能谱CT碘基图对鉴别肝内胆管细胞癌与非典型肝细胞癌的临床价值

The clinical value of spectral CT iodine-based material decomposition imaging in differentiating intrahepatic cholangiocarcinoma from atypical hepatocellular carcinoma

目的探讨能谱CT碘基图对鉴别肝内胆管细胞癌(ICC)与非典型肝细胞癌(AHCC)的临床价值。方法回顾性分析我院2013年4月—2014年2月间经病理证实为肝癌的52例病人(ICC 24例,AHCC 28例)的动脉期、门静脉期及平衡期能谱影像。测量ICC及AHCC 2组病灶和正常肝实质的3期碘浓度值,计算平衡期与动脉期病灶碘浓度差值(EAD)及平衡期病灶与正常肝实质碘浓度差值(LNDE),并对测量和计算结果分别进行两组间独立样本t检验及ROC曲线分析。结果 ICC的3期碘浓度值明显高于AHCC的,两组间差异均有统计学意义(均P<0.01);ICC的EAD值及LNDE值明显高于AHCC的,两组间差异均有统计学意义(均P<0.01)。ROC曲线分析示平衡期碘浓度值、EAD和LNDE鉴别ICC和AHCC的敏感度和特异度分别为95.8%、92.9%,62.5%、89.2%,95.8%、82.1%。结论能谱CT碘定量测定能够定量评价ICC的强化特点,平衡期的碘定量分析在ICC与AHCC的鉴别诊断方面具有较高的价值。

Objective To explore the clinical value of spectral CT Iodine-based material decomposition imaging in differentiating intrahepatic cholangiocarcinoma （ ICC ） from atypical hepatocellular carcinoma （ AHCC ） . Methods Retrospectively analyzed 52 patients of our hospital during April 2013-February 2014 who underwent tri-phase enhanced spectral CT imaging including arterial phase, portal venous phase and equilibrium phase. Primary hepatocellular carcinoma （ICC patients 24 cases, AHCC patients 28 cases）was pathologically confirmed in each case. The Iodine concentrations of ICC, AHCC, and normal hepatic tissue in tri-phase were measured. The iodine concentration differences between equilibrium phase and arterial phase （EAD）, lesion and normal hepatic tissue iodine concentration difference during equilibrium phase （LNDE） were calculated. The group differences of ICC and AHCC were evaluated by two samples t test and receiver operating characteristic curve （ROC） analysis. Results During arterial phase, portal venous phase, and equilibrium phase, the mean iodine concentrations of ICC were significantly higher than those of AHCC （P〈0.01）. The EAD and LNDE of ICC were significantly higher than those of AHCC （P〈0.01）. ROC analysis showed that the sensitivity and specificity of the iodine concentration during equilibrium phase, EAD and LNDE in differentiating between ICC and AHCC were 95.8%and 92.9%, 62.5%and 89.2%, 95.8%and 82.1%, respectively. Conclusion Spectral CT iodine-based material decomposition image is a suitable tool to quantitatively evaluate contrast enhancement characteristics of ICC, the iodine concentration measurement during equilibrium phase performs best in differentiating AHCC from ICC.