Ominde Sheila T, Mutala Timothy M
Department of Diagnostic Imaging and Radiation Medicine, University of Nairobi, Nairobi, Kenya.
SA J Radiol. 2019 May 21;23(1):1667. doi: 10.4102/sajr.v23i1.1667. eCollection 2019.
Current advancements in dynamic contrast imaging of the liver have enabled increased sensitivity in the diagnosis of liver lesions. Evaluation and characterisation of the enhancement pattern of liver lesions in respect to the liver parenchyma aids in making a specific diagnosis.
The aim of this study was to determine the liver findings on dynamic contrast computed tomography (CT) scanning and correlate them with clinicopathologic findings.
This prospective cross-sectional study included 61 patients and took place between August 2017 and February 2018. Dynamic contrast CT was performed and the images were evaluated by two experienced radiologists. Correlation of the CT findings with histology results from an ultrasound-guided biopsy was done. Data analysis was performed using SPSS version 20.0.
Hepatocellular carcinoma (HCC) was the most common malignant lesion seen and showed three patterns of enhancement: homogenous, abnormal internal vessels and heterogeneous enhancement. Abnormal internal vessel pattern was most specific (90.6%) and showed a high positive predictive value (PPV) of 78.6%. Rapid washout showed a specificity of 87.5% and a PPV of 72.2% in the diagnosis of HCC. Dynamic contrast CT scan had a sensitivity of 93%, specificity of 50%, PPV of 91% and diagnostic accuracy of 95.5% in differentiation of benign and malignant liver lesions. Considering only Liver Imaging Reporting and Data System (LI-RADS) category 5 as conclusive for HCC diagnosis, our study did not miss a significant number of HCCs. Liver Imaging Reporting and Data System category 5 showed specificity of 81.3% and PPV of 75%.
Enhancement patterns on a dynamic contrast CT scan of the liver are useful in the interpretation of CT images for specific diagnoses.
肝脏动态对比成像技术的当前进展提高了肝脏病变诊断的敏感性。评估肝脏病变相对于肝实质的强化模式有助于做出明确诊断。
本研究旨在确定动态对比计算机断层扫描（CT）的肝脏表现，并将其与临床病理结果相关联。
这项前瞻性横断面研究纳入了61例患者，研究时间为2017年8月至2018年2月。进行了动态对比CT检查，图像由两名经验丰富的放射科医生进行评估。将CT结果与超声引导下活检的组织学结果进行关联。使用SPSS 20.0版进行数据分析。
肝细胞癌（HCC）是最常见的恶性病变，表现出三种强化模式：均匀强化、内部血管异常和不均匀强化。内部血管异常模式最具特异性（90.6%），阳性预测值（PPV）高达78.6%。快速洗脱在HCC诊断中的特异性为87.5%，PPV为72.2%。动态对比CT扫描在鉴别肝脏良恶性病变方面的敏感性为93%，特异性为50%，PPV为91%，诊断准确性为95.5%。仅将肝脏影像报告和数据系统（LI-RADS）5类视为HCC诊断的确定性标准时，我们的研究未遗漏大量HCC。LI-RADS 5类的特异性为81.3%，PPV为75%。
肝脏动态对比CT扫描的强化模式有助于解读CT图像以进行明确诊断。
