Abstract: Objective To investigate the application value of computed tomography (CT) quantitative parameters combined with serum carbohydrate antigen 199 (CA199), carcinoembryonic antigen (CEA), and vascular endothelial growth factor C (VEGF-C) levels in the differentiating diagnosis of focal nodular hyperplasia (FNH) and hepatocellular carcinoma (HCC). Methods A retrospective study was conducted on the collected data of 88 cases treated at Rugao People′s Hospital between January 2020 and December 2024, including 40 HCC patients and 48 FNH patients. All patients underwent both CT plain and enhanced scans, and their serum samples were collected for detecting CA199, CEA, and VEGF-C levels. The differences in CT quantitative parameters [hepatic blood volume (BV), hepatic blood flow (HBF), hepatic arterial perfusion (HAP), portal venous perfusion (PVP), total liver perfusion (TLP), hepatic arterial perfusion index (HPI), mean transit time (mTT)] and serum markers between the two groups were analyzed. The sensitivity, specificity, and the area under the curve (AUC) of each indicator were evaluated by receiver operating characteristic (ROC) curve analysis. Results In terms of CT quantitative parameters, the HCC group showed higher BV (32.11±10.06 mL/100 mL), HBF (203.09±61.10 mL/100 mL·min), and PVP (22.10±6.02 mL/100 mL·min) compared to those of the FNH group (BV: 22.72±6.13 mL/100 mL, HBF: 126.01±33.13 mL/100 mL·min, PVP: 10.16±3.31 mL/100 mL·min), whereas the HCC group had lower HAP (43.80±11.22 mL/100 mL·min), HPI (66.02±10.16%), and mTT (5.79±1.70 s) compared to those of the FNH group (HAP: 59.54±16.10 mL/100mL·min, HPI: 84.74±8.83%, mTT: 8.12±2.10 s) (P<0.05). In terms of serum biomarkers, the HCC group had higher CA199 (126. 20±28.46 U/mL), CEA (58.41±23.84 ng/mL), and VEGF-C (336.41±101.93 pg/mL) levels than the FNH group (CA199: 30.21±6.08 U/ mL, CEA: 3.42±1.27 ng/mL, VEGF-C: 88.76±29.06 pg/mL) (P<0.05). The ROC curve analysis results showed that in the differential diagnosis of FNH and HCC, the AUCs of CT quantitative parameters combined with serum markers were as follows: BV 0.776, HBF 0.833, PVP 0.728, HAP 0.890, HPI 0.881, and mTT 0.780. The AUCs of serum markers CA199, CEA, and VEGF-C were 0.934, 0.933, and 0.936, respectively. When combined with all these serum markers, the AUC was 0.974. Conclusion The combination of CT quantitative parameters and serum markers CA199, CEA, and VEGF-C significantly improves the sensitivity and specificity for diagnosing of focal nodular hyperplasia and hepatocellular carcinoma, thus offering high clinical value.

Key words: CT quantitative parameters, Carbohydrate antigen 199, Carcinoembryonic antigen, Vascular endothelial growth factor C, Hepatocellular carcinoma, Focal nodular hyperplasia