肝纤维化或血管源行肝病及未诊断为肝硬化或慢性乙型肝炎感染的患者。即使有如此,许多放射科医师仍将LI-RADS影像学的部分特征用于儿童HCC的诊断及描述。现有的LI-RADS在儿童中的应用的相关研究十分有限,据我们所知,目前尚无关于儿童HCC动态增强模式的研究。

近日,发表在Radiology杂志的一项研究评价了LI-RADS 2018版在儿科HCC诊断中的应用价值,为临床标准化描述及诊断小儿HCC提供了思路及理论支持。

本项多中心回顾性研究评估了在2009年7月至2019年4月期间5家机构所有可用的小儿(≤18岁)HCC的CT及MRI扫描图像。对照组包括相同数量的其他肝脏病变。三名放射科医生独立应用LI-RADS 2018版标准对病变进行评估。参照标准为病理检查或1年以上的随访图像。LI-RADS的敏感性和特异性通过对LR-1、 LR-2或LR-3与LR-4、 LR-5、LR-TIV(静脉肿瘤)或LR-M(可能或肯定是恶性的,但不是典型HCC)的二分法分类来预测整个队列和HCC风险患者的肝脏病变恶性程度。

该队列包括116名儿童,其中包括58例HCC(平均年龄12岁±5岁;31例女孩)及58例其他强化的肝脏肿块(平均年龄12±5岁;42例女孩)。三位阅读者对典型HCC的主要标准如下:非环形动脉期高强化,49%-62%(39例患者中19-24例);非外周“快出”,36%-59%(39例患者中14-23例);“包膜”强化,28%-38%(39例患者中11-15例)。在整个队列中,LR-4、LR-5、LR-TIV或LR-M对恶性肿瘤的敏感性在85% (95% CI: 76,94)到88% (95% CI: 80,96)之间;LR-1、LR-2或LR-3对良性肿瘤的特异性为54% (95% CI: 40,68)至70% (95% CI: 57,83)。在高危亚组中,敏感性范围为58% (95% CI: 36,80)到68% (95% CI: 48,89);特异性为56% (95% CI: 37,74)至63% (95% CI: 45,81)。所有LR-TIV病变(n = 10-13)均为HCC。

表 研究队列中肝脏病变中常见的LI-RADS主要特征的分布。

本研究表明尽管肝脏成像报告和数据系统(LI-RADS)分类在儿童肝细胞癌(HCC)的诊断中与成人具有相当大的一致性,但由于特异性较低,因此其在指导小儿肝脏局灶性病变的成像及诊断方面的价值十分有限。同时,LI-RADS诊断高危成人HCC的主要标准仅见于儿童HCC的一个子集,并经常发生于儿童良性肝脏肿瘤中。因此本研究提示当LI-RADS应用于儿童肝脏病变的诊断及鉴别诊断时应十分慎重。

原文出处:

Geetika Khanna,Govind B Chavhan,Gary R Schooler,et al.Diagnostic Performance of LI-RADS Version 2018 for Evaluation of Pediatric Hepatocellular Carcinoma.DOI:10.1148/radiol.2021203559

