双能CT鉴别脂肪肝和急性胰腺炎肝损伤的价值评估  

The value of dual energy CT in distinguishing fatty liver from liver injury induced by acute pancreatitis

作　　者：汤晚露 陈英敏[1] 郑泓明[2] 张南 李康 TANG Wanlu;CHEN Yingmin;ZHENG Hongming;ZHANG Nan;LI Kang(Department of Medical Imaging,Hebei General Hospital,Shijiazhuang 050051,China;Department of Nuclear Medicine,the Second Hospital of Hebei Medical University,Shijiazhuang O50000,China;Department of Nuclear Medicine,Hebei General Hospital,Shijiazhuang 050051,China;Department of Medical Imaging,Army 82nd Group Military Hospital,Baoding,Hebei Province 071000,China)

机构地区：[1]河北省人民医院医学影像科,河北石家庄050051 [2]河北医科大学第二医院核医学科,河北石家庄050000 [3]河北省人民医院核医学科,河北石家庄050051 [4]陆军第82集团军医院医学影像科,河北保定071000

出　　处：《实用放射学杂志》2023年第1期70-74,共5页Journal of Practical Radiology

摘　　要：目的 探讨双能CT(DECT)碘浓度(IC)和脂肪分数(FF)对鉴别脂肪肝与急性胰腺炎(AP)肝损伤的应用价值.方法 前瞻性选取脂肪肝或AP患者,并于1周内行腹部DECT 3期增强扫描.将符合纳入标准的患者分为脂肪肝组(n=21)和肝损伤组(n=20),另外选取肝脏正常者纳入正常组(n=21)进行对照实验.测得肝脾CT值、肝脏FF、增强扫描3期肝脏和同层面腹主动脉的IC及肝脏标准化碘浓度(NIC)值.3组间各参数差异性分析采用单因素方差分析或Kruskal-Wallis检验.通过受试者工作特征(ROC)曲线并记录曲线下面积(AUC)评价其鉴别脂肪肝及AP肝损伤的诊断效能.Spearman相关性分析用于分析肝脏FF及增强扫描3期肝脏IC与肝脏CT值之间的相关性.结果 肝损伤组动脉期肝脏IC和肝脏NIC显著增高(P<0.01),与脂肪肝组鉴别的最佳界值分别为0.275 mg/mL(敏感度75.0%,特异度95.2%,AUC 0.914)、0.028 5(敏感度85.0%,特异度95.2%,AUC 0.955).肝损伤组动脉期腹主动脉IC显著减低(P<0.01),与脂肪肝组鉴别的最佳界值为9.700 mg/mL(敏感度100.0%,特异度61.9%,AUC 0.867).而肝脏FF对于鉴别脂肪肝及AP肝损伤的价值较低(AUC 0.595),2组肝脏FF均显著高于正常组(P<0.01).3组肝脏FF与肝脏CT值均呈显著负相关(P<0.01).脂肪肝组静脉期肝脏IC与肝脏CT值呈正相关(P<0.05).结论 DECT的IC能够对脂肪肝和AP肝损伤进行鉴别诊断,动脉期肝脏IC、腹主动脉IC及肝脏NIC均具有较高鉴别诊断价值,其中动脉期肝脏NIC对两者的鉴别诊断具有明显优势.Objective To investigate the application value of iodine concentration(IC)and fat fraction(FF)using dual energy CT(DECT)in differentiating fatty liver from liver injury induced by acute pancreatitis(AP).Methods The patients with fatty liver or AP were prospectively selected and underwent triple-phase enhanced abdominal DECT scans within one week.Patients who met the inclusion criteria were divided into fatty liver group(n=21)and liver injury group(n=20).Other patients with healthy liver were included in normal group(n=21).The liver FF,CT value of liver and spleen,the IC of triple-phase enhanced scanning of liver and ipsilateral abdominal aorta,and liver normaliz iodine concentration(NIC)value were measured.One-way ANOVA or Kruskal-Wallis test were used to analyze the differences among the three groups.Receiver operating characteristic(ROC)curves were constructed and the area under the curve(AUC)was recorded to evaluate the diagnostic efficiency in diferentiating fatty liver and AP liver injury.Spearman correlation analysis was used to analyze the correlation between liver FF,liver IC in the triple-phase enhancement scan and liver CT value.Results The liver IC and liver NIC in arterial phase were higher in liver injury group(P<.O1),and the best cutoff values for distinguishing the fatty liver group was 0.275 mg/mL(AUC 0.914)with a sensitivity of 75.0%and specificity of 95.2%,and 0.0285(AUC0.955)with a sensitivity of 85.0%and specificity of 95.2%,respectively.Abdominal aortic IC inarterial phase decreased significantlyin liver injury group(P<0.O1),and the best cutoff values for distinguishing fatty liver group was 9.700 mg/mL(AUC 0.867)with a sensitivity of 100.0%and specificity of 61.9%.The value of liver FF in differentiating fatty liver from AP liver injury was low(AUC 0.595).Liver FF in both groups was significantly higher than that in normal group(P<0.O1).Liver FF was negatively correlated with liver CT value in three groups(P<0.01).There was a positive correlation between liver IC in venous phase and liver CT

关 键 词：脂肪肝 胰腺炎 计算机体层成像 

分 类 号：R575.5[医药卫生—消化系统] R576[医药卫生—内科学] R814.42[医药卫生—临床医学]