双源CT双能量成像对肝内胆管癌与肝泡状棘球蚴的鉴别

Dual-energy CT imaging in the differential diagnosis of intrahepatic cholangiocarcinoma and hepatic alveolar echinococcosis

目的分析肝内胆管细胞癌与肝泡状棘球蚴在双源CT双能量成像中的形态学改变及碘值差异。方法肝内胆管细胞癌患者20例(ICC组),肝泡状棘球蚴患者20例(HAE组),2组均行三期动态增强扫描,比较2组病灶内部、病灶边缘及正常肝实质动脉期、静脉期与延迟期碘值。结果肝内胆管细胞癌病灶与肝泡状棘球蚴病灶部分有形态学差异,部分形态学相似;ICC组总体碘值((11.00±3.28)g/L)明显高于HAE组((8.70±1.44)g/L)(P<0.05);ICC组病灶内部碘值动脉期为0.9(0.4,1.2)g/L、静脉期为1.4(1.2,2.0)g/L、延迟期为1.9(1.3,2.6)g/L,HAE组动脉期为0.0(0.0,0.1)g/L、静脉期为0.4(0.3,0.6)g/L、延迟期为0.6(0.4,0.9)g/L,差异有统计学意义(P<0.05);ICC组病灶边缘碘值动脉期为1.5(0.8,2.4)g/L、静脉期为2.5(1.8,2.8)g/L、延迟期为2.1(1.9,3.3)g/L,HAE组动脉期为1.7(1.5,2.3)g/L、静脉期为2.7(2.6,3.3)g/L、延迟期为3.1(2.5,3.7)g/L,差异有统计学意义(P<0.05);ICC与HAE病灶均有延迟强化趋势,但ICC病变边缘碘值在静脉期达峰值,HAE病变边缘碘值在延迟期达峰值。结论ICC与HAE病灶内部三期碘值差异及延迟期病变边缘碘值差异有助于2种疾病的鉴别;双能量碘值技术可为鉴别ICC与HAE提供新依据。

Objective To analyze the morphological changes of intrahepatic cholangiocarcinoma（ICC）and hepatic alveolar echinococcosis（HAE）and the difference of iodine value in dual-energy CT imaging.Methods Twenty cases of ICC（ICC group）and 20 of HAE（HAE group）underwent three-phase contrast-enhanced CT scan.The iodine values of internal focus,focus edge and the arterial phase,venous phase and delayed phase of normal liver parenchyma were compared between two groups.Results Some ICC and HAE foci were morphologically different,and some were similar.The total iodine value was（11.00±3.28）g/L in ICC group,higher than that in HAE group（（8.70±1.44）g/L）.Internal iodine values in focus at arterial,venous and delay phases were 0.9（0.4,1.2）,1.4（1.2,2.0）,and 1.9（1.3,2.6）g/L in ICC group,and were 0.0（0.0,0.1）,0.4（0.3,0.6）,and 0.6（0.4,0.9）g/L in HAE group,showing significant differences（P〈0.05）.Iodine values of focus edge at arterial,venous and delay phases were 1.5（0.8,2.4）,2.5（1.8,2.8）,and 2.1（1.9,3.3）g/L in ICC group,and were 1.7（1.5,2.3）,2.7（2.6,3.3）,and 3.1（2.5,3.7）g/L in HAE group,showing significant differences（P〈0.05）.Both ICC and HAE focuses had the tendency of delay enhancement,but the iodine value of ICC focus edge reached the peak at venous phase,while the iodine value of HAE focus edge reached the peak at delay phase.Conclusion The differences of internal iodine value in focus at three phases of ICC and HAE,and the difference of the iodine value of focus edge at delay phase contribute to the differentiate diagnosis of these two diseases.Dual-energy iodine value technique provides a new basis for distinguishing ICC and HAE.