能谱CT多参数成像在肝癌TACE术后随访中的初步研究

Evaluation of Gemstone Spectral Imaging in HCC Patients After TACE

目的探讨能谱CT多参数成像在肝癌（HCC）肝动脉化疗栓塞术（TACE）术后随访中的应用价值。方法搜集在本院TACE治疗后复查的HCC患者34例,对所有患者行能谱CT及数字减影血管造影（DSA）检查。以DSA结果为参照,分别得到肿瘤活灶、邻近肝实质及坏死区的标准碘浓度值（NIC）、碘浓度差值（ICD）、肝动脉碘分数（AIF）及能谱曲线斜率（s-SHC）,对各参数进行统计学分析。结果肿瘤活灶的s-SHC（1.93±0.69）大于邻近肝实质（0.85±0.34）及坏死组织（0.50±0.31）（P〈0.05）。肿瘤活灶的动脉期、门静脉期NIC（0.13±0.05、0.47±0.14）,均大于邻近肝实质（0.06±0.03、0.46±0.12）及坏死组织（0.04±0.02、0.11±0.07）,其中门静脉期肿瘤活灶NIC与邻近肝实质差异无统计学意义（P〉0.05）,余两两比较差异均有统计学意义（P〈0.05）。肿瘤组织、邻近肝实质和坏死组织的ICD值分别为7.14±2.58、11.79±3.66、1.13±1.20,差异具有统计学意义（P〈0.05）。肿瘤组织AIF（0.61±0.17）大于邻近肝实质（0.29±0.12）,差异具有统计学意义（P〈0.001）。受试者工作特征（ROC）曲线显示,AIF对鉴别诊断肿瘤与邻近肝实质的效能最高（敏感度0.944,特异度0.828）,门静脉期NIC对鉴别诊断肿瘤与坏死组织的效能最高（敏感度0.963,特异度0.957）。结论能谱多参数成像有助于TACE术后不同组织间的鉴别诊断,在HCC的随访中具有重要价值。

Objective To investigate the assessment of GSI in HCC patients after TACE. Methods Thirty-four HCC patients after TACE were collected from our hospital and then performed by the gemstone spectral CT and DSA. According to the results of DSA,we measured the NIC,ICD,AIF and s-SHC of tumors,adjacent liver parenchyma and necrotic tissues,then statistical analysis was performed. Results The s-SHCs of tumors（ 1. 93 ± 0. 69） were significantly greater than liver parenchyma（ 0. 85 ± 0. 34） and necrotic tissues（ 0. 50 ± 0. 31）（ P 0. 05）. The NICs of AP and PP（ 0. 13 ± 0. 05,0. 47± 0. 14） were greater than liver parenchyma（ 0. 06 ± 0. 03,0. 46 ± 0. 12） and necrotic tissue（ 0. 04 ± 0. 02,0. 11 ± 0. 07）.There was no significant difference between the NICs of tumor and liver parenchyma in portal venous phase（ P 0. 05）.Others were statistically significant（ P 0. 05）. The ICDs of three different tissues were 7. 14 ± 2. 58,11. 79 ± 3. 66,1. 13± 1. 20（ P 0. 05）. The AIFs of tumors（ 0. 61 ± 0. 17） were greater than liver parenchyma（ 0. 29 ± 0. 12）（ P 0. 05）.ROC curves showed that AIF had high efficacy for the differential diagnosis of tumors and liver parenchyma（ sensitivity0. 944,specificity 0. 828） and NIC of PP had high efficacy in identifying tumors and necrotic tissues（ sensitivity 0. 963,specificity 0. 957）. Conclusion The multiple parameters of GSI play a key role in the assessment of HCC patients after TACE treatment.