能谱CT成像碘物质定量分析在肝细胞癌鉴别诊断中的应用价值

摘要/Abstract

摘要： 目的: 研究能谱CT成像碘物质定量分析在肝细胞癌(HCC)与富血供肝脏转移瘤(HVHM)鉴别诊断中的应用价值。方法: 纳入2015年8月至2019年8月于我院收治的141例肝脏恶性肿瘤患者为对象,按照病理类型分为A组(HVHM,60例)和B组(HCC,81例),均接受能谱CT扫描。比较两组动脉期、门静脉期标准化碘(水)浓度值、病灶与正常肝组织碘浓度比值、水(碘)浓度、能谱曲线斜率及病灶动静脉期碘浓度差,并分析上述能谱定量参数对HCC与HVHM的鉴别诊断效能。结果: A组门静脉期标准化碘(水)浓度值、病灶与正常肝组织碘浓度比值、能谱曲线斜率显著高于B组(P<0.05)。门静脉期标准化碘(水)浓度值、门静脉期病灶与正常肝组织碘浓度比值、门静脉期能谱曲线斜率对HCC和HVHM的鉴别诊断效能均较好,曲线下面积分别为0.746、0.778、0.802。结论: HCC与HVHM门静脉期能谱CT特征性物质含量及能谱曲线差异明显,为两者鉴别诊断提供了重要参考依据。

关键词: 能谱CT成像, 肝细胞癌, 富血供肝脏转移瘤

Abstract: Objective To study the application value of quantitative assessment of iodine concentration by computed tomography (CT) energy spectrum imaging in the differential diagnosis of hepatocellular carcinoma (HCC) and hypervascular hepatic metastases (HVHM). Methods A total of 141 patients with malignant liver tumors admitted to our hospital from August 2015 to August 2019 were enrolled. They were divided into group A (HVHM, 60 cases) and group B (HCC, 81 cases) according to pathological types. All patients underwent spectral CT scanning. The normalized iodine (water) concentration in arterial phase and portal phase, the ratio of iodine concentration between lesions and normal liver tissue, water (iodine) concentration, slope of energy spectral curve and iodine concentration difference between venous and arterial phase were compared between the 2 groups. And the efficacy of the quantitative parameters above in differential diagnosis of HCC and HVHM was analyzed. Results The values of normalized iodine (water) concentration, the ratio of iodine concentration between lesions and normal liver tissue, and the slope of energy spectral curve in group A were significantly higher than those in group B (P<0.05). The normalized iodine (water) concentration value in the portal phase, the ratio of iodine concentration between the lesions and normal liver tissue in the portal phase, and the slope of the energy spectral curve in the portal phase were all effective in the differential diagnosis of HCC and HVHM, and the area under the curve was 0.746, 0.778 and 0.802, respectively. Conclusion There are significant differences in quantitative parameters of spectral CT imaging, which provides an important reference for the differential diagnosis of HCC and HVHM.

Key words: Computed tomography energy spectrum imaging, Hepatocellular carcinoma, Hypervascular liver metastases

甘郑宁, 马梦雪, 严小娟. 能谱CT成像碘物质定量分析在肝细胞癌鉴别诊断中的应用价值[J]. 肝脏, 2020, 25(7): 695-698.

GAN Zhen-ning, MA Meng-xue, YAN Xiao-juan. Application value of quantitative assessment of iodine concentration by CT energy spectral imaging in differential diagnosis of hepatacellular carcinoma[J]. Chinese Hepatolgy, 2020, 25(7): 695-698.

参考文献

[1] 周玮, 王凤山. 胆管内生长型肝细胞癌的临床特征分析. 中华普通外科杂志, 2015, 30:242-243.
[2] 赵荣荣, 邓永东, 袁宏, 等. 236例原发性肝癌患者流行病学及临床特点分析. 临床肝胆病杂志, 2016, 32:1538-1542.
[3] Karahan OI, Yikilmaz A, Isin S, et al. Characterization of hepatocellular carcinomas with triphasic CT and correlation with histopathologic findings. Acta Radiol, 2015, 44:566-571.
[4] 游幼匡, 段少银. 甲胎蛋白阴性肝细胞癌的CT特征. 中国医学影像学杂志, 2016, 24:360-363.
[5] Li C, Shi C, Zhang H, et al. Computer-aided diagnosis for preoperative invasion depth of gastric cancer with dual-energy spectral CT imaging. Acad Radiol, 2015, 22:149-157.
[6] 中华人民共和国卫生部. 原发性肝癌诊疗规范(2011年版). 临床肝胆病杂志, 2011, 20:929-946.
[7] Schmid-Tannwald C , Thomas S , Ivancevic MK , et al. Diffusion-weighted MRI of metastatic liver lesions: is there a difference between hypervascular and hypovascular metastases?Acta Radiol, 2014, 55:515-523.
[8] Lin YY, Chen CM, Huang YH, et al. Liver metastasis from hepatoid adenocarcinoma of the stomach mimicking hepatocellular carcinoma: dynamic computed tomography findings. World J Gastroenterol, 2015, 21:13524-13531.
[9] 黄仁军, 李勇刚. 能谱CT的临床应用与研究进展. 放射学实践, 2015, 30:81-83.
[10] 贾永军, 贺太平. 宝石能谱CT临床应用及研究进展. 实用放射学杂志, 2016, 32:799-801.
[11] 邢古生, 王爽, 李忱瑞, 等. 宝石能谱CT成像碘含量测定法在肝细胞癌患者经动脉化疗栓塞术后随访中的应用. 中华肿瘤杂志, 2015, 37:208-212.
[12] 赵慧萍, 吕培杰, 张丽英,等. 基于能谱CT智能匹配技术的半剂量能谱CT联合自适应统计迭代重建技术在肥胖患者上腹部扫描中的应用价值. 中华医学杂志, 2017, 97:3686.
[13] 吕培杰, 王明月, 刘杰,等. 能谱CT单能量成像联合图像融合技术对小肝细胞癌图像质量的影响. 中华放射学杂志, 2015, 49:168-172.
[14] 陈雅菲, 雷雷. CT征象和肝细胞癌患者临床病理特征与血管内皮生长因子的相关性研究. 中国CT和MRI杂志, 2018, 16:94-96.
[15] Matos AP, Altun E, Ramalho M, et al. An overview of imaging techniques for liver metastases management. Expert Rev Gastroenterol Hepatol, 2015, 9:1561-1576.