结合增强CT影像的多因素模型在WHCC与FNH中的鉴别诊断价值

The differential diagnostic value of a multivariate model combined with enhanced CT imaging in WHCC and FNH

目的探讨高分化肝细胞癌(WHCC)与局灶性结节增生(FNH)的临床、实验室检查及CT影像学特征,为WHCC与FNH的鉴别诊断提供依据。方法回顾性分析2019年1月至2021年12月经手术或活检病理证实的50例WHCC患者和42例FNH患者的临床资料、实验室检查及CT影像定性定量特征,包括病灶短径、长径以及CT值,并计算强化差值、强化率、强化比值。采用独立样本t检验或非参数秩和检验进行组间单因素分析。应用Logistic回归分析获得有统计学意义的单因素,并建立多因素模型。绘制受试者操作特征(ROC)曲线分析,计算曲线下面积(AUC),采用DeLong检验。结果与FNH患者相比,WHCC患者发病年龄更高,多为男性,乙肝病史常见。WHCC组的甲胎蛋白(AFP)、丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、总胆红素(TBIL)、白蛋白-胆红素(ALBI)评分均高于FNH组。WHCC组CT征象中血管分布混合(瘤内、瘤周)、瘤内囊变、假包膜征象出现率高于FNH组;瘢痕、瘢痕延迟强化征象出现率低于FNH组。WHCC组动脉期(AP)差值、静脉期(VP)差值、延迟期(DP)差值及AP增强率(SIAP)、VP增强率(SIVP)、DP增强率(SIDP)均低于FNH组。单因素分析结果显示,AUC值最高的三个单项指标分别为AST值、瘢痕及AP差值。多因素Logistic回归分析显示,AST值、AP差值、年龄是鉴别WHCC的相关因素。多因素模型鉴别WHCC的ROC曲线AUC值为0.996,经DeLong检验,多因素模型的AUC大于瘢痕、AST值、AP差值的AUC,差异有统计学意义(Z=5.603、3.953、2.976,P<0.05)。结论基于AST值、AP差值、年龄建立的多因素模型可为鉴别WHCC与FNH提供参考。

Objective To investigate the clinical,laboratory and CT imaging features of well-differentiated hepatocellular carcinoma(WHCC)and focal nodular hyperplasia(FNH),and to provide evidence for the differential diagnosis of WHCC and FNH.Methods A retrospective collection of clinical data,laboratory tests,and both qualitative and quantitative CT imaging features was conducted from January 2019 to December 2021 for 50 patients diagnosed with WHCC and 42 patients with FNH through surgery or biopsy pathology.This included the measurement of lesion diameters(short and long)and CT values,along with the calculation of enhancement differences,enhancement ratios,and enhancement values.Univariate analysis between groups was performed using independent sample t-tests or non-parametric rank sum tests.Significant univariate factors were identified using Logistic regression analysis to construct a multifactorial model.The performance of the multifactorial model was assessed through receiver operating characteristic(ROC)curve analysis,with the area under the curve(AUC)comparison conducted using the DeLong test.Results Compared with FNH patients,individuals with WHCC tend to be older,predominantly male,and more frequently have a history of Hepatitis B.The WHCC group showed higher levels of alpha-fetoprotein(AFP),alanine aminotransferase(ALT),aspartate aminotransferase(AST),total bilirubin(TBIL),and albumin-bilirubin(ALBI)scores compared to the FNH group.In the WHCC group,the incidence of mixed vascular distribution(within and around the tumor),intratumoral necrosis,and the presence of a pseudocapsule was higher compared to the FNH group.Whereas the appearance of scars and delayed scar enhancement were less frequent than in the FNH group.The WHCC group had lower arterial phase(AP)difference,venous phase(VP)difference,delayed phase(DP)difference,and lower values for spleen intensity in arterial phase(SIAP),spleen intensity in venous phase(SIVP),and spleen intensity in delayed phase(SIDP)compared to the FNH group.The three single indicators with the highest AUC values were AST,the presence or absence of scars,and the AP values.AST levels,AP values,and age were identified as relevant independent risk factors for distinguishing WDCC.The ROC curve AUC value for the differentiation of WHCC by the multifactorial diagnostic model was 0.996(95%CI:0.953~1.0).The DeLong test showed that the AUC of the multifactorial model was significantly greater than the AUCs of the presence of scars,AST values,and AP difference(Z=5.603,3.953,2.976,P<0.05).Conclusion The multifactorial model established on the basis of liver function AST levels,AP difference,and age carries clinical significance for differentiating WHCC from FNH.