CT能谱成像在肝细胞肝癌与肝血管瘤鉴别诊断中的价值  

Study of CT spectral imaging in the differentiation of hepatocellular carcinoma and hepatic hemangioma

作　　者：李卫侠[1] 林晓珠[2] 张静 陈克敏 柴维敏[1] 严福华[1] LI Wei-xia;LIN Xiao-zhu;ZHANG Jing(Department of Radiology,Ruijin Hospital,Shanghai Jiaotong University School of Medicine,Shanghai 200025,China)

机构地区：[1]上海交通大学医学院附属瑞金医院放射科,上海200025 [2]上海交通大学医学院附属瑞金医院核医学科,上海200025 [3]上海交通大学医学院附属瑞金医院北院放射科,上海201801

出　　处：《放射学实践》2018年第9期882-887,共6页Radiologic Practice

基　　金：国家自然科学基金青年项目(NSFC编号为81401406)

摘　　要：目的:分析CT能谱成像相关参数在肝细胞肝癌(HCC)与肝血管瘤(HH)中的差异,探讨CT能谱成像在HCC与HH鉴别诊断中的价值。方法:31例HCC患者和13例HH患者(17个病灶)均行能谱CT扫描,获得动脉期和门静脉期的能谱系列图像。分别测量病灶在动脉期和门静脉期从40~140keV每隔10keV的单能量平均CT值、标准差(SD,即病灶的不均质性)、碘浓度(ICpp)及水浓度值(WCap,WCpp),并计算病灶能谱曲线的斜率(Sap,Spp)、动脉期标准化碘浓度(NIC)、病灶碘摄取比值(IURpp)及碘浓度比(ICR)。结果:动脉期40~140keV能量段、门脉期40~90keV能量段HH组的各单能量平均CT值均显著低于HCC,差异均有统计学意义(P值均<0.05),门脉期40~100keV能量段HH与HCC间的SD值差异有统计学差异,且两者间IURap、IURpp、Sap、Spp、NICap、ICap、ICpp及ICR的差异均具有统计学意义(P值均<0.05)。鉴别HCC与HH的最佳能谱定量参数为动脉期50keV的平均CT值,阈值为106.87HU,ROC曲线下面积为0.898,鉴别诊断两者的敏感度和特异度分别为90.3%和82.4%;其次为ICR,阈值为0.61,ROC曲线下面积为0.890,鉴别诊断两者的敏感度和特异度分别为87.1%和82.4%。结论:CT能谱成像多参数分析有助于HCC与HH的鉴别诊断,尤其是动脉期50keV的平均CT值和ICR在两者的鉴别诊断中具有较高的应用价值。Objective:To study the value of CT spectral imaging in the differentiation of hepatocellular carcinoma(HCC)and hepatic hemangioma(HH)by analyzing the related difference of parameters.Methods:A total of 44 patients with space occupying lesion of liver including HCC(n=31)and HH(n=14)were recruited.All underwent spectral CT scanning to obtain a series of spectral images of arterial phase(AP)and portal vein phase(PP).From 40~140keV in AP and PP,the mean CT values of single energy,Iodine concentration(IC pp),water concentration(WC ap,WC pp)of the lesions at every 10keV were measured,and the slope of spectral curves(S ap,S pp)standardized Iodine concentration in arterial phase(NIC),lesion Iodine uptake ratio(IUR pp)and Iodine concentration ratio(ICR)were calculated.Results:The mean CT values of HH group from 40~140kev in AP and from 40~90kev in PP were significantly lower than that of HCC group,with statistic difference(all P<0.05).There were statistically significant differences in SD at energy levels from 40 to 100keV during PP between HCC and HH group.There were significant differences in IUR ap,IUR pp,S ap,S pp,NIC ap,IC ap,IC pp and ICR between HCC and HH group(all P<0.05).The best spectral parameter in differentiating HCC and HH was the mean CT values in AP on 50keV,with the cutoff value as 106.87HU,area under the ROC curves(0.898),the sensitivity and specificity was 90.3%and 82.4%respectively.Then,the next was ICR,with the cutoff value as 0.61,area under ROC 0.890,and the sensitivity and specificity in differential diagnosis was 87.1%and 82.4%respectively.Conclusion:Multi-parameter analysis of CT spectral imaging,especially the mean CT value at 50keV in AP and ICR,could be helpful in the differential diagnosis of HCC from HH.

关 键 词：肝肿瘤 肝细胞肝癌 血管瘤 体层摄影术 X线计算机 CT能谱成像 能谱曲线 

分 类 号：R735.7[医药卫生—肿瘤] R814.42[医药卫生—临床医学]