Marin Daniele, Catalano Carlo, De Filippis Gianmaria, Di Martino Michele, Guerrisi Antonino, Rossi Massimo, Passariello Roberto
Department of Radiology, University of Rome La Sapienza, Viale Regina Elena 324, Rome 00164, Italy.
AJR Am J Roentgenol. 2009 Jan;192(1):180-7. doi: 10.2214/AJR.07.3652.
The purpose of our study was to prospectively assess the added value of isotropic coronal reformations of the liver when using 64-MDCT for the detection of hepatocellular carcinoma (HCC).
Seventy-one consecutive patients (60 men, 11 women; mean age, 65 years) suspected of having HCC underwent 64-MDCT with coronal reformations. A multiphasic CT protocol that included unenhanced, hepatic arterial, portal venous, and equilibrium phases was performed. Three independent, blinded readers interpreted the transverse scan alone, the coronal scan alone, and the combined transverse and coronal scans for the presence of HCC. Sensitivity, positive predictive value, area under the receiver operating characteristic curve (A(z)), and interpretation time were calculated for each reading session.
Seventy-six HCC nodules were confirmed in 48 patients using histopathologic analysis or follow-up with long-term CT, MRI, or both (mean follow-up time, 12 months; range, 12-15 months) as the reference standard. Mean sensitivity, positive predictive value, and A(z) value for HCC detection were, respectively, 84% (191/228 readings), 91% (191/210 readings), and 0.85 for the transverse scan alone; 83% (189/228 readings), 93% (189/203 readings), and 0.86 for the coronal scan alone; and 87% (198/228 readings), 93% (198/213 readings), and 0.87 for combined interpretation of transverse and coronal scans. No comparisons were statistically significant. Forty-eight false-positive interpretations were recorded (19 for the transverse, 14 for the coronal, and 15 for the combined interpretation sets). The reading session in which combined transverse and coronal scans were available for interpretation showed significantly superior reader confidence for HCC detection as well as longer interpretation times (p<0.05 for both comparisons). The average reading time for the combined interpretation of transverse and coronal image sets (mean, 12.1+/-0.8 minutes) was significantly longer than for the transverse image set (7.4+/-1.5 minutes) or the coronal image set (7.1+/-1.3 minutes) (p<0.01).
With 64-MDCT, the addition of isotropic coronal reformations to transverse images significantly improved reader confidence for the detection of HCC, with no statistically significant improvement in sensitivity, positive predictive value, or diagnostic accuracy (as determined by the A(z) value). This improvement comes at the cost of a longer interpretation time.
本研究的目的是前瞻性评估在使用64层螺旋CT检测肝细胞癌（HCC）时，肝脏各向同性冠状位重建的附加价值。
71例连续怀疑患有HCC的患者（60例男性，11例女性；平均年龄65岁）接受了64层螺旋CT冠状位重建检查。采用包括平扫、肝动脉期、门静脉期和平衡期的多期CT扫描方案。三位独立的、不知情的阅片者分别解读仅横轴位扫描、仅冠状位扫描以及横轴位与冠状位联合扫描图像，以判断是否存在HCC。计算每次阅片的敏感度、阳性预测值、受试者操作特征曲线下面积（A(z)）以及解读时间。
以组织病理学分析或长期CT、MRI随访（平均随访时间12个月；范围12 - 15个月）作为参考标准，48例患者中确认了76个HCC结节。单独横轴位扫描检测HCC的平均敏感度、阳性预测值和A(z)值分别为84%（191/228次解读）、91%（191/210次解读）和0.85；单独冠状位扫描分别为83%（189/228次解读）、93%（189/203次解读）和0.86；横轴位与冠状位联合解读分别为87%（198/228次解读）、93%（198/213次解读）和0.87。各比较均无统计学显著差异。记录到48例假阳性解读（横轴位19例，冠状位14例，联合解读组15例）。可同时解读横轴位与冠状位联合扫描图像的阅片过程显示，阅片者对HCC检测的信心显著更高，且解读时间更长（两项比较均p<0.05）。横轴位与冠状位图像联合解读的平均阅片时间（平均12.1±0.8分钟）显著长于横轴位图像组（7.4±1.5分钟）或冠状位图像组（7.1±1.3分钟）（p<0.01）。
对于64层螺旋CT，在横轴位图像基础上增加各向同性冠状位重建显著提高了阅片者对HCC检测的信心，但在敏感度、阳性预测值或诊断准确性（由A(z)值确定）方面无统计学显著改善。这种改善是以更长的解读时间为代价的。
