小结直肠癌肝转移:能谱CT碘定量量化增强特点  

Small colorectal cancer liver metastases: Clinical value of quantitative iodine-based material decomposition images of spectral CT

作　　者：冯琴[1,2] 李琼[2] 胡瑶[2] 王秋霞[2] 胡道予[2] 李震[2] 

机构地区：[1]湖北省广水市第一人民医院放射科,湖北省广水市432700 [2]华中科技大学同济医学院附属同济医院放射科,湖北省武汉市430030

出　　处：《世界华人消化杂志》2016年第15期2421-2428,共8页World Chinese Journal of Digestology

基　　金：国家自然科学基金资助项目;No.81271529;湖北省自然科学基金资助项目;No.2014CFB298~~

摘　　要：目的:探讨宝石能谱CT碘定量量化分析在结直肠癌肝脏小转移(<3 cm)中的临床价值.方法:所有915例肝占位患者采用宝石能谱CT行双期增强扫描,140例诊断为肝转移.在工作站上重建为最佳单能量图像,分析<3 cm的转移性肝肿瘤的病灶检出率.对其中41例结直肠癌的106个病灶进行回顾性分析,分别在CT图和碘基图上测量病灶中心、病灶边缘、正常肝组织的动脉期和静脉期的CT值和碘基值.比较分析病灶边缘、病灶中心及正常肝组织的CT值和碘基值的差异,探讨能谱CT碘定量量化分析的临床价值.结果:对于小转移瘤的病灶检出率上,最佳单能量图像优于传统C T混合能量图像(Z=3.306,P=0.001).动脉期病灶边缘部分较中心部分CT值升高37.65%,而碘值升高65.95%,差异具有显著地统计学意义(P<0.001).正常肝组织较病灶边缘部分CT值升高22.99%,而碘值升高17.96%,无明显统计学意义(P=0.225).静脉期病灶边缘部分较中心部分CT值升高32.13%,而碘值升高40.01%,具有显著地统计学差异(P<0.001).正常肝组织较病灶边缘部分C T值升高34.47%,而碘值升高40.92%,差异具有显著地统计学意义(P<0.001).结论:能谱CT的碘定量分析可能有利于提高小病灶的检出率,有助于显示结直肠癌转移性肝肿瘤强化特征,有利于提高对转移性病灶诊断的准确率.AIM：To retrospectively assess the diagnostic value of quantitative iodine-based material decomposition images of spectral CT in evaluating small liver metastases（3 cm） from colorectal cancer.METHODS：Nine hundred and fifteen consecutive patients with liver lesions were recruited,and 140 of them were confirmed to have metastatic liver cancer.All the patients underwent double-phase[arterial phase（AP）and portal venous phase（PVP）]spectral CT scans and the best single energy images were obtained at the workstation.Fifteen different sources of small metastatic liver lesions（3 cm） were analyzed,and the diagnosis rate was compared between the best single energy images and traditional images.The final study group included 41 patients with hepatic metastases from colorectal cancer.Iodine concentrations and CT values of normal liver parenchyma and metastatic lesions were derived from iodine-based materialdecomposition CT or conventional CT images.The differences in iodine concentration and CT values between the AP and PVP were recorded and the lesion-to-normal liver parenchyma differences were calculated.The paired t-test was employed to compare CT value and iodine concentrations between AP and PVP.Two readers qualitatively assessed lesion types on the basis of conventional CT characteristics.The two-sample t-test was performed to compare the iodine concentrations and CT values changes between AP and PVP in normal liver parenchyma and metastatic lesions（central and marginal）.RESULTS：Compared with traditional CT hybrid energy images,the detection rate of small metastases was much higher by spectral CT images（Wilcoxon sighed-rank test Z = 3.306,P = 0.001）.In the AP,comparing the marginal with the central parts of the lesions,the CT values increased by 37.65%while the iodine value increased by 65.95%,and there was a significant difference between them（P 〈0.001）.Comparing normal liver tissues with the marginal parts of the lesions,the CT values increased by 22.99%while the iodine value increas

关 键 词：结直肠癌 转移性肝肿瘤 能谱CT 碘基值 

分 类 号：R735.34[医药卫生—肿瘤] R730.44[医药卫生—临床医学]