基于DECT的NIC评估肝硬化患者肝功能分级的研究

Study on NIC Based on DECT in Evaluating Liver Function Grading in Patients with Cirrhosis

目的探究基于双能量CT(Dual-Energy CT,DECT)获取标准化碘浓度(Normalized Iodine Concentration,NIC)无创评估肝硬化患者肝功能分级的价值,并确定NIC最佳提取期相。方法前瞻性收集我院2022年5月至2023年10月行腹部DECT扫描患者,筛选经临床/病理诊断为肝硬化患者68例,同时选取健康对照患者25例。通过DECT扫描的门静脉期、3 min延时期获取碘值计算门静脉期NIC和延时期NIC,采用白蛋白-胆红素(Albumin-Bilirubin,ALBI)评分进行肝功能分级(ALBI 1级=25例;ALBI 2级=23例;ALBI 3级=20例)。使用Spearman相关性分析NIC与ALBI分级之间的相关性;KruskalWallis H检验比较各组间NIC的差异性;使用受试者工作特征(Receiver Operating Characteristic,ROC)曲线评估NIC鉴别不同ALBI分级的诊断效能,并计算其ROC曲线下面积(Area Under Curve,AUC)。结果门静脉期NIC与ALBI分级呈负相关(r=-0.83,P<0.01);延时期NIC与ALBI分级呈正相关(r=0.68,P<0.01);门静脉期NIC鉴别不同ALBI分级的AUC分别为0.84、0.83、0.82;延时期NIC鉴别不同ALBI分级的AUC分别为0.79、0.72、0.65,两期NIC联合后评估效能进一步提升。结论基于DECT获取的NIC能够作为评估肝硬化患者肝功能的可靠指标,门静脉期NIC评估肝功能效能优于延时期NIC;此外,两期NIC联合评估肝功能效果更佳。

Objective To explore the value of noninvasive evaluation of liver function grading in patients with cirrhosis based on normalized iodine concentration(NIC)obtained by dual-energy CT(DECT),and determine the optimal extraction phase of NIC.Methods A prospective collection of patients who underwent abdominal DECT scan in our hospital from May 2022 to October 2023 was conducted.A total of 68 patients with cirrhosis diagnosed clinically/pathologically were screened,and 25 healthy control patients were selected.The portal venous NIC and the extended NIC were calculated by obtaining iodine values during the portal venous phase and 3 min extended phase of DECT scanning,and the albumin-Bilirubin(ALBI)score was used for liver function grading(ALBI grade 1=25 cases;ALBI grade 2=23 cases;ALBI grade 3=20 cases).Spearman correlation was used to analyze the correlation between NIC and ALBI grade;Kruskal-Wallis H test was used to compare the differences of NIC among groups;the receiver operating characteristic(ROC)curve was used to evaluate the diagnostic efficacy of NIC in differentiating different ALBI grades,and the area under curve(AUC)of ROC was calculated.Results The NIC in portal venous phase was negatively correlated with ALBI grade(r=-0.83,P<0.01);NIC in extended phase was positively correlated with ALBI grade(r=0.68,P<0.01).The AUC of NIC in portal venous phase in differentiating different ALBI grades was 0.84,0.83,0.82 respectively;the AUC of NIC in differentiating different ALBI grades in the extended phase were 0.79,0.72,0.65,respectively.The evaluation efficiency of NIC in the two phases was further improved after the combination.Conclusion The NIC obtained based on DECT can be used as a reliable index to evaluate liver function in patients with cirrhosis,and the efficacy of portal venous phase NIC in evaluating liver function is better than that of extended phase NIC.In addition,the joint evaluation of liver function by two phases NIC is better.