双源双能量CT对肝内肿块型胆管癌和肝脓肿的鉴别诊断

Dual-source Dual-energy CT in Differentiating Intrahepatic Mass-forming Type Cholangiocarcinoma from Liver Abscess

目的通过双源双能量CT(DECT)定量分析肝内肿块型胆管细胞癌(IMCC)和肝脓肿(LA)病灶的参数特点,探讨DECT在两者鉴别诊断中的优势。资料与方法回顾性分析经病理确诊并行DECT扫描的48例IMCC和39例LA患者的影像学资料,分析所有病例的常规CT征象,并通过双能量分析软件对病变进行定量分析。比较CT常规征象与DECT定量分析在鉴别诊断IMCC和LA中的敏感度、特异度及准确度。结果常规CT征象鉴别诊断IMCC和LA的敏感度、特异度、准确度分别为66.7%、70.2%、68.4%。IMCC的动、静脉期标准化碘浓度(NIC)值及k值均高于LA,差异有统计学意义(P<0.05);当以静脉期NIC=0.194、k=1.697作为诊断阈值时,联合静脉期NIC和k值对IMCC和LA鉴别诊断的敏感度、特异度、准确度分别为87.5%、85.1%、86.3%。结论DECT提供的NIC值和k值可以定量鉴别IMCC和LA,且其诊断价值优于普通CT,值得临床推广。

Purpose To quantitatively analyze the parameter characteristic of intrahepatic mass-forming cholangiocarcinoma(IMCC)and liver abscess(LA)by dual-source dual-energy CT(DECT),and to explore the advantage of DECT in differentiating IMCC from LA.Materials and Methods Imaging of 48 patients with IMCC and 39 patients with LA who underwent DECT were retrospectively analyzed.The conventional CT features were analyzed,and lesions was quantitatively analyzed by dual-energy analysis software.The sensitivity,specificity and accuracy was compared between conventional CT and DECT in differentiating IMCC from LA.Results The sensitivity,specificity and accuracy of conventional CT features in differentiating IMCC from LA was 66.7%,70.2%and 68.4%,respectively.For DECY,the normalized iodine concentration(NIC)and k values of IMCC were higher than those of LA in both arterial and venous phase,with statistically significant differences(P<0.05).With NIC=0.194 and k=1.697 in venous phase as the diagnostic thresholds,the sensitivity,specificity and accuracy of combined NIC and k values in the differential diagnosis of IMCC and LA was 87.5%,85.1%and 86.3%,respectively.Conclusion NIC and k values provided by DECT can quantitatively differentiate IMCC from LA,and the diagnostic value is better than that of conventional CT,which is worthy of clinical promotion.