评估CT-超声对照作为超声检查质量控制方法在肝脏局灶性病变漏诊中的应用效果。

研究对象为自2022年12月至2023年4月在北京大学深圳医院接受影像学检查的患者。通过CT-超声对照，以CT检查结果作为“金标准”，根据CT提示局灶性病变的最大径，将病例分为≤1.0 cm、1.1~2.0 cm及＞2.0 cm 3组。分析病灶部位和最大径，将匹配结果分类为“轻度不一致（≤1.0 cm）”“中度不一致（1.1~2.0 cm）”“重度不一致（＞2.0 cm）”及“可能一致”，并进行统计分析。配对记录根据CT和超声报告的时间顺序分为“事前质控”（CT报告时间早于超声报告）和“事后质控”（CT报告时间晚于超声报告），并统计每类记录的数量。对“重度不一致”的记录进行核查，再进行数据分析和质量控制反馈。

在2397例CT-超声配对的肝脏局灶性病变中，总不一致率为24.53%（588/2397）。其中，≤1.0 cm组不一致率最高（42.62%，430/1009），＞2.0 cm组不一致率最低（7.66%，49/640）。不一致类别的比例：“轻度不一致”“中度不一致”和“重度不一致”比例分别为17.94%（430/2397）、4.55%（109/2397）和2.04%（49/2397）。“重度不一致”的病例主要集中在肝左外叶近包膜处和肝右叶近膈顶处。在所有不一致病例中，47.96%（282/588）为“事前质控”。

CT-超声对照的方法可以作为一种实用的质量控制策略，用以改善超声在肝脏局灶性病变中的漏诊现况。

To evaluate the effectiveness of CT-ultrasound comparison as a quality control method for the missed diagnosis of focal liver lesions by ultrasound.

The study subjects were patients who underwent imaging examinations at Peking University Shenzhen Hospital from December 2022 to April 2023. Using the CT examination results as the "gold standard", cases were divided into three groups based on the maximum diameter of the focal lesions suggested by CT: "≤1.0 cm", "1.1-2.0 cm", and "＞2.0 cm". The lesion locations and maximum diameters were analyzed, and the CT-ultrasound comparison results were classified as "weakly inconsistent (≤1.0 cm)", "moderately inconsistent (1.1-2.0 cm)", "strongly inconsistent (＞2.0 cm)", and "possibly consistent". Statistical analysis was then conducted. Based on the chronological order of CT and ultrasound reports, the paired records were categorized into "pre-examination quality control" (CT report before ultrasound report) and "post-examination quality control" (CT report after ultrasound report), and the quantity of records in each category was recorded. Records of "strongly inconsistent" were reviewed, followed by data analysis and quality control feedback.

Among the 2397 cases of CT-ultrasound paired focal liver lesions, the "inconsistency rate" was 24.53% (588/2397); the inconsistency rate of the "≤1.0 cm" group was the highest (42.62%, 430/1009), and that of the "＞2.0 cm" group was the lowest (7.66%, 49/640). The proportions of "weakly inconsistent", "moderately inconsistent", and "strongly inconsistent" categories were 17.94% (430/2397), 4.55% (109/2397), and 2.04% (49/2397), respectively. Cases of "strongly inconsistent" were mainly concentrated near the capsule of the left outer lobe of the liver and the diaphragmatic top of the right lobe. Among all inconsistent cases, 47.96% (282/588) were in the "pre-examination quality control" category.

The method of CT-ultrasound comparison can serve as a practical quality control strategy to improve the missed diagnosis of focal liver lesions in ultrasound examinations.