能谱CT在诊断鉴别肝癌与FNH中的应用价值  

Clinical value of energy spectrum CT in the differential diagnosis of liver cancer and FNH

作　　者：李飞飞 沈加林[1] 

机构地区：[1]上海交通大学医学院附属仁济医院肿瘤介入科,上海200127

出　　处：《中华普外科手术学杂志（电子版）》2017年第5期387-389,共3页Chinese Journal of Operative Procedures of General Surgery(Electronic Edition)

摘　　要：目的探究能谱CT在诊断鉴别肝癌与肝脏局灶性结节性增生(FNH)中的应用价值。方法回顾性分析2014年5月至2016年4月57例肝脏占位性病变患者的能谱CT扫描结果,其中肝癌患者35例(肝癌组),FNH患者22例(FNH组)。数据采用SPSS 18.0统计学软件进行分析处理,对比分析两组患者不同能量水平下病灶—肝组织对比噪声比(CNR)、标准化碘浓度(NIC)、病灶与肝组织碘浓度比值(LNR)等采用均数±标准差(x珋±s)表示,组间比较采用t检验。P<0.05表明差异有统计学意义。结果动脉期两组患者CNR在50 ke V最佳:肝癌组(3.6±1.2),FNH组(8.3±2.2),同能量水平下肝癌患者CNR均显著低于FNH组,P<0.05;门静脉期最佳CNR分别为:肝癌组70ke V(1.9±0.1),FNH组50ke V(1.2±0.3),其趋势与动脉期相似,除部分能量点外其CNR值均随单光子能量上升而逐渐降低。NIC动脉期:肝癌组(0.3±0.1),FNH组(0.5±0.1);静脉期:肝癌组(0.5±0.2),FNH组(0.9±0.2)。LNR动脉期:肝癌组(2.9±0.3),FNH组(6.1±0.1);静脉期:肝癌组(1.1±0.1),FNH组(1.4±0.2);结果均显示肝癌组患者显著低于FNH组患者,P<0.05。结论能谱CT在诊断鉴别肝癌与FNH中能给出较为精确的参考,显著提高诊断的准确率,具有较大的临床价值。Objective To explore the clinical value of energy spectrum CT in the differential diagnosis of liver cancer and hepatic focal nodular hyperplasia （FNH）. Methods A retrospective study was conducted in 57 patients with hepatoproliferative lesions （including 35 cases of hepatocellular carcinoma （HCC） and 22 cases of FNH） from May 2014 to April 2016.Statistical analysis were performed by using SPSS 18.0 software.Clinical data of patients, including contrast-to-noise ratio （ CNR）, normalized iodine concentration （NIC）, and lesion-to-normal ratio （LNR） , were expressed as -x ±s and compared between two groups at different energy levels by using t test.A P value 〈0.05 was considered as statistically significant difference. Results CNR value was optimal at 50 keV in HCC group （3.6 ±1.2）, significantly lower than that in FNH （8.3 ±2.2） under the same energy, P 〈0.05.The optimal CNR was 70keV, （1.9 ±0.1）in group of portal vein HCC and 50keV, （1.2 ±0.3）in group of FNH, respectively.In all patients, the trend of CNR values was similar in both portal vein and arterial phase , in which the CNR values decreased following with the increase of single photon energy , except for very few energy points .NIC values of the two groups were： arterial phase, liver cancer group（0.3 ±0.1）, FNH（0.5 ±0.1）;venous phase, liver cancer group （0.5 ±0.2）, FNH（0.9 ±0.2）.LNR values of the two groups were： arterial phase, liver cancer group （2.9 ±0.3）, FNH（6.1 ±0.1）;venous phase, liver cancer group （1.1 ±0.1）, FNH （1.4 ±0.2）.The NIC values in all patients of the HCC group were significantly lower than those of the FNH group when compared between the portal vein and arterial phase , P 〈0.05. Conclusion The energy spectrum CT is more accurate and has great clinical value in the differential diagnosis of hepatocellular carcinoma and FNH .

关 键 词：癌 肝细胞 腹腔镜检查 局限性结节状增生 诊断 

分 类 号：R730.44[医药卫生—肿瘤] R735.7[医药卫生—临床医学]