光谱CT鉴别动脉期高强化肝转移瘤与肝细胞癌的价值  

Value of spectral CT in differentiating arterial phase hyperenhancement hepatic metastases from hepatocellular carcinoma

作　　者：黄冬冬 梁嘉辉 刘猛 谢传淼[1] HUANG Dongdong;LIANG Jiahui;LIU Meng;XIE Chuanmiao(Department of Radiology,State Key Laboratory of Oncology in South China,Guangdong Provincial Clinical Research for Cancer,Sun Yat-sen University Cancer,Guangdong 510060,China)

机构地区：[1]中山大学肿瘤防治中心影像科、华南恶性肿瘤防治全国重点实验室、广东省恶性肿瘤临床医学研究中心,广东广州510060 [2]中山大学肿瘤防治中心核医学科、华南恶性肿瘤防治全国重点实验室、广东省恶性肿瘤临床医学研究中心,广东广州510060

出　　处：《影像诊断与介入放射学》2024年第3期163-169,共7页Diagnostic Imaging & Interventional Radiology

基　　金：2023年国家重点研发计划“生物与信息融合(BT与IT融合)”重点专项项目(2023YFF1204303)。

摘　　要：目的探讨双层探测器光谱CT在鉴别动脉期高强化肝转移瘤(APHEHM)和肝细胞癌(HCC)中的价值。方法回顾性收集2021年12月—2023年6月临床或病理确诊的53例动脉期高强化肝脏恶性肿瘤者,将其分为APHEHM组(n=23)和HCC组(n=30),计算光谱参数,包括标准化虚拟单能量图像(VMI)、肿瘤/肝实质的标准化无水碘(NINW-L)、标准化碘密度(NID-L)以及标准化有效原子序数(NZeff-L),并计算肿瘤/腹主动脉的标准化有效原子序数(NZeff-A)。通过受试者工作特征(ROC)曲线和Cohen|d|分析其鉴别效能和临床意义。结果动脉期中APHEHM在以肝实质为对照的40 keV、50 keV、60 keV下的标准化VMI CT值[NCT-L(40keV),NCT-L(50keV),NCT-L(60keV)]、NINW-L、NID-L、NZeff-L以及NZeff-A均小于HCC,差异均具有统计学意义(P<0.05)。动脉期下的NINW-L曲线下面积(AUC)最大,为0.752,以2.985为阈值鉴别两者最佳,敏感度和特异度分别为63.3%、87.0%。结论动脉期下的NCT-L(40keV)、NINW-L和NID-L可作为临床上鉴别APHEHM和HCC的重要指标。Objective To investigate the value of dual-layer detector spectral CT in the differential diagnosis of arterial phase hyperenhancement(APHE)liver metastases and hepatocellular carcinoma(HCC).Methods Fifty-three patients with clinical or pathologically confirmed APHE liver metastasis(23)and HCC(30)from December 2021 to June 2023 were included in this retrospective study.The spectral CT parameters on the standardized virtual monoenergetic image(VMI)including tumor/liver standardized iodine no water(NINW-Ltumor to liver),tumor/liver standardized iodine density(NID-L),tumor/liver standardized Z-effective(NZeff-L),and tumor/abdominal aorta NZeff(NZeff-Atumor to aorta)were calculated.The receiver operating characteristic(ROC)curve and Cohen d were used to analyze the diagnostic effectiveness of these parameters.Results In the arterial phase,the CT values of liver on 40 keV(NCT-L40keV),50 keV(NCT-L50keV),and 60 keV(NCT-L60keV)VMI,NINW-L,NID-L,NZeff-L and NZeff-A of APHE liver metastases were significantly less than that of HCC(P<0.05).The area under the ROC curve of NINW-L in the arterial phase was the highest at 0.752.The 0.298 threshold value of NINW-L in the arterial phase had the best differentiation between liver metastases and HCC with 63.3%sensitivity and 87.0%specificity.Conclusion NCT-L40keV,NINW-L and NID-L in the arterial phase are valuable for differentiating APHE liver metastasis from HCC.

关 键 词：肝细胞癌 动脉期高强化 转移性肝癌 体层摄影术 X线计算机 光谱参数 

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