能谱CT定量参数在肝细胞癌与肝血管瘤诊断中的鉴别价值

摘要/Abstract

摘要： 目的探究能谱CT定量参数在肝细胞癌(HCC)与肝血管瘤(HH)中的鉴别价值。方法收集2021年1月至2024年12月东台市中医院初步诊断为肝内占位性病变患者82例,组织病理学结果判别为HCC 42例、HH 40例。分析不同keV能量水平HCC、HH患者CT值,比较HCC、HH各期碘浓度(IC)、水浓度(WC)、病灶碘摄取比值(IUR)、有效原子数(Effective-Z)及病灶能谱曲线斜率,以及对HCC、HH的鉴别效能。结果 HCC、HH患者CT值均随keV能量水平增加而降低;HCC在40～90 keV能量水平相应CT值显著高于HH(P<0.05);HCC、HH在100～140 keV能量水平相应CT值比较差异无统计学意义(P>0.05)。HCC、HH患者动脉期和门静脉期WC差异均无统计学意义(P>0.05);而HCC患者动脉期和门静脉期IC、IUR、Effective-Z和病灶能谱曲线斜率均显著大于HH(P<0.05)。能谱CT定量参数IC、IUR、Effective-Z和病灶能谱曲线斜率等在动脉期、门静脉期鉴别HCC、HH的截断值分别为1.8(100 μg/cm³)、2.0、7.9和1.9;2.0(100 μg/cm³)、0.9、8.3和2.0。按照上述能谱定量CT参数截断值设置,动脉期、门静脉期联合诊断灵敏度、特异度、准确度、AUC及Kappa值均高于动脉期、门静脉期单独诊断。结论能谱CT定量参数(IC、IUR、Effective-Z、能谱曲线斜率)在HCC与HH鉴别诊断中具有重要价值,动脉期和门静脉期联合诊断可提高诊断的灵敏度、特异度和准确性。

关键词: 肝细胞癌, 肝血管瘤, 能谱CT定量参数

Abstract: Objective To explore the diagnostic value of quantitative parameters of energy spectrum CT in hepatocellular carcinoma (HCC) and its differentiation from hepatic hemangioma (HH). Methods Between January 2021 and December 2024, 82 patients who were initially diagnosed with intrahepatic space occupying lesions were collected in Dongtai Hospital of Traditional Chinese Medicine, of whom 42 were diagnosed with HCC and 40 with HH by histopathological results obtained by ultrasound-guided puncture or surgical resection. The CT values of the lesions in HCC and HH patients at different keV energy levels were analyzed, and the iodine concentration (IC), water concentration (WC), iodine uptake ratio (IUR) and Effective-Z atomic number of HCC and HH were compared. Results Generally speaking, the CT values of HCC and HH patients decreased with the increase of keV energy level. The CT value of HCC at 40 ~ 90 keV energy level was significantly higher than that of HH (P<0.05). There was no significant difference in CT values between HCC and HH at the energy level of 100～140 keV (P>0.05). There was no significant difference in WC between HCC and HH patients in arterial phase and portal phase (P>0.05). However, IC, IUR, Effective-Z and the slope of energy spectrum curve of HCC patients in arterial phase and portal phase were significantly higher than HH(P<0.05). The cutoff points of quantitative parameters such as IC, IUR, Effective-Z and the slope of the focus energy spectrum CT in differentiating HCC and HH in arterial phase and portal phase were 1.8(100 μg/cm³), 2.0, 7.9 and 1.9; 2.0(100 μg/cm³), 0.9, 8.3 and 2.0. The sensitivity, specificity, accuracy, area under the curve (AUC) and Kappa values of combined diagnosis of arterial phase and portal phase were significantly higher than those of single diagnosis of arterial phase and portal phase (P<0.05). Conclusion Quantitative parameters of energy spectrum CT (IC, IUR, Effective-Z and slope of energy spectrum curve) are of great value in the differential diagnosis of HCC and HH. The combined diagnosis of arterial phase and portal phase significantly improves the sensitivity, specificity and accuracy of diagnosis.

Key words: Hepatocellular carcinoma, Hepatic hemangioma, Quantitative parameters of energy spectrum CT

孙翌峰, 吴华萍, 黄晶晶. 能谱CT定量参数在肝细胞癌与肝血管瘤诊断中的鉴别价值[J]. 肝脏, 2025, 30(12): 1660-1663.

SUN Yi-feng, WU Hua-ping, HUANG Jing-jing. Diagnostic manifestations of quantitative parameters of energy spectrum CT in hepatocellular carcinoma and its differentiation from hepatic hemangioma[J]. Chinese Hepatolgy, 2025, 30(12): 1660-1663.

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