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目的:分析肝硬化背景上肝细胞肝癌(HCC)的MRI动态增强表现,探讨2014版肝脏影像报告及数据系统(LI-RADS)所定义的各种征象在MRI上的识别率。方法:2008年12月-2014年8月共54例乙肝肝硬化患者入组本多中心研究,所有患者均行MRI平扫和增强扫描、且经病理诊断证实有HCC。由两位阅片者对MR图像进行独立盲法读片,阅片方法遵循LI-RADS流程:对主要征象、次要征象进行评价(出现/未出现),计算2位阅片者对LI-RADS所定义的各种MRI征象的识别率。通过Kappa检验来分析两位阅片者对征象识别的一致性。结果:两位阅片者对病灶的3个主要征象(动脉期高强化、“廓清”表现、“包膜”表现)的识别率依次分别为83.3%和85.2%、77.8%和64.8%、51.9%和61.1%,阅片者间的一致性(Kappa值)分别为0.791、0.512和0.589。对于次要征象,大部分征象均有一定的识别率,以T2WI上稍高信号、扩散受限的识别率最高,分别为90.7%和87.0%、88.9%和90.7%,阅片者间的一致性(Kappa值)分别为0.813和0.899。结论:基于LI-RADS的诊断标准,平扫及动态增强MR图像上乙肝肝硬化背景上的HCC病灶的主要征象能较多地被识别,且阅片者的一致性较好;次要征象中T2WI稍高信号和扩散受限的识别率较高,阅片者间的一致性也非常好。
OBJECTIVE: To analyze the dynamic MRI findings of hepatocellular carcinoma (HCC) on cirrhotic cirrhosis and to investigate the MRI recognition rates of various signs defined by LI-RADS 2014. METHODS: From December 2008 to August 2014, a total of 54 patients with hepatitis B cirrhosis were enrolled in this multicentre study. All patients underwent MRI plain scan and enhanced scan, and HCC was confirmed by pathological diagnosis. The MR images were read blindly by two readers. The reading method followed the LI-RADS procedure. The main signs and secondary signs were evaluated (appeared / not appeared) Recognition rates of various MRI signs defined by RADS. By Kappa test to analyze the two readers on the identity of the identity of the sign. Results: The recognition rates of the three main signs of the lesion (arterial phase enhancement, “clearance ” performance, “capsule ” performance) were 83.3%, 85.2% and 77.8% 64.8%, 51.9% and 61.1% respectively. The consistency among readers (Kappa values) was 0.791, 0.512 and 0.589 respectively. For the secondary signs, most of the signs have a certain recognition rate, with a slightly higher signal on the T2WI, the highest recognition rate is 90.7%, 87.0%, 88.9% and 90.7%, respectively The Kappa values were 0.813 and 0.899, respectively. Conclusions: Based on the LI-RADS diagnostic criteria, the main signs of HCC lesions on the cirrhotic patients with hepatitis B cirrhotic and cirrhotic and dynamic contrast-enhanced MR images can be identified more often and the readers have better agreement. In the secondary signs T2WI slightly higher signal and diffusion limited recognition rate is higher, the consistency between readers is also very good.