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目的研究CT能谱成像动脉期(AP)和门静脉期(PP)在鉴别肝细胞癌(HCC)和局灶性结节增生(FNH)中的价值。方法 58例病人(42例为肝细胞癌,16例为肝局灶性结节增生)均行能谱CT动脉期和门静脉期扫描。计算不同能量水平的病变-肝脏对比噪声比(CNR)、标准碘浓度(NIC)和病变-正常实质碘浓度比(LNR)。定量参数采用两样本t检验。2名阅片者根据影像特点对病变进行定性评价。比较定性和定量研究的敏感性和特异性。结果一般情况下,低能量水平(40～70keV)的CNR高于高能量水平(80～140keV)的CNR。HCC的NIC和LNR与FNH的相应指标存在显著差异:AP的平均NIC为(0.25±0.08)mg/mL和(0.42±0.12)mg/mL,PP的平均NIC为(0.52±0.14)mg/mL和(0.86±0.18)mg/mL。AP的平均LNR为2.97±0.50和6.15±0.62,PP的平均LNR为0.99±0.12和1.22±0.26。HCC的NIC和LNR低于FNH的相应指标。AP的LNR鉴别HCC和FNH的敏感性和特异性最高。结论 CT能谱成像有助于提高病变的检出和HCC与FNH鉴别的准确性。要点①CT能谱成像有助于HCC的检出。②CT能谱成像有助于鉴别HCC和局灶性结节增生。③碘浓度的定量分析能提供更大的诊断信心。④给予治疗更大信心。
Objective To investigate the value of CT spectral imaging in distinguishing between hepatocellular carcinoma (HCC) and focal nodular hyperplasia (FNH) in arterial phase (AP) and portal vein phase (PP). Methods Fifty-eight patients (42 with hepatocellular carcinoma and 16 with focal nodular hyperplasia) underwent CT scan of the arterial and portal venous phases. Lesions at different energy levels were calculated for CNR, NIC and lesion-normal substance iodine concentration ratio (LNR). Quantitative parameters using two-sample t test. Two readers according to the characteristics of the lesions on the qualitative evaluation. Compare the sensitivity and specificity of qualitative and quantitative studies. Results In general, CNRs at low energy levels (40-70 keV) were higher than those at high energy levels (80-140 keV). There was a significant difference between NIC and LNR in HCC and corresponding indexes of FNH: the mean NIC of AP was (0.25 ± 0.08) mg / mL and (0.42 ± 0.12) mg / mL, and the average NIC of PP was (0.52 ± 0.14) mg / mL And (0.86 ± 0.18) mg / mL, respectively. The average LNR for AP was 2.97 ± 0.50 and 6.15 ± 0.62, and the average LNR for PP was 0.99 ± 0.12 and 1.22 ± 0.26. HCC NICs and LNR below the corresponding indicators of FNH. The LN of the AP has the highest sensitivity and specificity for identifying HCC and FNH. Conclusion CT spectral imaging can help improve the detection of lesions and the accuracy of HCC and FNH. Key points ① CT spectroscopy contributes to the detection of HCC. ②CT spectral imaging can help identify HCC and focal nodular hyperplasia. Quantitative analysis of iodine concentration can provide greater diagnostic confidence. ④ give greater confidence in treatment.