Xing Gusheng, Wang Shuang, Li Chenrui, Zhao Xinming, Zhou Chunwu
Department of Diagnostic Imaging, Cancer Institute and Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100021, China.
Department of Diagnostic Imaging, Cancer Institute and Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100021, China; Email:
Zhonghua Zhong Liu Za Zhi. 2015 Mar;37(3):208-12.
To investigate the value of quantitative iodine-based material decomposition images with gemstone spectral CT imaging in the follow-up of patients with hepatocellular carcinoma (HCC) after transcatheter arterial chemoebolization (TACE).
Consecutive 32 HCC patients with previous TACE treatment were included in this study. For the follow-up, arterial phase (AP) and venous phase (VP) dual-phase CT scans were performed with a single-source dual-energy CT scanner (Discovery CT 750HD, GE Healthcare). Iodine concentrations were derived from iodine-based material-decomposition images in the liver parenchyma, tumors and coagulation necrosis (CN) areas. The iodine concentration difference (ICD) between the arterial-phase (AP) and venal-phase (VP) were quantitatively evaluated in different tissues.The lesion-to-normal parenchyma iodine concentration ratio (LNR) was calculated. ROC analysis was performed for the qualitative evaluation, and the area under ROC (Az) was calculated to represent the diagnostic ability of ICD and LNR.
In all the 32 HCC patients, the region of interesting (ROI) for iodine concentrations included liver parenchyma (n=42), tumors (n=28) and coagulation necrosis (n=24). During the AP the iodine concentration of CNs (median value 0.088 µg/mm(3)) appeared significantly higher than that of the tumors (0.064 µg/mm(3), P=0.022) and liver parenchyma (0.048 µg/mm(3), P=0.005). But it showed no significant difference between liver parenchyma and tumors (P=0.454). During the VP the iodine concentration in hepatic parenchyma (median value 0.181 µg/mm(3)) was significantly higher than that in CNs (0.140 µg/mm(3), P=0.042). There was no significant difference between liver parenchyma and tumors, CNs and tumors (both P>0.05). The median value of ICD in CNs was 0.006 µg/mm(3), significantly lower than that of the HCC (0.201 µg/mm(3), P<0.001) and hepatic parenchyma (0.117 µg/mm(3), P<0.001). The ICDs in tumors and hepatic parenchyma showed no significant difference (P=0.829). During the AP, the LNR had no significant difference between CNs and tumors (a median value 1.805 vs. 1.310, P=0.389), and during the VP, the difference was also non-significant (the median value 0.647 vs. 0.713, P=0.660). The mean Az value of ICDs for evaluation of surviving tumor tissues was 0.804, whiles LNR measured a disappointing result in both AV images and VP images.
Quantitative iodine-based material decomposition images with gemstone spectral CT imaging can improve the diagnostic efficacy of CT imaging for HCC patients after TACE treatment.
探讨宝石能谱CT成像的定量碘基物质分解图像在肝细胞癌（HCC）经动脉化疗栓塞术（TACE）后患者随访中的价值。
本研究纳入32例曾接受TACE治疗的HCC患者。随访时，使用单源双能量CT扫描仪（Discovery CT 750HD，GE医疗）进行动脉期（AP）和静脉期（VP）双期CT扫描。碘浓度来自肝实质、肿瘤和凝固性坏死（CN）区域的碘基物质分解图像。定量评估不同组织中动脉期（AP）和静脉期（VP）之间的碘浓度差（ICD）。计算病变与正常实质碘浓度比（LNR）。进行ROC分析以进行定性评估，并计算ROC曲线下面积（Az）以代表ICD和LNR的诊断能力。
在所有32例HCC患者中，碘浓度的感兴趣区域（ROI）包括肝实质（n = 42）、肿瘤（n = 28）和凝固性坏死（n = 24）。在AP期，CNs的碘浓度（中位数0.088μg/mm³）显著高于肿瘤（0.064μg/mm³，P = 0.022）和肝实质（0.048μg/mm³，P = 0.005）。但肝实质与肿瘤之间无显著差异（P = 0.454）。在VP期，肝实质中的碘浓度（中位数0.181μg/mm³）显著高于CNs（0.140μg/mm³，P = 0.042）。肝实质与肿瘤、CNs与肿瘤之间均无显著差异（均P>0.05）。CNs中ICD的中位数为0.006μg/mm³，显著低于HCC（0.201μg/mm³，P<0.001）和肝实质（0.117μg/mm³，P<0.001）。肿瘤和肝实质中的ICD无显著差异（P = 0.829）。在AP期，CNs与肿瘤之间的LNR无显著差异（中位数分别为1.805和1.310，P = 0.389），在VP期，差异也不显著（中位数分别为0.647和0.713，P = 0.660）。用于评估存活肿瘤组织的ICD的平均Az值为0.804，而LNR在AP图像和VP图像中的结果均不理想。
宝石能谱CT成像的定量碘基物质分解图像可提高TACE治疗后HCC患者CT成像的诊断效能。
