能谱CT增强扫描参数鉴别诊断肝血管瘤与肝细胞癌价值研究*

doi:10.3969/j.issn.1672-5069.2024.02.029

摘要/Abstract

摘要： 目的研究能谱CT增强扫描参数鉴别诊断肝血管瘤(HH)与肝细胞癌(HCC)的价值。方法 2021年1月～2022年12月我院收治的原发性肝脏占位性病变患者78例, 均接受肝叶切除术治疗, 术后组织病理学检查显示HH患者46例和HCC患者32例。术前, 均接受能谱CT平扫和增强扫描, 测量并计算不同单能量CT值、碘(水)浓度(IC)、水(碘)浓度(WC)、病灶碘摄取比值(IUR)和病灶能谱曲线斜率。以组织病理学检查为金标准, 采用kappa系数检验, 分析动脉期参数和门脉期参数单独或联合诊断HCC的价值。结果 HCC组病灶动脉期50～90 keV 5个单能量水平的CT值分别为(152.3±48.5)、(117.5±41.6)、(95.2±34.3)、(83.1±29.8)和(70.5±25.3), 均显著高于HH组【分别为(81.4±29.6)、(66.5±21.4)、(58.9±16.5)、(54.6±15.2)和(48.3±13.5), P＜0.05】, 门脉期5个单能量水平的CT值分别为(177.5±51.2)、(130.9±35.9)、(106.8±22.8)、(85.9±20.3)和(74.6±19.8), 均显著高于HH组【分别为(130.9±46.3)、(105.8±31.7)、(84.6±22.9)、(73.4±20.5)和(64.2±15.9), P＜0.05】; HCC组动脉期IC、IUR和能谱曲线斜率分别为(2.0±0.6)、(2.7±0.5)和(2.8±0.9), 显著高于HH组【分别为(0.8±0.2)、(1.3±0.4)和(1.0±0.3), P＜0.05】, 门脉期IC、IUR和能谱曲线斜率分别为(2.6±0.8)、(0.9±0.3)和(3.5±1.1), 显著高于HH组【分别为(1.7±0.5)、(0.6±0.2)和(2.5±0.8), P＜0.05】;动脉期与门脉期参数联合诊断HCC的敏感度、特异度和准确率分别为90.6%、89.1%和89.7%, 与组织病理学诊断的一致性(Kappa值=0.790), 显著优于动脉期参数或门脉期参数诊断(P＜0.05)。结论应用能谱CT增强扫描参数可以帮助诊断HCC而与HH作鉴别, 值得进一步研究和验证。

关键词: 肝细胞癌, 肝血管瘤, 能谱CT成像, 诊断

Abstract: Objective The aim of this study was to investigate the differentiation of hepatocellular carcinoma (HCC) from hepatic hemangioma (HH) by using contrast-enhanced energy spectrum CT parameters. Methods 78 patients with primary intrahepatic space-occupying lesions were encountered in our hospital between January 2021 and December 2022, and all patients underwent hepatectomy. The postoperative histopathological examination revealed 46 patients with HH and 32 patients with HCC. At presentation, all patients received plain and enhanced energy spectrum CT scanning, and the iodine (water) concentration (IC), water (iodine) concentration (WC), iodine uptake ratio (IUR) of lesions, and slope of energy spectrum curve of lesions at 50, 60, 70, 80 and 90 keV single-energy CT values were recorded. The kappa coefficient test was applied to analyze the diagnostic performance of CT parameters. Results The foci CT values at 5 single energy levels of arterial phase in patients with HCC were (152.3±48.5), (117.5±41.6), (95.2±34.3), (83.1±29.8) and (70.5±25.3), all significantly higher than , and the foci CT values at 5 single energy levels of portal phase were (177.5±51.2), (130.9±35.9), (106.8±22.8), (85.9±20.3) and (74.6±19.8), all significantly higher than in HH foci; the arterial IC, IUR and energy spectrum curve in patients with HCC were (2.0±0.6), (2.7±0.5) and (2.8±0.9), significantly higher than , and the portal IC, IUR and energy spectrum curve were (2.6±0.8), (0.9±0.3) and (3.5±1.1), significantly higher than in HH foci; the sensitivity, specificity and accuracy were 90.6%, 89.1% and 89.7% when the arterial and portal CT parameter were combined for the prediction of HCC, which was much consistent with histopathological examination (Kappa=0.790). Conclusion The energy spectrum CT enhanced scanning might help differentiate the HCC from HH, and needs further clinical investigation.

Key words: Hepatoma, Hepatic hemangioma, Energy spectrum CT imaging, Diagnosis

崔甜甜, 张海波, 陈莉莉. 能谱CT增强扫描参数鉴别诊断肝血管瘤与肝细胞癌价值研究^*[J]. 实用肝脏病杂志, 2024, 27(2): 275-278.

Cui Tiantian, Zhang Haibo, Chen Lili. Differentiation of hepatocellular carcinoma from hepatic hemangioma by using contrast-enhanced energy spectrum CT parameters[J]. Journal of Practical Hepatology, 2024, 27(2): 275-278.

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能谱CT增强扫描参数鉴别诊断肝血管瘤与肝细胞癌价值研究^*

Differentiation of hepatocellular carcinoma from hepatic hemangioma by using contrast-enhanced energy spectrum CT parameters

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