BACKGROUND Contrast-enhanced ultrasound(CEUS)is considered a secondary examination compared to computed tomography(CT)and magnetic resonance imaging(MRI)in the diagnosis of hepatocellular carcinoma(HCC),due to the ris...BACKGROUND Contrast-enhanced ultrasound(CEUS)is considered a secondary examination compared to computed tomography(CT)and magnetic resonance imaging(MRI)in the diagnosis of hepatocellular carcinoma(HCC),due to the risk of misdiagnosing intrahepatic cholangiocarcinoma(ICC).The introduction of CEUS Liver Imaging Reporting and Data System(CEUS LI-RADS)might overcome this limitation.Even though data from the literature seems promising,its reliability in real-life context has not been well-established yet.AIM To test the accuracy of CEUS LI-RADS for correctly diagnosing HCC and ICC in cirrhosis.METHODS CEUS LI-RADS class was retrospectively assigned to 511 nodules identified in 269 patients suffering from liver cirrhosis.The diagnostic standard for all nodules was either biopsy(102 nodules)or CT/MRI(409 nodules).Common diagnostic accuracy indexes such as sensitivity,specificity,positive predictive value(PPV),and negative predictive value(NPV)were assessed for the following associations:CEUS LR-5 and HCC;CEUS LR-4 and 5 merged class and HCC;CEUS LR-M and ICC;and CEUS LR-3 and malignancy.The frequency of malignant lesions in CEUS LR-3 subgroups with different CEUS patterns was also determined.Inter-rater agreement for CEUS LI-RADS class assignment and for major CEUS pattern identification was evaluated.RESULTS CEUS LR-5 predicted HCC with a 67.6%sensitivity,97.7%specificity,and 99.3%PPV(P<0.001).The merging of LR-4 and 5 offered an improved 93.9%sensitivity in HCC diagnosis with a 94.3%specificity and 98.8%PPV(P<0.001).CEUS LR-M predicted ICC with a 91.3%sensitivity,96.7%specificity,and 99.6%NPV(P<0.001).CEUS LR-3 predominantly included benign lesions(only 28.8%of malignancies).In this class,the hypo-hypo pattern showed a much higher rate of malignant lesions(73.3%)than the iso-iso pattern(2.6%).Inter-rater agreement between internal raters for CEUS-LR class assignment was almost perfect(n=511,k=0.94,P<0.001),while the agreement among raters from separate centres was substantial(n=50,k=0.67,P<0.001).Agreement was strong展开更多
基于全球数值预报模式,利用格点同化系统(Grid point Statistical Interpolation system,GSI)将中国区域2170个地面自动气象站进行数据同化,建立了中国区域新的模式初始场,对比了中国区域气温、气压和风速3种气象要素的背景场和初始场...基于全球数值预报模式,利用格点同化系统(Grid point Statistical Interpolation system,GSI)将中国区域2170个地面自动气象站进行数据同化,建立了中国区域新的模式初始场,对比了中国区域气温、气压和风速3种气象要素的背景场和初始场特征以及同化后预报效果与欧洲中心再分析数据差异。结果表明:尽管仅仅同化了中国区域的观测数据,但同化后的模式平均偏差、均方根偏差和代价函数均显著降低,表明同化地面观测站资料能有效地降低模式背景场中的气温、气压和风速等基本物理量的误差,使模式的初始分析场和实际观测场更为一致;而在中国区域,3种气象要素的预报中气压的预报效果最好,7个区域气压的相关系数均达0.94以上,且同化后7个区域的相关系数均有提升,东北、华东等区域相关系数高达0.99;各区域气温的相关系数在同化后也略有提高,均方根误差在同化后有所降低,其中华南地区降幅最大,降低了2.3%。相对气压和气温而言,经向风和纬向风同化后改进不大,与再分析数据的相关系数偏小,同时均方根误差较大。其中,华东、西南和华中区域的经向风相关系数低于0.5,东北地区的经向风和纬向风的均方根误差均大于5 m s^(-1)。展开更多
基金Supported by the Fondazione di Sardegna,No.FDS2019VIDILIthe University of Sassari,No.FAR2019.
文摘BACKGROUND Contrast-enhanced ultrasound(CEUS)is considered a secondary examination compared to computed tomography(CT)and magnetic resonance imaging(MRI)in the diagnosis of hepatocellular carcinoma(HCC),due to the risk of misdiagnosing intrahepatic cholangiocarcinoma(ICC).The introduction of CEUS Liver Imaging Reporting and Data System(CEUS LI-RADS)might overcome this limitation.Even though data from the literature seems promising,its reliability in real-life context has not been well-established yet.AIM To test the accuracy of CEUS LI-RADS for correctly diagnosing HCC and ICC in cirrhosis.METHODS CEUS LI-RADS class was retrospectively assigned to 511 nodules identified in 269 patients suffering from liver cirrhosis.The diagnostic standard for all nodules was either biopsy(102 nodules)or CT/MRI(409 nodules).Common diagnostic accuracy indexes such as sensitivity,specificity,positive predictive value(PPV),and negative predictive value(NPV)were assessed for the following associations:CEUS LR-5 and HCC;CEUS LR-4 and 5 merged class and HCC;CEUS LR-M and ICC;and CEUS LR-3 and malignancy.The frequency of malignant lesions in CEUS LR-3 subgroups with different CEUS patterns was also determined.Inter-rater agreement for CEUS LI-RADS class assignment and for major CEUS pattern identification was evaluated.RESULTS CEUS LR-5 predicted HCC with a 67.6%sensitivity,97.7%specificity,and 99.3%PPV(P<0.001).The merging of LR-4 and 5 offered an improved 93.9%sensitivity in HCC diagnosis with a 94.3%specificity and 98.8%PPV(P<0.001).CEUS LR-M predicted ICC with a 91.3%sensitivity,96.7%specificity,and 99.6%NPV(P<0.001).CEUS LR-3 predominantly included benign lesions(only 28.8%of malignancies).In this class,the hypo-hypo pattern showed a much higher rate of malignant lesions(73.3%)than the iso-iso pattern(2.6%).Inter-rater agreement between internal raters for CEUS-LR class assignment was almost perfect(n=511,k=0.94,P<0.001),while the agreement among raters from separate centres was substantial(n=50,k=0.67,P<0.001).Agreement was strong
文摘基于全球数值预报模式,利用格点同化系统(Grid point Statistical Interpolation system,GSI)将中国区域2170个地面自动气象站进行数据同化,建立了中国区域新的模式初始场,对比了中国区域气温、气压和风速3种气象要素的背景场和初始场特征以及同化后预报效果与欧洲中心再分析数据差异。结果表明:尽管仅仅同化了中国区域的观测数据,但同化后的模式平均偏差、均方根偏差和代价函数均显著降低,表明同化地面观测站资料能有效地降低模式背景场中的气温、气压和风速等基本物理量的误差,使模式的初始分析场和实际观测场更为一致;而在中国区域,3种气象要素的预报中气压的预报效果最好,7个区域气压的相关系数均达0.94以上,且同化后7个区域的相关系数均有提升,东北、华东等区域相关系数高达0.99;各区域气温的相关系数在同化后也略有提高,均方根误差在同化后有所降低,其中华南地区降幅最大,降低了2.3%。相对气压和气温而言,经向风和纬向风同化后改进不大,与再分析数据的相关系数偏小,同时均方根误差较大。其中,华东、西南和华中区域的经向风相关系数低于0.5,东北地区的经向风和纬向风的均方根误差均大于5 m s^(-1)。
