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