双层探测器光谱CT多参数成像术前预测粗梁实体型肝细胞癌的价值  

Predictive value of dual-layer spectral detector CT multi-parameter imaging for macrotrabecular-massive hepatocellular carcinoma(MTM-HCC)

作　　者：于永泉 梁逍雪 侯国旗 陈杏彪 侯红军 张洪胜 YU Yongquan;LIANG Xiaoxue;HOU Guoqi;CHEN Xingbiao;HOU Hongjun;ZHANG Hongsheng(Department of Imaging,Weihai Central Hospital Affiliated to Qingdao University,Weihai 264400,China;Weihai Key Laboratory of Interventional Minimally Invasive Technology Based on Radiology,Weihai 264400,China;Department of Pathology,Weihai Central Hospital Affiliated to Qingdao University,Weihai 264400,China;Clinical Science,Philips Healthcare,Shanghai 200070,China)

机构地区：[1]青岛大学附属威海市中心医院影像科,山东威海264400 [2]威海市基于影像科学的介入微创技术重点实验室,山东威海264400 [3]青岛大学附属威海市中心医院病理科,山东威海264400 [4]飞利浦医疗临床科研部,上海200070

出　　处：《中国中西医结合影像学杂志》2025年第2期145-149,154,共6页Chinese Imaging Journal of Integrated Traditional and Western Medicine

基　　金：山东省医药卫生科技发展计划项目(202209010213)。

摘　　要：目的:探讨双层探测器光谱CT多参数成像预测粗梁实体型肝细胞癌(MTM-HCC)的价值。方法:回顾性收集经手术病理证实的肝细胞癌患者52例,根据术后病理结果分为MTM-HCC组18例和非MTM-HCC组34例。用40 keV单能量图像对病灶的定性影像学特征进行分析,包括肿瘤大小、非边缘动脉期高强化、非边缘门静脉期廓清、不光整的肿瘤边缘、包膜完整、瘤内坏死、瘤内血管、动脉期瘤内低强化区;测量并计算病灶的门静脉期、平衡期的碘浓度(IC)、标准化碘浓度(NIC)、有效原子序数(Z_(eff))和能谱曲线斜率(λ)等定量指标。2组定量资料比较行独立样本t检验,定性资料比较行χ^(2)检验。采用多因素logistic回归分析评估MTM-HCC的独立危险因素,并构建联合模型。采用ROC曲线评估各独立危险因素和联合模型的诊断效能。结果:2组血清甲胎蛋白水平、动脉期瘤内低强化区,以及门静脉期和平衡期IC、Z_(eff)、λ差异均有统计学意义(均P<0.05)。多因素logistic回归分析显示,动脉期瘤内低强化区和平衡期IC是评估MTM-HCC的独立危险因素(OR=5.494,21.071;均P<0.05)。动脉期瘤内低强化区、平衡期IC和两者构建的联合模型预测MTM-HCC的AUC分别为0.714、0.761、0.829。结论:光谱CT的动脉期瘤内低强化区和平衡期IC对预测MTM-HCC具有巨大潜在价值;两者构建的联合模型诊断效能较好。Objective:To investigate the predictive value of dual-layer spectral detector CT(DLCT)multi-parameter imaging for macrotrabecular-massive hepatocellular carcinoma(MTM-HCC).Methods:This retrospective study included 52 HCC patients,classified into MTM-HCC group(18 cases)and non-MTM-HCC group(34 cases)based on postoperative histopathology.Qualitative imaging features were evaluated on 40 keV virtual monoenergetic images(VMI),including tumor size,non-peripheral arterial hyperenhancement,non-peripheral portal phase washout,irregular tumor margins,capsule integrity,intratumoral necrosis,intratumoral vessels,and arterial phase intratumoral hypovascular components.Quantitative parameters were measured during portal and equilibrium phases,including iodine concentration(IC),normalized iodine concentration(NIC),effective atomic number(Z_(eff)),and spectral curve slope(λ).Independent t-tests andχ^(2) tests compared quantitative and qualitative data,respectively.Multivariate logistic regression identified independent predictors of MTM-HCC,followed by ROC curve analysis to evaluate diagnostic performance.Results:Significant intergroup differences were observed in AFP,arterial phase intratumoral hypovascular components,and IC,Z_(eff),andλduring portal and equilibrium phases(all P<0.05).Multivariate logistic regression analysis identified arterial phase intratumoral hypovascular components and equilibrium phase IC as independent predictors of MTM-HCC(OR=5.494,21.071,both P<0.05).The AUCs for predicting MTM-HCC were 0.714(arterial phase intratumoral hypovascular components),0.761(equilibrium phase IC),and 0.829(the combined model).Conclusions:The arterial phase intratumoral hypovascular components and equilibrium phase IC derived from DLCT have significant potential for predicting MTM-HCC,and their combined model has a better diagnostic efficiency for MTM-HCC.

关 键 词：癌 肝细胞 粗梁实体型 光谱成像 体层摄影术 X线计算机 

分 类 号：R73[医药卫生—肿瘤]