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    2021-05-15 zhanfl
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    2021-08-20 江川靖瑶
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  4. [GetPortalCommentsPageByObjectIdResponse(id=1746783, encodeId=72da1e4678391, content=<a href='/topic/show?id=a4e2108e086' target=_blank style='color:#2F92EE;'>#LI-RADS#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=92, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10870, encryptionId=a4e2108e086, topicName=LI-RADS)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=65a635842372, createdName=zhanfl, createdTime=Sat May 15 21:15:50 CST 2021, time=2021-05-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1792997, encodeId=09fd1e92997bc, content=<a href='/topic/show?id=6d7e150911e' target=_blank style='color:#2F92EE;'>#RADS#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=15091, encryptionId=6d7e150911e, topicName=RADS)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTK17mLkWpia3T92NlEWTkEhrhZa7XPNic2JqQumEicZXGYFG6Ww5SCIl0Uq62bhhPnibAqIZDHtRva92A/132, createdBy=e0752500025, createdName=江川靖瑶, createdTime=Fri Aug 20 03:15:50 CST 2021, time=2021-08-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2029531, encodeId=6d26202953162, content=<a href='/topic/show?id=c4222014ff' target=_blank style='color:#2F92EE;'>#ADS#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2014, encryptionId=c4222014ff, topicName=ADS)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=38232500109, createdName=1249898am15暂无昵称, createdTime=Fri Dec 17 13:15:50 CST 2021, time=2021-12-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1979113, encodeId=a86019e9113b4, content=<a href='/topic/show?id=3b90e79787f' target=_blank style='color:#2F92EE;'>#细胞癌#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=77978, encryptionId=3b90e79787f, topicName=细胞癌)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e457184, createdName=qingting, createdTime=Wed Jun 02 12:15:50 CST 2021, time=2021-06-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1863554, encodeId=64ae18635548e, content=<a href='/topic/show?id=c0b68135561' target=_blank style='color:#2F92EE;'>#肝细胞#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=81355, encryptionId=c0b68135561, topicName=肝细胞)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d59291, createdName=xjy02, createdTime=Sat Oct 30 00:15:50 CST 2021, time=2021-10-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=962382, encodeId=4542962382a8, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=86, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=52de5265073, createdName=1480e627m57暂无昵称, createdTime=Sun May 02 22:54:22 CST 2021, time=2021-05-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=962380, encodeId=f7ad96238048, content=好, beContent=null, objectType=article, channel=null, level=null, likeNumber=87, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=52de5265073, createdName=1480e627m57暂无昵称, createdTime=Sun May 02 22:47:32 CST 2021, time=2021-05-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=961695, encodeId=5f2f9616956e, content=学习了,谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=86, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7c592194322, createdName=1209e435m98(暂无昵称), createdTime=Thu Apr 29 23:45:56 CST 2021, time=2021-04-29, status=1, ipAttribution=)]
  5. [GetPortalCommentsPageByObjectIdResponse(id=1746783, encodeId=72da1e4678391, content=<a href='/topic/show?id=a4e2108e086' target=_blank style='color:#2F92EE;'>#LI-RADS#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=92, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10870, encryptionId=a4e2108e086, topicName=LI-RADS)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=65a635842372, createdName=zhanfl, createdTime=Sat May 15 21:15:50 CST 2021, time=2021-05-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1792997, encodeId=09fd1e92997bc, content=<a href='/topic/show?id=6d7e150911e' target=_blank style='color:#2F92EE;'>#RADS#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=15091, encryptionId=6d7e150911e, topicName=RADS)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTK17mLkWpia3T92NlEWTkEhrhZa7XPNic2JqQumEicZXGYFG6Ww5SCIl0Uq62bhhPnibAqIZDHtRva92A/132, createdBy=e0752500025, createdName=江川靖瑶, createdTime=Fri Aug 20 03:15:50 CST 2021, time=2021-08-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2029531, encodeId=6d26202953162, content=<a href='/topic/show?id=c4222014ff' target=_blank style='color:#2F92EE;'>#ADS#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2014, encryptionId=c4222014ff, topicName=ADS)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=38232500109, createdName=1249898am15暂无昵称, createdTime=Fri Dec 17 13:15:50 CST 2021, time=2021-12-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1979113, encodeId=a86019e9113b4, content=<a href='/topic/show?id=3b90e79787f' target=_blank style='color:#2F92EE;'>#细胞癌#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=77978, encryptionId=3b90e79787f, topicName=细胞癌)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e457184, createdName=qingting, createdTime=Wed Jun 02 12:15:50 CST 2021, time=2021-06-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1863554, encodeId=64ae18635548e, content=<a href='/topic/show?id=c0b68135561' target=_blank style='color:#2F92EE;'>#肝细胞#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=81355, encryptionId=c0b68135561, topicName=肝细胞)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d59291, createdName=xjy02, createdTime=Sat Oct 30 00:15:50 CST 2021, time=2021-10-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=962382, encodeId=4542962382a8, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=86, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=52de5265073, createdName=1480e627m57暂无昵称, createdTime=Sun May 02 22:54:22 CST 2021, time=2021-05-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=962380, encodeId=f7ad96238048, content=好, beContent=null, objectType=article, channel=null, level=null, likeNumber=87, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=52de5265073, createdName=1480e627m57暂无昵称, createdTime=Sun May 02 22:47:32 CST 2021, time=2021-05-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=961695, encodeId=5f2f9616956e, content=学习了,谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=86, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7c592194322, createdName=1209e435m98(暂无昵称), createdTime=Thu Apr 29 23:45:56 CST 2021, time=2021-04-29, status=1, ipAttribution=)]
    2021-10-30 xjy02
  6. [GetPortalCommentsPageByObjectIdResponse(id=1746783, encodeId=72da1e4678391, content=<a href='/topic/show?id=a4e2108e086' target=_blank style='color:#2F92EE;'>#LI-RADS#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=92, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10870, encryptionId=a4e2108e086, topicName=LI-RADS)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=65a635842372, createdName=zhanfl, createdTime=Sat May 15 21:15:50 CST 2021, time=2021-05-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1792997, encodeId=09fd1e92997bc, content=<a href='/topic/show?id=6d7e150911e' target=_blank style='color:#2F92EE;'>#RADS#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=15091, encryptionId=6d7e150911e, topicName=RADS)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTK17mLkWpia3T92NlEWTkEhrhZa7XPNic2JqQumEicZXGYFG6Ww5SCIl0Uq62bhhPnibAqIZDHtRva92A/132, createdBy=e0752500025, createdName=江川靖瑶, createdTime=Fri Aug 20 03:15:50 CST 2021, time=2021-08-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2029531, encodeId=6d26202953162, content=<a href='/topic/show?id=c4222014ff' target=_blank style='color:#2F92EE;'>#ADS#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2014, encryptionId=c4222014ff, topicName=ADS)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=38232500109, createdName=1249898am15暂无昵称, createdTime=Fri Dec 17 13:15:50 CST 2021, time=2021-12-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1979113, encodeId=a86019e9113b4, content=<a href='/topic/show?id=3b90e79787f' target=_blank style='color:#2F92EE;'>#细胞癌#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=77978, encryptionId=3b90e79787f, topicName=细胞癌)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e457184, createdName=qingting, createdTime=Wed Jun 02 12:15:50 CST 2021, time=2021-06-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1863554, encodeId=64ae18635548e, content=<a href='/topic/show?id=c0b68135561' target=_blank style='color:#2F92EE;'>#肝细胞#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=81355, encryptionId=c0b68135561, topicName=肝细胞)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d59291, createdName=xjy02, createdTime=Sat Oct 30 00:15:50 CST 2021, time=2021-10-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=962382, encodeId=4542962382a8, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=86, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=52de5265073, createdName=1480e627m57暂无昵称, createdTime=Sun May 02 22:54:22 CST 2021, time=2021-05-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=962380, encodeId=f7ad96238048, content=好, beContent=null, objectType=article, channel=null, level=null, likeNumber=87, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=52de5265073, createdName=1480e627m57暂无昵称, createdTime=Sun May 02 22:47:32 CST 2021, time=2021-05-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=961695, encodeId=5f2f9616956e, content=学习了,谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=86, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7c592194322, createdName=1209e435m98(暂无昵称), createdTime=Thu Apr 29 23:45:56 CST 2021, time=2021-04-29, status=1, ipAttribution=)]
    2021-05-02 1480e627m57暂无昵称

