Laroia S T, Bhadoria Ajeet Singh, Venigalla Yamini, Chibber G K, Bihari Chagan, Rastogi Archana, Sarin S K
Department of Radiology, Institute of Liver and Biliary Sciences, Sector D-1, Vasant Kunj, New Delhi 110070, India.
Department of Community Medicine, Institute of Liver & Biliary Sciences, Sector D-1, Vasant Kunj, New Delhi 110 070, India.
Eur J Radiol Open. 2016 Jul 20;3:162-71. doi: 10.1016/j.ejro.2016.05.007. eCollection 2016.
To investigate dual-energy spectral CT in characterization of hepatocellular Carcinoma (HCC) in patients with chronic liver disease.
Dynamic computed tomography (CT) was performed in 3600 patients (2879 males; 721 females, mean age 50.9 ± 11.9 years) with working clinical diagnosis of liver cirrhosis for hepatocellular carcinoma screening and other clinical indications. The study was conducted over a period of 3 years. During dynamic CT scanning, spectral (monochromatic) and routine (polychromatic) CT acquisitions were obtained on a single tube, dual energy, 64 slice multi-detector CT scanner. Imaging findings were studied on routine CT. On the basis of routine CT findings, indeterminate lesions (lesions not showing characteristic hypervascularity followed by washout on dynamic routine CT scan) that were referred for biopsy or surgery were segregated. A retrospective blinded review of the lesions, acquired by the spectral CT acquisitions was done with the help of gem stone imaging (GSI) software to characterize these lesions. All the above lesions were analyzed qualitatively in the arterial phase for lesion conspicuity as well as quantitatively using the monochromatic data sets and nodule Iodine concentration on material density maps, respectively. This data was studied with respect to predictability of HCC using the spectral CT technique. Iodine density of the lesion, surrounding liver parenchyma, and lesion to liver parenchyma ratio (LLR) were derived and statistically analyzed. Histopathology of the lesion in question was treated as gold standard for analysis.
It was observed via statistical analysis that the value of iodine density of the lesion on material density sets of ≥29.5 mg/dl, enabled a discriminatory power of 86.5%, sensitivity of 90.5% with 95% confidence Interval (CI) (69.2-98.8%) and specificity of 81.2% with 95% Confidence Interval (54.4-95.9%) in predicting HCC. Qualitative assessment also showed higher lesion conspicuity with spectral CT image sets as compared to routine CT data.
This study reveals that spectral imaging is an excellent qualitative as well as a quantitative tool for assessing and predicting hepatocellular carcinoma in cirrhotic patients.
探讨双能谱CT在慢性肝病患者肝细胞癌（HCC）特征性诊断中的应用。
对3600例（男性2879例；女性721例，平均年龄50.9±11.9岁）临床诊断为肝硬化的患者进行动态计算机断层扫描（CT），以筛查肝细胞癌及其他临床指征。该研究历时3年。在动态CT扫描过程中，使用单管双能64层多探测器CT扫描仪获取光谱（单色）和常规（多色）CT图像。对常规CT图像的影像学表现进行研究。根据常规CT表现，将需要进行活检或手术的不明确病变（在动态常规CT扫描中未显示典型的高血供及洗脱表现的病变）分离出来。借助宝石成像（GSI）软件对光谱CT采集的病变进行回顾性盲法分析，以明确这些病变的特征。对所有上述病变在动脉期进行定性分析，观察病变的显影情况，并分别使用单色数据集和物质密度图上的结节碘浓度进行定量分析。研究该数据关于使用光谱CT技术预测HCC的可预测性。得出病变、周围肝实质的碘密度以及病变与肝实质比值（LLR），并进行统计学分析。将所研究病变的组织病理学结果作为分析的金标准。
通过统计分析观察到，在预测HCC时，物质密度集上病变碘密度≥29.5mg/dl的值具有86.5%的鉴别能力，90.5%的敏感性（95%置信区间[CI]为69.2 - 98.8%）以及81.2%的特异性（95%置信区间为54.4 - 95.9%）。定性评估还显示，与常规CT数据相比，光谱CT图像集的病变显影更好。
本研究表明，光谱成像对于评估和预测肝硬化患者的肝细胞癌是一种优秀的定性和定量工具。
