CT能谱成像对肝脏局灶性病变鉴别诊断价值的初步研究  

Diagnostic value of spectral CT imaging in the differentiation of focal liver disease： a preliminary study

作　　者：贺太平[1] 于勇[1] 段海峰[1] 贾永军[1] 田骞 杨创勃[1] 

机构地区：[1]陕西中医学院附属医院CT室,陕西咸阳712000

出　　处：《实用放射学杂志》2014年第9期1506-1509,共4页Journal of Practical Radiology

摘　　要：目的 初步探讨能谱CT对常见肝脏局灶性病变的诊断和鉴别的临床应用价值.方法 51例肝脏局灶性病变患者,其中肝癌18例,单发微小转移瘤4例,异型增生结节（大再生结节）3例,单发肝脏小囊肿7例,血管瘤12例（18处病灶）,肝脓肿5例,血管平滑肌脂肪瘤2例.均采用宝石能谱成像（GSI）模式扫描,获得平扫、动脉期、门静脉期的70 keY单能量图像和碘基、水基图像,利用GSI分析功能,观察不同肝脏占位性病变各期的能谱衰减曲线特点及基物质含量,比较不同局灶性病变间各期的碘基值、水基值及能谱曲线斜率[能谱曲线斜率=（HU40keV-HU90keV）/50]的差异,分别行独立样本t检验.结果 肝脏小囊肿斜率（1.20±0.50）与血管平滑肌脂肪瘤斜率（-1.40±0.62）因具有特异的组织构成,平扫即表现出特征性能谱曲线;肝血管瘤边缘部分碘含量在动脉期[（37.3±11.8） mg/mL]、门静脉期[（39.2±16.4） mg/mL]均高于小肝癌（15.8±7.3和23.6±4.5）、肝脓肿[（13.2±4.9） mg/mL和（21.9±10.2） mg/mL]和肝微小转移瘤[（9.5±7.2） mg/mL和（25.0±8.3） mg/mL];肝癌动脉期碘含量[（15.8±7.3 mg/mL]、能谱曲线斜率（2.14±0.92）高于异型增生结节（10.8±3.2和1.15±0.53）,上述参数差异均具有统计学意义（P＜0.05）.结论 通过CT能谱成像的能谱曲线、碘基含量可以反映肝脏局灶性病变的特有组织成分和血供特点,有助于肝脏局灶性病变的鉴别诊断.Objective To investigate the clinical value of dual energy spectral CT with some quantitative parameters in diagnosis of some focal liver diseases. Methods 51 patients underwent 3-phasic （plain, enhanced arterial phase （AP） and venous phase （VP）） spectral CT of the liver. In these patients, primary carcinoma in 18, single micrometastasis in 4, atypical hyperplasia in 3, single he- patic cysts in 7, cavernous hemangioma in 12 withl8 lesions, abscess in 5 and angiomyolipoma in 2 were found. Both the monochro- matic image sets （40-140 keV） and iodine-based material decomposition images were obtained from a single CT scan. All images were analyzed with the gemstone spectral imaging （GSI） viewer to obtain spectral CT-specific parameters： Slope= （HU40 keV- Hu90 keV）/50 from the spectral HU curve and iodine content from the iodine （water）-based material decomposition images. Meas- ured values from different types of liver lesions were compared with the student t test. Results The single hepatic cyst and liver an- giomyolipoma demonstrated distinctively different spectral HU curves in the plain scan with slopes of （1.20±0.50） and （-1.40±0.62）, respectively （P〈0.05）. The peripheral iodine contents of cavernous hemangioma were （ 37. 3 ±11.8 ） mg/mL in AP and （39.2±16.4） mg/mL in VP, and both were significantly higher than those of the small primary carcinoma （15.8±7.3 and 23.6±4.5）,single micrometastasis （13. 2±4. 9） mg/mL and （21.9±10.2） mg/mL and abscess （9.5±7. 2） mg/mg and （25.0!8.3） mg/mI. （all P〈0.05）. The iodine content of the small primary carcinoma （15.8±7. 3） mg/mL in AP was also higher than that of atypical hyperplasia （10. 8±3.2） mg/mL （ P〈0.05 ）. Conclusion The parameters of the dual energy spectral CT including the slope of the spectral HU curve and iodine con- tent may reflect the characteristics of the blood supply and tissue composition, and are helpful for the differential diagnosis of the fo- cal diseas

关 键 词：肝脏 计算机体层成像 能谱成像 碘基图像 

分 类 号：R575[医药卫生—消化系统] R814.42[医药卫生—内科学]