双能CT定量参数对肝细胞癌患者经动脉化疗栓塞术后不同组织类型的诊断价值

摘要/Abstract

摘要： 目的探讨双能CT定量参数在评估经动脉化疗栓塞(TACE)治疗的肝细胞癌(HCC)患者中的作用。方法回顾性分析2021年6月至2024年6月期间青岛市第三人民医院接受TACE治疗的72例HCC患者临床和双能CT影像学资料。以数字减影血管造影(DSA)为参考标准,分析双能CT碘图中肿瘤活动区、癌旁正常肝组织、肿瘤坏死区的ROI测量指标,包括动脉期标化碘浓度(NICAP)、门静脉期标化碘浓度(NICPP)、碘浓度差(ICD)、动脉碘分数(AIF)和Hounsfield单位曲线斜率(λHu)。使用受试者工作特征(ROC)曲线分析双能CT定量参数对不同组织类型的诊断效能。结果 72例患者中,共测量401个ROI,其中肿瘤活动区175个、癌旁正常肝组织175个、肿瘤坏死区51个。肿瘤活动区的λHu、NICAP、NICPP分别为3.34±0.97、(16.33±6.77)%、(46.56±12.37)%,均高于癌旁正常肝组织和肿瘤坏死区的[0.69±0.21、(2.56±0.61)%、(39.49±9.77)%和0.36±0.18、(2.40±0.61)%、(9.14±2.53)%],差异均有统计学意义(P<0.05)。肿瘤活动区的ICD为(0.52±0.18) mg/mL,较癌旁正常肝组织的(1.32±0.37) mg/mL更低,较肿瘤坏死区的(0.31±0.12) mg/mL更高(P均<0.05)。肿瘤活动区的AIF为0.97±0.26,较癌旁正常肝组织(0.13±0.03)更高,较肿瘤坏死区(1.08±0.35)更低(P均<0.05)。λHu、NICAP、NICPP、ICD和AIF对肿瘤活动区和癌旁正常肝组织的诊断曲线下面积(AUC)分别为0.998、0.978、0.669、0.975和1.000。λHu、NICAP、NICPP、ICD和AIF对肿瘤活动区和肿瘤坏死区的AUC分别为0.998、0.978、0.656、0.979和1.000。结论双能CT定量参数可有效区分TACE后肝脏中的肿瘤活动区、癌旁正常肝组织、肿瘤坏死区。

关键词: 肝细胞癌, 双能CT, 经动脉化疗栓塞, 肿瘤成像

Abstract: Objective To explore the role of dual energy CT quantitative parameters in evaluating patients with hepatocellular carcinoma (HCC) treated with transarterial chemoembolization (TACE). Methods A retrospective analysis was conducted on the clinical and dual energy CT imaging data of 72 HCC patients who received TACE treatment in Qingdao Third People's Hospital from June 2021 to June 2024. Digital subtraction angiography (DSA) was used as a reference standard, the arterial phase standardized iodine concentration (NICAP), portal vein phase standardized iodine concentration (NICPP), iodine concentration difference (ICD), arterial iodine fraction (AIF), and Hounsfield unit curve slope (λHu) of region of interest (ROI) measurements in tumor active areas, normal liver tissue adjacent to cancer, and tumor necrosis areas were analyzed in dual energy CT iodine maps. Receiver operating characteristic (ROC) curves were used to analyze the diagnostic efficacy of dual energy CT quantitative parameters for different tissue types. Results In a total of 72 patients, 401 ROIs were measured, including 175 in the tumor active area, 175 in the peritumor normal liver tissue, and 51 in the tumor necrosis area. The λHu, NICAP, and NICPP of the tumor active area were 3.34±0.97, (16.33±6.77)%, and (46.56±12.37)%, respectively, which were all higher than those of the peritumor normal liver tissue [0.69±0.21, (2.56±0.61)%, (39.49±9.77)%] and the tumor necrosis area [0.36±0.18, (2.40±0.61)%, (9.14±2.53)%], with statistically significant differences (P<0.05). The ICD of the tumor active area was (0.52±0.18) mg/mL, which was lower than that of the peritumor normal liver tissue (1.32±0.37) mg/mL and higher than that of the tumor necrosis area (0.31±0.12) mg/mL (P values were all <0.05). The AIF of the tumor active area was 0.97±0.26, which was higher than that of the peritumor normal liver tissue (0.13±0.03) and lower than that of the tumor necrosis area (1.08±0.35) (P values were all <0.05). Conclusion Dual energy CT quantitative parameters can effectively distinguish between tumor active areas, normal liver tissue adjacent to cancer, and tumor necrotic areas in the liver after TACE.

