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