Abstract: Objective The aim of this study was to investigate computed tomography (CT) spectral imaging features of lymph node metastasis in patients with primary liver cancer (PLC). Methods 118 consecutive patients with PLC were encountered in our hospital between January 2023 and June 2025, and all received CT spectral imaging to record iodine concentration (IC), normalized iodine concentration (NIC) and slope of spectral curve (λHU) of interested lymph nodes. All patients underwent radical resection of intrahepatic tumors and adjacent enlarged lymph nodes. Results Of the 118 patients with PLC, histopathological examination found lymph node metastasis in 31 cases(26.3%),and without lymph node metastasis in 87 cases (73.7%); tumor diameter in lymph node metastasis group was(5.9±1.5)cm, significantly greater than [(5.1±1.2)cm, P<0.05],and percentage of tumor stage Ⅲ/Ⅳ was 61.3%,significantly higher than 36.8%(P<0.05) in those without lymph node metastasis group; IC, NIC and λHU at arterial phase in lymph node metastasis group were (12.9±3.1)×100 μg/cm³,(0.3±0.1)×100 μg/cm³ and (1.5±0.2),all significantly lower than [(19.3±3.8)×100 μg/cm³, (0.5±0.1)×100 μg/cm³ and (1.9±0.4),respectively, all P<0.05] in those without metastasis. Conclusion CT spectral imaging could effectively identify lymph node metastasis in time in patients with PLC, which might help determine clinical tumor stages and put forward management strategy.

Key words: Hepatoma, Lymph node metastasis, CT spectral imaging, Feature