双层探测器光谱CT在早期原发性肝癌中的诊断价值  

Diagnostic value of dual-detector spectral CT in early primary liver cancer

作　　者：欧阳佳裕 李刚[1] 贺露瑶 罗娜 Ouyang Jiayu;Li Gang;He Luyao;Luo Na(Department of Radiology,the Third Affiliated Hospital of Sun Yat-sen University,Guangzhou 510630,China)

机构地区：[1]中山大学附属第三医院放射科,广州510630

出　　处：《中华肝脏外科手术学电子杂志》2024年第4期557-561,共5页Chinese Journal of Hepatic Surgery(Electronic Edition)

摘　　要：目的探讨双层探测器光谱CT在早期原发性肝癌(肝癌)中的诊断价值。方法本研究对象为2022年3月至2023年3月在中山大学附属第三医院就诊的60例肝癌和(或)肝硬化患者。患者已签署知情同意书,符合医学伦理学规定。其中男49例,女11例;年龄50~70岁,中位年龄57岁。肝癌直径1.2~3.0 cm,中位直径1.8 cm;数目单发21例,多发9例。患者均采用双层探测器光谱CT增强检查,扫描完成后重建出虚拟40 keV单能量增强图像、碘密度含量增强图像及有效原子序数增强图像,疑诊患者加做MRI扫描。采用双盲法读片方式由具有肝脏诊断经验的2名影像医师评判结果,以病理学检查为诊断金标准进行诊断试验。3种图像单独及其联合诊断早期肝癌检出率比较采用χ^(2)检验,诊断价值采用ROC曲线下面积(AUC)分析。结果病理学检查结果为早期肝癌30例,肝硬化30例。120 kV常规图像诊断早期肝癌的检出率为63%(19/30),其中11例疑诊患者为MRI检出。虚拟40 keV单能量增强图像诊断早期肝癌的检出率为67%(20/30),碘密度含量增强图像为80%(24/30),有效原子序数增强图像为83%(25/30),3种图像联合为93%(28/30)。相较于单独3种增强图像,3种图像联合诊断检出率明显升高(χ^(2)=17.37,5.43,4.01;P<0.05)。ROC曲线分析显示,3种图像及其联合诊断的AUC分别为0.638、0.760、0.782和0.904,其中3种图像联合诊断价值最高。结论双层探测器光谱CT扫描3种图像联合在早期肝癌的诊断中具有较高检出率,可以帮助医师更早地发现肝癌病灶,提高治疗效果和预后。Objective To evaluate the diagnostic value of dual-detector spectral CT in early primary liver cancer(PLC).Methods 60 patients with PLC and/or cirrhosis admitted to the Third Affiliated Hospital of Sun Yat-sen University were enrolled in this study.The informed consents of all patients were obtained and the local ethical committee approval was received.Among them,49 patients were male and 11 female,aged from 50 to 70 years,with a median age of 57 years.The diameter of liver cancer was 1.2-3.0 cm,with a median diameter of 1.8 cm.21 patients had a single lesion and 9 cases of multiple lesions.All patients received by dual-detector spectral enhanced CT.After CT scan,virtual 40 keV single-energy enhanced CT images,iodine density enhanced CT images and effective atomic number enhanced CT images were reconstructed.The suspected patients further received MRI.The results were evaluated by two radiologists experienced in liver cancer diagnosis by double-blind method.Pathological examination was considered as the diagnostic gold standard.The diagnostic rates of three imaging methods or the combined for early PLC were assessed by Chi-square test.The diagnostic value was analyzed by the area under the ROC curve(AUC).Results Pathological examination showed that 30 patients were diagnosed with early PLC and 30 cases of liver cirrhosis.The diagnostic rate for early PLC by 120 kV conventional CT images was 63%(19/30),including 11 suspected patients diagnosed by MRI.The diagnostic rate of virtual 40 keV single-energy enhanced CT images for early PLC was 67%(20/30),80%(24/30)for the iodine density enhanced CT images,83%(25/30)for the effective atomic number enhanced CT images,and 93%(28/30)for the combination of three images,respectively.Compared with single use of three enhanced CT images,the diagnostic rate of the three combined was significantly enhanced(χ^(2)=17.37,5.43,4.01;P<0.05).ROC curve analysis showed that the AUC of three images and the three combined was 0.638,0.760,0.782 and 0.904,respectively.The diagnostic value o

关 键 词：肝肿瘤 光谱技术 计算机体层摄影 检出率 

分 类 号：R735.7[医药卫生—肿瘤]