GSI多参数对肝脏良恶性肿瘤评估的临床意义  

Clinical significance of GSI multiparameters in the assessment of benign and malignant liver tumours

作　　者：褚云 张军[2] 赵红星[1] CHU Yun;ZHANG Jun;ZHAO Hongxing(Department of Radiology,Huzhou First People's Hospital,Huzhou 313000,Zhejiang,China;Department of Radiology,Junge Hospital of the 72nd Group of the Chinese People's Liberation Army,Huzhou 313000,Zhejiang,China)

机构地区：[1]湖州市第一人民医院放射科,浙江湖州313000 [2]中国人民解放军陆军第七十二集团军医院放射科,浙江湖州313000

出　　处：《中国现代医生》2023年第8期15-20,共6页China Modern Doctor

基　　金：浙江省医药卫生科技计划项目(2018KY774)。

摘　　要：目的探讨宝石能谱CT成像(gemstone spectral imaging,GSI)多参数在肝脏良恶性肿瘤中的变化及对手术可切除性的评估价值。方法选取2018年5月至2021年8月湖州市第一人民医院收治的89例肝脏恶性肿瘤患者作为恶性组,同期的89例肝脏良性肿瘤患者作为良性组,进行回顾性分析。两组均行GSI检查,比较两组GSI参数[能谱曲线斜率(slope of spectral Hu curve,s-SHC)、动脉期标准碘浓度值(normalized iodine concentration,NIC)、门静脉期NIC、碘浓度差值(iodine concentration difference,ICD)、肝动脉碘分数(arterial iodine fraction,AIF)],分析GSI参数对肝脏肿瘤癌变风险的影响及对肝脏良恶性肿瘤的诊断价值。将恶性组根据临床评估情况分为可切除患者(n=28)与不可切除患者(n=61),对比两组患者的GSI参数水平,分析GSI参数对肝癌手术可切除性的评估价值。结果恶性组s-SHC、动脉期NIC、门静脉期NIC、AIF均高于良性组,ICD低于良性组,差异均有统计学意义(P<0.05);s-SHC、动脉期NIC、门静脉期NIC、AIF高水平患者的癌变风险分别是低水平患者的3.68倍、2.71倍、5.85倍、3.68倍,ICD低水平患者的癌变风险是高水平患者的16.80倍(P<0.05);受试者操作特征曲线显示,GSI多参数联合诊断肝脏恶性肿瘤的曲线下面积为0.933(95%置信区间:0.886~0.965),大于各参数单独诊断(P<0.05);恶性组不可切除患者s-SHC、动脉期NIC、门静脉期NIC、AIF高于可切除患者,ICD低于可切除患者,差异均有统计学意义(P<0.05);Spearman相关性分析显示,s-SHC、动脉期NIC、门静脉期NIC、AIF与肝癌手术可切除性均呈正相关(P<0.05),ICD与肝癌手术可切除性呈负相关(P<0.05);GSI多参数联合评估手术可切除性的曲线下面积为0.905(95%置信区间:0.824~0.957),大于各参数单独评估(P<0.05)。结论肝脏恶性肿瘤中s-SHC、动脉期NIC、门静脉期NIC、AIF较高,ICD较低,各GSI参数与良性肿瘤存在明显差异,多参数联合检Objective To investigate the changes of multi-parameters of gemstone spectral CT imaging(GSI)in benign and malignant liver tumors and the evaluation value of surgical resectability.Methods A total of 89 patients with malignant liver tumors admitted to the First People's Hospital of Huzhou from May 2018 to August 2021 were selected as the malignant group,and 89 patients with benign liver tumors during the same period were selected as the benign group for retrospective analysis.GSI examination was performed for both groups,and the GSI parameters[slope of energy spectrum curve(s-SHC),standard iodine concentration in arterial phase(NIC),NIC in portal venous phase,iodine concentration difference(ICD),and hepatic arterial iodine fraction(AIF)]were compared between the two groups,analyzed the effect of GSI parameters on the risk of liver tumor carcinogenesis and the diagnostic value of benign and malignant liver tumors,and divided the malignant group into resectable patients and unresectable patients according to clinical evaluation,compared the GSI parameter levels of two groups,and analyzed the effect of GSI parameters on the evaluation of surgical resectability of liver cancer.Results The malignant group had higher s-SHC,arterial phase NIC,portal venous phase NIC and AIF than those in the benign group,and lower ICD than that in the benign group,and the differences were statistically significant(P<0.05).The cancer risk of patients with high levels of s-SHC,arterial NIC,portal venous NIC,and AIF was 3.68 times,2.71 times,5.85 times,and 3.68 times than those of patients with low levels,and the cancer risk of patients with low ICD levels was 16.80 times that of patients with high levels(P<0.05).The receiver operating characteristic curve showed that area under the curve of GSI multi-parameter combined diagnosis of liver malignant tumor was 0.933 (95% confidence interval: 0.886-0.965), which was greater than that of each parameter alone (P<0.05);In the malignant group, the s-SHC, arterial phase NIC, portal venous phase NI

关 键 词：宝石能谱CT成像 肝脏 肿瘤 可切除性 肿瘤癌变风险 

分 类 号：R730.55[医药卫生—肿瘤]