改良环状动脉期高强化标准提升LI-RADS对原发性肝脏恶性肿瘤的诊断效能
采用改良标准后，LR-5的AUC、敏感度和准确率显著提高，LR-M的AUC、特异度和准确率也显著提高，提示该改良标准可同时改善HCC和非HCC恶性肿瘤的诊断效能。
要点
- 环状动脉期高强化最厚处总厚度与肿瘤直径比值是Rim APHE的最优测量标准。
- 改良Rim APHE标准使LR-5的敏感度从72.5%提升至76.0%，准确率从73.9%提升至76.5%。
- 改良标准使LR-M的特异度从88.7%提升至92.7%，准确率从84.9%提升至87.9%。
关键影像表现/征象
- Rim APHE表现为肿瘤周边动脉期高强化，改良标准关注环状高强化最厚处的总厚度与肿瘤直径的比值。
诊断标准与关键数值
- Rim APHE最优标准为环状高强化最厚处总厚度与肿瘤直径的比值，AUC为0.852（P < .001）。
- 应用改良标准后LR-5的AUC为0.770（vs 0.752，p = .007），敏感度76.0%（vs 72.5%，p = .016），准确率76.5%（vs 73.9%，p = .016）。
- 应用改良标准后LR-M的AUC为0.831（vs 0.811，p = .004），特异度92.7%（vs 88.7%，p = .008），准确率87.9%（vs 84.9%，p = .008）。
临床应用与阅片要点
- 日常阅片测量Rim APHE时，应关注环状高强化最厚处的总厚度，并计算其与肿瘤直径的比值。
- 采用改良标准有助于更准确地将HCC归入LR-5、将非HCC恶性肿瘤归入LR-M。
局限性
- 本研究为回顾性设计，可能存在选择偏倚。
- 研究仅纳入经病理证实的原发性肝脏恶性肿瘤患者，未包含良性病变或其他肝脏占位。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
英文原文（摘要）· 点击展开
PURPOSE: To refine the diagnostic criteria for rim arterial phase hyperenhancement (Rim APHE) and to evaluate the impact of this modification on the diagnostic performance for primary liver malignancies.
MATERIALS AND METHODS: This multicenter, retrospective study included patients with pathologically confirmed primary liver malignancies who underwent preoperative magnetic resonance imaging (MRI) before June 2021. Thirteen different measurement methods for Rim APHE were evaluated to determine the optimal criterion based on diagnostic performance. Two radiologists independently reviewed all observations, assigned Liver Imaging Reporting and Data System (LI-RADS) categories according to version 2018. The diagnostic performance of LI-RADS using original versus modified Rim APHE criteria was compared.
RESULTS: The study enrolled 272 patients, including 204 with Hepatocellular carcinoma (HCC) (170 men and 34 women; mean age, 57 years ±10) and 68 with non-HCC malignancies (53 men and 15 women; mean age, 56 years ±10). The optimal criterion for Rim APHE was the total thickness of the thickest part of peripheral hyperenhancement to tumor diameter (area under the receiver operating characteristic (ROC) curve [AUC] = 0.852; P < .001). With implementation of the modified Rim APHE criterion, the LR-5 criteria showed significantly superior AUC (0.770 vs. 0.752, p = .007), sensitivity (76.0% vs. 72.5%, p = .016) and accuracy (76.5% vs. 73.9%, p = .016); the LR-M criteria showed higher AUC (0.831 vs. 0.811, p = .004), specificity (92.7% vs. 88.7%, p = .008) and accuracy (87.9% vs. 84.9%, p = .008).
CONCLUSION: The optimal criterion for Rim APHE can improve the diagnostic performance for both HCC and non-HCC malignancies.
引用
- Feng C, Liu J, Yang D, et al. A modified Rim APHE criterion to improve LI-RADS diagnostic performance for primary liver malignancies. Abdom Radiol (NY). 2026. PMID: 42138744. doi:10.1007/s00261-026-05551-9
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。