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目的探讨能谱CT成像定量分析在富血供肝脏转移瘤(HVHM)与肝细胞肝癌(HCC)鉴别诊断中的临床应用价值。方法分析行能谱CT扫描的肝脏恶性肿瘤患者47例,分为HVHM组(n=20)和HCC组(n=27),获取动脉期、门静脉期单能量图像,以及碘基图、水基图,测量病灶边缘明显强化区域、正常肝组织和腹主动脉的能谱参数,并计算标准化碘浓度(NIC)、病灶与正常肝组织碘浓度比值(LNR)、病灶动静脉期碘浓度差(ICD)及能谱曲线斜率,对上述参数行独立样本t检验和ROC曲线分析。结果动脉期HVHM组和HCC组的NIC、LNR、能谱曲线斜率无明显差异(P>0.05)。门静脉期HVHM组和HCC组NIC、LNR及能谱曲线斜率差异有统计学意义(P<0.05):两组门静脉期NIC分别为0.59±0.08、0.45±0.10;LNR分别为1.17±0.22、0.92±0.16;能谱曲线斜率分别为1.85±0.49、1.18±0.34。HVHM组和HCC组ICD参数分别为(0.54±0.39)g/L、(0.45±0.39)g/L,差异无统计学意义(P>0.05)。水(碘)浓度在动脉期、门静脉期差异无统计学意义(P>0.05)。门静脉期能谱曲线斜率对HVHM组和HCC组的鉴别诊断效能最高。结论 HVHM和HCC在门静脉期的能谱CT特征性物质含量及能谱曲线具有明显差异,CT能谱成像为HVHM和HCC鉴别诊断提供了一种多参数定量分析方法。
Objective To investigate the clinical value of spectral CT imaging in the differential diagnosis of hepatocellular carcinoma (HCC) and blood-rich donor liver metastases (HVHM). Methods Forty-seven patients with hepatic malignancies were divided into HVHM group (n = 20) and HCC group (n = 27). Single-energy images of arterial phase and portal vein phase were obtained, Graphs were taken to measure the spectral parameters of the border area, normal liver tissue and abdominal aorta, and the normalized iodine (NIC), LNR, and iodine concentration difference in the arteriovenous phase ICD) and the slope of the energy spectrum curve, independent samples t-test and ROC curve analysis of the above parameters. Results There was no significant difference in the slopes of NIC, LNR and energy spectrum between arterial phase HVHM group and HCC group (P> 0.05). There were significant differences in the slope of NIC, LNR and energy spectrum between portal vein HVHM group and HCC group (P <0.05): the portal vein NICs in the two groups were 0.59 ± 0.08 and 0.45 ± 0.10 respectively; the LNRs were 1.17 ± 0.22 and 0.92 ± 0.22 0.16; slope of the energy spectrum curve was 1.85 ± 0.49 and 1.18 ± 0.34, respectively. The ICD parameters in HVHM group and HCC group were (0.54 ± 0.39) g / L and (0.45 ± 0.39) g / L, respectively, with no significant difference (P> 0.05). Water (iodine) concentration in the arterial phase, portal vein difference was not statistically significant (P> 0.05). The slope of spectral curve of portal venous phase was the most effective in differential diagnosis between HVHM group and HCC group. Conclusions There is a significant difference in the characteristic substance content and energy spectrum curve between HVHM and HCC during the portal venous phase. CT spectral imaging provides a multi-parameter quantitative analysis method for the differential diagnosis of HVHM and HCC.