双源CT肝动脉三期扫描和增强灌注扫描诊断肝硬化背景下小原发性肝癌价值研究  

Diagnosis of small primary liver cancer under the background of liver cirrhosis by dual-source CT hepatic artery three-phase scanning and enhanced perfusion scanning

作　　者：林永祝 史红媛 穆西虎 Lin Yongzhu;Shi Hongyuan;Mu Xihu(Department of Radiology,First Affiliated Hospital,Nanjing Medical University,Nanjing 210003,Jiangsu Province,China)

机构地区：[1]南京医科大学第一附属医院放射科,南京市210003

出　　处：《实用肝脏病杂志》2023年第3期412-415,共4页Journal of Practical Hepatology

基　　金：江苏省青年医学重点人才项目(编号:QNRC2016855)。

摘　　要：目的 探讨双源CT肝动脉三期扫描和增强灌注扫描诊断肝硬化背景下小原发性肝癌(sPLC)的价值。方法 2019年2月~2021年9月我院收治的130例肝内有结节的肝硬化患者,行双源CT肝动脉三期扫描和增强灌注扫描,记录病灶血容量(BV)、肝动脉分数(HAF)、血流量(BF)和肝动脉灌注量(HAP)。取外科手术组织或肝穿刺活检组织行病理学检查。绘制受试者工作特征曲线(ROC),以曲线下面积(AUC)分析双源CT肝动脉三期扫描和增强灌注扫描参数诊断sPLC的价值。结果 在130例存在肝内结节的肝硬化患者中,发现sPLC者85例;病灶直径为0.8~3.0 cm,平均为(1.85±0.37)cm;动脉晚期和动脉中期扫描病灶CT绝对值分别为(69.8±15.9)Hu和(65.8±15.2)Hu,显著高于动脉早期扫描【(48.4±10.3)Hu,P<0.05】,病灶强化值分别为(24.9±5.1)Hu和(23.6±4.9)Hu,显著高于动脉早期扫描【(15.2±3.9)Hu,P<0.05】,病灶检查率分别为91.3%和88.0%,显著高于动脉早期扫描的40.2%(P<0.05);sPLC病灶BV、HAF、BF和HAP分别为(17.4±5.1)mL/100 g、(0.21±0.02)、(183.8±15.4)mL/(min·100 g)和(38.4±4.9)mL/(min·100 g),显著低于45例良性结节【分别为(19.4±6.9)mL/100 g、(0.26±0.03)、(201.9±18.3)mL/(min·100 g)和(52.3±5.6)mL/(min·100 g),P<0.05】;双源CT肝动脉三期扫描与增强灌注扫描诊断肝硬化背景下sPLC的AUC值(95%CI)分别为0.842(0.768~0.899)和0.888(0.821~0.936),其灵敏度分别为83.5%和90.6%,特异度分别为84.8%和87.0%(Z值=1.012,P值=0.312)。结论 应用双源CT肝动脉三期扫描有助于发现肝硬化背景下sPLC病灶,而增强灌注扫描可有效评估病灶性质,对确定诊断有裨益。Objective The aim of this study was to investigate the diagnostic performance of dual-source CT hepatic artery three-phase scanning and enhanced perfusion scanning in finding small primary liver cancer(sPLC)under the background of liver cirrhosis.Methods 130 patients with liver cirrhosis and intrahepaticnodules were encountered in our hospital between February 2019 and September 2021,and all underwent dual-source CT hepatic artery three-phase scanning and enhanced perfusion scanning.The blood volume(BV),hepatic artery fraction(HAF),blood flow(BF)and hepatic arterial perfusion(HAP)were recorded.The histopathological diagnosis was made by post-operational or needle aspiration biopsy specimen.The receiver operating characteristic curve(ROC)was drawn,and the area under the curve(AUC)was applied to analyze the diagnostic performance of dual-source CT hepatic artery three-phase scan and enhanced perfusion scan for sPLC under liver cirrhosis background.Results 85 patients with sPLC was proven by pathological examination out of the 130 patients with liver cirrhosis in our series,with the average diameter of(1.85±0.37)cm at range of 0.8-3.0 cm;the absolute CT value of malignant lesion at late arterial and mid-arterial stage were(69.8±15.9)Hu and(65.8±15.2)Hu,both significantly higher than[(48.4±10.3)Hu,P<0.05],the enhancement CT value were(24.9±5.1)Hu and(23.6±4.9)Hu,both significantly higher than[(15.2±3.9)Hu,P<0.05],and the detection rates were 91.3%and 88.0%,both significantly higher than 40.2%(P<0.05)at early arterial stage;the BV,HAF,BF and HAP in sPLC lesions were(17.4±5.1)mL/100 g,(0.21±0.02),(183.8±15.4)mL/(min·100 g)and(38.4±4.9)mL/(min·100 g),all significantly lower than[(19.4±6.9)mL/100 g,(0.26±0.03),(201.9±18.3)mL/(min·100 g)and(52.3±5.6)mL/(min·100 g),respectively,P<0.05]in benign lesions in 45 patients;the AUCs were(95%CI):0.842(0.768-0.899)and 0.888(0.821-0.936)by dual-source CT hepatic artery three-phase scanning and enhanced perfusion scanning in diagnosingsPLC under the background of l

关 键 词：原发性肝癌 双源CT肝动脉三期扫描 增强灌注扫描 肝硬化 诊断 

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