双能CT在肝细胞肝癌微血管侵犯中的评估价值

Dual-energy CT in evaluating the microvascular invasion of hepatocellular carcinoma

目的探讨双能CT定量参数在肝细胞肝癌(HCC)微血管侵犯中的评估价值。方法回顾性分析经本院病理确诊为HCC且术前行双能CT扫描的56例患者的临床病理及影像资料,将所有患者分为微血管侵犯组(28例)和无微血管侵犯组(28例),测量动静脉期病灶实性、病灶边缘、病灶边缘1 cm内及病灶边缘1 cm外的碘密度(ID)值和同层面腹主动脉ID值,比较两组间各双能CT参数的差异,并绘制受试者工作特征(ROC)曲线,评价有统计学意义的定量参数在HCC微血管侵犯评估中的诊断效能,并比较其诊断效能。结果动脉期病灶实性ID的曲线下面积(AUC)为0.756,病灶边缘ID的AUC为0.690,病灶边缘1 cm内ID的AUC为0.677;静脉期病灶边缘1 cm外ID的AUC为0.694。而动脉期病灶边缘1 cm外ID、静脉期病灶实性ID、病灶边缘ID、病灶边缘1 cm内ID差异均无统计学意义(P>0.05)。联合年龄、血清甲胎蛋白(AFP)、天门冬氨酸转氨酶(AST)、动脉期病灶实性ID、静脉期病灶边缘1 cm外ID这五个危险因素,AUC达0.926,敏感度82.14%,特异度96.43%。比较动脉期病灶实性ID与静脉期病灶边缘1 cm外ID,两者之间无明显统计学差异(P>0.05)。结论双能CT定量参数对术前HCC微血管侵犯评估和临床治疗决策具有一定的指导意义。

Objective To investigate the diagnostic value of quantitative parameters of dual-energy CT(DECT)in the microvascular invasion of HCC.Methods Clinicopathological and imaging data of 56 patients,who underwent preoperative DECT for pathologically confirmed HCC were retrospectively analyzed.The iodine densities(ID)of solid part of the lesion,edge of the lesion,within 1 cm of the lesion edge,1 cm outside the lesion,and abdominal aorta on the same plane in the arterial and venous phases were measured.According to Standardization for Diagnosis and Treatment of Primary Hepatic Carcinoma(2019 edition),all 56 patients were classified as 28 microvascular invasion(MVI)or 28 non-MVI.The parameters of DECT were compared between the two groups.The receiver operating characteristic(ROC)curves were drawn to evaluate the diagnostic efficacy of any statistically significant quantitative parameters in the MVI of HCC.Results There were no significant differences in the ID of outside 1 cm of the lesion in the arterial phase and solid part of the lesion,edge of the lesion,within 1 cm of the lesion in venous phase(P>0.05).There was no significant difference(P>0.05)between the ID of solid part of the lesion in arterial phase(AUC=0.756)and outside 1 cm edge the lesion in venous phase(0.694).Combined with age,alpha-fetoprotein(AFP),and aspartate aminotransferase(AST),ID of solid part of the lesion in arterial phase and ID of outside 1 cm of the lesion in the venous phase had AUC of 0.926 with sensitivity of 82.14%,and specificity of 96.43%.Conclusion The ID of solid part of the HCC in arterial phase and ID of outside 1 cm of the lesion in the venous phase on DECT can aid preoperative evaluation of HCC microvascular invasion.