Department of Radiology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, No.197, Rui Jin Er Road, Shanghai, China 200025.
Eur Radiol. 2013 Jun;23(6):1660-8. doi: 10.1007/s00330-012-2747-0. Epub 2013 Jan 10.
To investigate the value of CT spectral imaging in differentiating hepatocellular carcinoma (HCC) from focal nodular hyperplasia (FNH) during the arterial phase (AP) and portal venous phase (PP).
Fifty-eight patients with 42 HCCs and 16 FNHs underwent spectral CT during AP and PP. The lesion-liver contrast-to-noise ratio (CNR) at different energy levels, normalised iodine concentrations (NIC) and the lesion-normal parenchyma iodine concentration ratio (LNR) were calculated. The two-sample t test compared quantitative parameters. Two readers qualitatively assessed lesion types according to imaging features. Sensitivity and specificity of the qualitative and quantitative studies were compared.
In general, CNRs at low energy levels (40-70 keV) were higher than those at high energy levels (80-140 keV). NICs and LNRs for HCC differed significantly from those of FNH: mean NICs were 0.25 mg/mL ± 0.08 versus 0.42 mg/mL ± 0.12 in AP and 0.52 mg/mL ± 0.14 versus 0.86 mg/mL ± 0.18 in PP. Mean LNRs were 2.97 ± 0.50 versus 6.15 ± 0.62 in AP and 0.99 ± 0.12 versus 1.22 ± 0.26 in PP. NICs and LNRs for HCC were lower than those of FNH. LNR in AP had the highest sensitivity and specificity in differentiating HCC from FNH.
CT spectral imaging may help to increase detectability of lesions and accuracy of differentiating HCC from FNH.
• CT spectral imaging may help to detect hepatocellular carcinoma (HCC). • CT spectral imaging may help differentiate HCC from focal nodular hyperplasia. • Quantitative analysis of iodine concentration provides greater diagnostic confidence. • Treatment can be given with greater confidence.
探讨 CT 能谱成像在动脉期（AP）和门静脉期（PP）鉴别肝细胞癌（HCC）和局灶性结节增生（FNH）中的价值。
58 例患者共 42 个 HCC 和 16 个 FNH 行 CT 能谱扫描。计算不同能量水平的病灶-肝脏对比噪声比（CNR）、标准化碘浓度（NIC）及病灶-正常肝实质碘浓度比（LNR）。采用两样本 t 检验比较定量参数。两位观察者根据影像学特征对病灶类型进行定性评估。比较定性和定量研究的灵敏度和特异性。
总体而言，低能水平（40-70 keV）的 CNR 高于高能水平（80-140 keV）。HCC 的 NIC 和 LNR 与 FNH 有显著差异：AP 时，HCC 的平均 NIC 为 0.25mg/mL±0.08，FNH 为 0.42mg/mL±0.12；PP 时，HCC 的平均 NIC 为 0.52mg/mL±0.14，FNH 为 0.86mg/mL±0.18。AP 时 HCC 的平均 LNR 为 2.97±0.50，FNH 为 6.15±0.62；PP 时 HCC 的平均 LNR 为 0.99±0.12，FNH 为 1.22±0.26。HCC 的 NIC 和 LNR 均低于 FNH。AP 时的 LNR 在鉴别 HCC 和 FNH 方面具有最高的灵敏度和特异性。
CT 能谱成像有助于提高病变的检出率，提高 HCC 与 FNH 的鉴别诊断准确性。
• CT 能谱成像有助于检测肝细胞癌（HCC）。• CT 能谱成像有助于鉴别 HCC 和局灶性结节增生。• 碘浓度定量分析提供更大的诊断信心。• 可以更有信心地进行治疗。