    学习

    0

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    2021-05-02 1480e627m57暂无昵称

    0

  8. [GetPortalCommentsPageByObjectIdResponse(id=1746783, encodeId=72da1e4678391, content=<a href='/topic/show?id=a4e2108e086' target=_blank style='color:#2F92EE;'>#LI-RADS#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=92, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10870, encryptionId=a4e2108e086, topicName=LI-RADS)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=65a635842372, createdName=zhanfl, createdTime=Sat May 15 21:15:50 CST 2021, time=2021-05-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1792997, encodeId=09fd1e92997bc, content=<a href='/topic/show?id=6d7e150911e' target=_blank style='color:#2F92EE;'>#RADS#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=15091, encryptionId=6d7e150911e, topicName=RADS)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTK17mLkWpia3T92NlEWTkEhrhZa7XPNic2JqQumEicZXGYFG6Ww5SCIl0Uq62bhhPnibAqIZDHtRva92A/132, createdBy=e0752500025, createdName=江川靖瑶, createdTime=Fri Aug 20 03:15:50 CST 2021, time=2021-08-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2029531, encodeId=6d26202953162, content=<a href='/topic/show?id=c4222014ff' target=_blank style='color:#2F92EE;'>#ADS#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2014, encryptionId=c4222014ff, topicName=ADS)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=38232500109, createdName=1249898am15暂无昵称, createdTime=Fri Dec 17 13:15:50 CST 2021, time=2021-12-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1979113, encodeId=a86019e9113b4, content=<a href='/topic/show?id=3b90e79787f' target=_blank style='color:#2F92EE;'>#细胞癌#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=77978, encryptionId=3b90e79787f, topicName=细胞癌)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e457184, createdName=qingting, createdTime=Wed Jun 02 12:15:50 CST 2021, time=2021-06-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1863554, encodeId=64ae18635548e, content=<a href='/topic/show?id=c0b68135561' target=_blank style='color:#2F92EE;'>#肝细胞#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=81355, encryptionId=c0b68135561, topicName=肝细胞)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d59291, createdName=xjy02, createdTime=Sat Oct 30 00:15:50 CST 2021, time=2021-10-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=962382, encodeId=4542962382a8, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=86, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=52de5265073, createdName=1480e627m57暂无昵称, createdTime=Sun May 02 22:54:22 CST 2021, time=2021-05-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=962380, encodeId=f7ad96238048, content=好, beContent=null, objectType=article, channel=null, level=null, likeNumber=87, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=52de5265073, createdName=1480e627m57暂无昵称, createdTime=Sun May 02 22:47:32 CST 2021, time=2021-05-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=961695, encodeId=5f2f9616956e, content=学习了,谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=86, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7c592194322, createdName=1209e435m98(暂无昵称), createdTime=Thu Apr 29 23:45:56 CST 2021, time=2021-04-29, status=1, ipAttribution=)]
    2021-04-29 1209e435m98(暂无昵称)

    学习了,谢谢分享

    0

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