Key words: Hepatocellular carcinoma, Dual energy CT, Transarterial chemoembolization, Tumor imaging

张秀娟, 臧传诚, 邹红梅. 双能CT定量参数对肝细胞癌患者经动脉化疗栓塞术后不同组织类型的诊断价值[J]. 肝脏, 2026, 31(2): 224-227.

ZHANG Xiu-juan, ZANG Chuan-cheng, ZOU Hong-mei. The diagnostic value of dual energy CT quantitative parameters for different tissue types in patients with hepatocellular carcinoma after arterial chemoembolization[J]. Chinese Hepatolgy, 2026, 31(2): 224-227.

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参考文献

[1] 中国医师协会介入医师分会临床诊疗指南专委会. 中国肝细胞癌经动脉化疗栓塞(TACE)治疗临床实践指南(2023年版)[J]. 中华医学杂志, 2023, 103(34):2674-2694.
[2] 国际肝胆胰协会中国分会, 中国抗癌协会肝癌专业委员会, 中国研究型医院学会肝胆胰外科专业委员会, 等. 乙肝病毒相关肝细胞癌抗病毒治疗中国专家共识(2023版)[J]. 中华消化外科杂志, 2023, 22(1):29-41.
[3] 中国医师协会介入医师分会临床诊疗指南专委会. 肝细胞癌经动脉化疗栓塞抵抗及后续治疗专家共识[J]. 介入放射学杂志, 2022, 31(11):1039-1044.
[4] Tsujita Y, Sofue K, Ueshima E, et al. Evaluation and prediction of treatment response for hepatocellular carcinoma[J]. Magn Reson Med Sci, 2023, 22(2):209-220.
[5] 纪晓兰, 杨素君. CT双能量成像在肝细胞癌TACE术后疗效评估中的应用[J]. 医学影像学杂志, 2023, 33(5):780-784.
[6] 李小英, 杨朝凤, 李杨. 双能量CT在肝细胞癌非手术治疗中的应用进展[J]. 中国中西医结合影像学杂志, 2023, 21(5):587-590.
[7] 张婧, 周虹. DSCT双能量扫描成像法与常规CT增强在肝癌TACE术后的临床应用[J]. 医学影像学杂志, 2023, 33(2):342-344.
[8] 买志峰, 徐芳芳, 张建进. 双能量CT定量评价肝动脉化疗栓塞术后肝细胞癌的价值[J]. 中国CT和MRI杂志, 2023, 21(8):108-110.
[9] Li J, Zhao S, Ling Z, et al. Dual-energy computed tomography imaging in early-stage hepatocellular carcinoma: a preliminary study[J]. Contrast Media Mol Imaging, 2022, 2022:2146343.
[10] Ota T, Hori M, Sasaki K, et al. Multimaterial decomposition algorithm for quantification of fat in hepatocellular carcinoma using rapid kilovoltage-switching dual-energy CT: a comparison with chemical-shift MR imaging[J]. Medicine (Baltimore), 2021, 100(20):e26109.
[11] 喻朋辉, 赵香田. 双源CT全肝灌注成像用于原发性肝细胞癌患者动脉导管化疗栓塞术后疗效评估研究[J]. 中西医结合肝病杂志, 2018, 28(5):307-309.
[12] Cheng S M, Ling W, Zhu J, et al. Dual energy spectral CT imaging in the assessment of gastric cancer and cell proliferation: a preliminary study[J]. Sci Rep, 2018, 8(1):17619.
[13] 胡伟, 盛兆国, 李正腾, 等. 双能CT影像学在肝癌肝动脉栓塞化疗术后效果判定中的应用价值分析[J]. 河北医学, 2022, 28(8):1336-1340.
[14] 李大铭, 张玉婷, 马小梅. 能谱CT成像在评估肝细胞癌微血管侵犯中的价值[J]. 中国CT和MRI杂志, 2024, 22(1):91-93, 106.
[15] Mulé S, Pigneur F, Quelever R, et al. Can dual-energy CT replace perfusion CT for the functional evaluation of advanced hepatocellular carcinoma? [J]. Eur Radiol, 2018, 28(5):1977-1985.