Matsuo M, Kanematsu M, Inaba Y, Matsueda K, Yamagami T, Kondo H, Arai Y, Hoshi H
Department of Radiology, Gifu University School of Medicine, 40 Tsukasamachi, Gifu 500-8705, Japan.
Clin Radiol. 2001 Feb;56(2):138-45. doi: 10.1053/crad.2000.0593.
The purpose of our study was to evaluate the observer performance with combined helical CT during arterial portography (CTAP) and biphasic CT hepatic arteriography (CTHA) in the pre-operative detection of malignant hepatic tumours.
Computed tomography images obtained in 41 patients with suspected hepatic tumours were retrospectively reviewed. In a blind fashion, three off-site, independent radiologists reviewed CTAP and early-phase CTHA combined for the first review, then late-phase CTHA was added for the second review. Statistical analysis was conducted on lesion-by-lesion and segment-by-segment bases; a total of 328 liver segments including 65 segments with 74 malignant hepatic tumours ranging in size from 5 to 100 mm (mean, 21.4 mm) were analysed.
Sensitivity for detection of liver segments harbouring tumours of CTAP and biphasic CTHA combined (82%) was identical to that of CTAP and early-phase CTHA combined (82%). Specificity of CTAP and biphasic CTHA combined (93%) was greater than that of CTAP and early-phase CTHA combined (90%, P < 0.005). The mean confidence level for the 74 tumours significantly increased by adding late-phase CTHA (P < 0.0005). The mean confidence level for 100-142 benign perfusion abnormalities detected with CTAP and early-phase CTHA combined significantly decreased by adding late-phase CTHA (P < 0.0005).
By combining late-phase CTHA with CTAP and early-phase CTHA information, the specificity for the detection of malignant hepatic tumours rises significantly, allowing more accurate preoperative tumour detection.
本研究旨在评估在术前检测肝脏恶性肿瘤时，联合螺旋CT进行动脉性门静脉造影（CTAP）和双期CT肝动脉造影（CTHA）时观察者的表现。
回顾性分析41例疑似肝脏肿瘤患者的计算机断层扫描图像。三位不在现场的独立放射科医生以盲法先对CTAP和早期CTHA联合图像进行首次评估，然后再加上晚期CTHA图像进行第二次评估。对逐个病灶和逐个肝段进行统计分析；共分析了328个肝段，其中65个肝段有74个肝脏恶性肿瘤，大小从5到100毫米不等（平均21.4毫米）。
CTAP和双期CTHA联合检测含肿瘤肝段的敏感性（82%）与CTAP和早期CTHA联合检测的敏感性（82%）相同。CTAP和双期CTHA联合检测的特异性（93%）高于CTAP和早期CTHA联合检测的特异性（90%，P<0.005）。加上晚期CTHA后，74个肿瘤的平均置信度显著提高（P<0.0005）。CTAP和早期CTHA联合检测到的100 - 142个良性灌注异常，加上晚期CTHA后平均置信度显著降低（P<0.0005）。
通过将晚期CTHA与CTAP和早期CTHA信息相结合，检测肝脏恶性肿瘤的特异性显著提高，从而能更准确地进行术前肿瘤检测。
