Kim Ji Eun, Kim Hyun Ok, Bae Kyungsoo, Cho Jae Min, Choi Ho Cheol, Choi Dae Seob
Department of Radiology, Gyeongsang National University School of Medicine, 79 Gangnam-ro, Jinju 52727, Republic of Korea.
Department of Internal Medicine, Gyeongsang National University School of Medicine, 79 Gangnam-ro, Jinju 52727, Republic of Korea.
Eur J Radiol. 2017 Jul;92:145-152. doi: 10.1016/j.ejrad.2017.05.012. Epub 2017 May 11.
To investigate the use of dual source dual-energy CT (DECT) quantitative parameters compared with the use of conventional CT for differentiating small (≤3cm) intrahepatic mass-forming cholangiocarcinoma (IMCC) from small liver abscess (LA) during the portal venous phase (PVP).
In this institutional review board-approved, retrospective study, 64 patients with IMCCs and 52 patients with LAs who were imaged in PVP using dual-energy mode were included retrospectively. A radiologist drew circular regions of interest in the lesion on the virtual monochromatic images (VMI), color-coded iodine overlay images, and linear blending images with a linear blending ratio of 0.3 to obtain CT value, its standard deviation, slope (k) of spectral curve and normalized iodine concentration (NIC). Two radiologists assessed lesion type on the basis of qualitative CT imaging features.
CT values on VMI at 50-130keV (20keV-interval), k, and NIC values were significantly higher in IMCCs than in LAs (p<0.0001). The best single parameter for differentiating IMCC from LA was CT value at 90keV, with sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of 89.1%, 86.5%, 87.9%, 89.1%, and 86.5%, respectively. The best combination of parameters was CT value at 90keV, k, and NIC, with values of 87.5%, 84.6%, 83.6%, 87.5%, and 84.6%, respectively. Compared with CT value at linear blending images, CT value at 90keV showed greater sensitivity (89.1% vs 60.9%, p<0.0001) and similar specificity (86.5% vs 84.6%, p=1.0000), and combined CT value at 90keV, k, and NIC showed greater sensitivity (87.5% vs 60.9%, p<0.0001) and similar specificity (84.6% vs 84.6%, p=1.0000). Compared with qualitative analysis, CT value at 90keV showed greater sensitivity (89.1% vs 65.6%, p=0.0059) and specificity (86.5% vs 69.2%, p=0.0352), and combined CT value at 90keV, k, and NIC showed greater sensitivity (87.5% vs 65.6%, p=0.0094) and similar specificity (84.6% vs 69.2%, p >0.05).
Quantitative analysis of dual source dual-energy CT quantitative parameters showed greater accuracy than quantitative and qualitative analyses of conventional CT for differentiating small IMCCs from small LAs on single PVP scan.
探讨在门静脉期（PVP），双源双能量CT（DECT）定量参数与传统CT相比，对鉴别小（≤3cm）肝内肿块型胆管癌（IMCC）和小肝脓肿（LA）的应用价值。
本研究经机构审查委员会批准，为回顾性研究，回顾性纳入了64例IMCC患者和52例LA患者，这些患者均在PVP期采用双能量模式进行了成像。一名放射科医生在虚拟单色图像（VMI）、彩色编码碘叠加图像和线性融合比为0.3的线性融合图像上，在病变处绘制圆形感兴趣区，以获得CT值、其标准差、光谱曲线斜率（k）和归一化碘浓度（NIC）。两名放射科医生根据定性CT成像特征评估病变类型。
IMCC在50-130keV（间隔20keV）的VMI上的CT值、k值和NIC值显著高于LA（p<0.0001）。鉴别IMCC和LA的最佳单一参数是90keV时的CT值，其灵敏度、特异度、准确度、阳性预测值和阴性预测值分别为89.1%、86.5%、87.9%、89.1%和86.5%。最佳参数组合是90keV时的CT值、k值和NIC值，其值分别为87.5%、84.6%、83.6%、87.5%和84.6%。与线性融合图像上的CT值相比，90keV时的CT值显示出更高的灵敏度（89.1%对60.9%，p<0.0001）和相似的特异度（86.5%对84.6%，p=1.0000），90keV时的CT值、k值和NIC值组合显示出更高的灵敏度（87.5%对60.9%，p<0.0001）和相似的特异度（84.6%对84.6%，p=1.0000）。与定性分析相比，90keV时的CT值显示出更高的灵敏度（89.1%对65.6%，p=0.0059）和特异度（86.5%对69.2%，p=0.0352），9名放射科医生根据定性CT成像特征评估病变类型。
在单次PVP扫描中，双源双能量CT定量参数的定量分析在鉴别小IMCC和小LA方面比传统CT的定量和定性分析具有更高的准确性。
