肝细胞癌：多排螺旋CT平扫及延迟期扫描在肝硬化患者中的作用

Hepatocellular carcinoma: role of unenhanced and delayed phase multi-detector row helical CT in patients with cirrhosis.

作者信息

Iannaccone Riccardo, Laghi Andrea, Catalano Carlo, Rossi Plinio, Mangiapane Filippo, Murakami Takamichi, Hori Masatoshi, Piacentini Francesca, Nofroni Italo, Passariello Roberto

机构信息

Department of Radiological Sciences, University of Rome La Sapienza, Policlinico Umberto I, Rome, Italy.

出版信息

Radiology. 2005 Feb;234(2):460-7. doi: 10.1148/radiol.2342031202.

DOI:10.1148/radiol.2342031202

PMID:15671002

Abstract

PURPOSE

To determine, by using multi-detector row helical computed tomography (CT), the added value of obtaining unenhanced and delayed phase scans in addition to biphasic (hepatic arterial and portal venous phases) scans in the detection of hepatocellular carcinoma (HCC) in patients with cirrhosis.

MATERIALS AND METHODS

Local ethical committee approval and patient consent were obtained. One hundred ninety-five patients (129 men, 66 women; mean age, 61 years; age range, 39-78 years) with 250 HCCs underwent multi-detector row helical CT of the liver. A quadruple-phase protocol that included unenhanced, hepatic arterial, portal venous, and delayed phases was performed. Analysis of images from hepatic arterial and portal venous phases combined, hepatic arterial and portal venous phases with the unenhanced phase, hepatic arterial and portal venous phases with the delayed phase, and all phases combined was performed separately by three independent radiologists. Relative sensitivity, positive predictive value, and area under the receiver operating characteristic curve (A(z)) were calculated for each reading session.

RESULTS

Mean sensitivity and positive predictive values, respectively, for HCC detection were 88.8% (666 of 750 readings) and 97.8% (666 of 681 readings) for the combined hepatic arterial and portal venous phases, 89.2% (669 of 750 readings) and 97.8% (669 of 684 readings) for hepatic arterial and portal venous phases with the unenhanced phase, 92.8% (696 of 750 readings) and 97.3% (696 of 715 readings) for hepatic arterial and portal venous phases with the delayed phase, and 92.8% (696 of 750 readings) and 97.3% (696 of 715 readings) for all four phases combined. The reading sessions in which delayed phase images were available for interpretation showed significantly (P < .05) superior sensitivity and A(z) values.

CONCLUSION

Unenhanced phase images are not effective for HCC detection. Because of the significant increase in HCC detection, a delayed phase can be a useful adjunct to biphasic CT in patients at risk for developing HCC.

摘要

目的

通过使用多排螺旋计算机断层扫描（CT），确定在肝硬化患者肝细胞癌（HCC）检测中，除双期（肝动脉期和门静脉期）扫描外，进行平扫和延迟期扫描的附加价值。

材料与方法

获得当地伦理委员会批准并取得患者同意。195例患有250个HCC的患者（129例男性，66例女性；平均年龄61岁；年龄范围39 - 78岁）接受了肝脏多排螺旋CT检查。采用包括平扫、肝动脉期、门静脉期和延迟期的四期扫描方案。由三名独立的放射科医生分别对肝动脉期和门静脉期联合图像、肝动脉期和门静脉期加平扫图像、肝动脉期和门静脉期加延迟期图像以及所有四期联合图像进行分析。计算每次读片的相对敏感度、阳性预测值和受试者操作特征曲线下面积（A(z)）。

结果

对于HCC检测，肝动脉期和门静脉期联合的平均敏感度和阳性预测值分别为88.8%（750次读片中的666次）和97.8%（681次读片中的666次），肝动脉期和门静脉期加平扫的为89.2%（750次读片中的669次）和97.8%（684次读片中的669次），肝动脉期和门静脉期加延迟期的为92.8%（750次读片中的696次）和97.3%（715次读片中的696次），所有四期联合的为92.8%（750次读片中的696次）和97.3%（715次读片中的696次）。有延迟期图像可供解读的读片显示出显著更高的敏感度和A(z)值（P < 0.05）。