使用多期双能量CT碘图对肝硬化进行无创评估：与终末期肝病模型评分的相关性
Non-invasive assessment of cirrhosis using multiphasic dual-energy CT iodine maps: correlation with model for end-stage liver disease score.
作者信息
Mastrodicasa Domenico, Willemink Martin J, Duran Celina, Pizzi Andrea Delli, Hinostroza Virginia, Molvin Lior, Khalaf Mohamed, Jeffrey R Brooke, Patel Bhavik N
机构信息
Department of Radiology, Stanford University School of Medicine, 300 Pasteur Dr, Rm H1307, MC 5105, Stanford, CA, 94305, USA.
Boston University School of Medicine, Boston, MA, USA.
出版信息
Abdom Radiol (NY). 2021 May;46(5):1931-1940. doi: 10.1007/s00261-020-02857-0. Epub 2020 Nov 19.
PURPOSE
To determine whether multiphasic dual-energy (DE) CT iodine quantitation correlates with the severity of chronic liver disease.
METHODS
We retrospectively included 40 cirrhotic and 28 non-cirrhotic patients who underwent a multiphasic liver protocol DECT. All three phases (arterial, portal venous (PVP), and equilibrium) were performed in DE mode. Iodine (I) values (mg I/ml) were obtained by placing regions of interest in the liver, aorta, common hepatic artery, and portal vein (PV). Iodine slopes (λ) were calculated as follows: (I-I)/time and (I-I)/time. Spearman correlations between λ and MELD scores were evaluated, and the area under the curve of the receiver operating characteristic (AUROC) was calculated to distinguish cirrhotic and non-cirrhotic patients.
RESULTS
Cirrhotic and non-cirrhotic patients had significantly different λ [IQR] for the caudate (λ = 2.08 [1.39-2.98] vs 1.46 [0.76-1.93], P = 0.007), left (λ = 2.05 [1.50-2.76] vs 1.51 [0.59-1.90], P = 0.002) and right lobes (λ = 1.72 [1.12-2.50] vs 1.13 [0.41-0.43], P = 0.003) and for the PV (λ = 3.15 [2.20-5.00] vs 2.29 [0.85-2.71], P = 0.001). λ were significantly different for the right (λ = 0.11 [- 0.45-1.03] vs - 0.44 [- 0.83-0.12], P = 0.045) and left lobe (λ = 0.30 [- 0.25-0.98] vs - 0.10 [- 0.35-0.24], P = 0.001). Significant positive correlations were found between MELD scores and λ for the caudate lobe (ρ = 0.34, P = 0.004) and λ for the caudate (ρ = 0.26, P = 0.028) and right lobe (ρ = 0.33, P = 0.007). AUROC in distinguishing cirrhotic and non-cirrhotic patients were 0.72 (P = 0.002), 0.71 (P = 0.003), and 0.75 (P = 0.001) using λ for the left lobe, right lobe, and PV, respectively. The λ AUROC of the right lobe was 0.73 (P = 0.001).
CONCLUSION
Multiphasic DECT iodine quantitation over time is significantly different between cirrhotic and non-cirrhotic patients, correlates with the MELD score, and it could potentially serve as a non-invasive measure of cirrhosis and disease severity with acceptable diagnostic accuracy.
目的
确定多期双能量（DE）CT碘定量与慢性肝病严重程度是否相关。
方法
我们回顾性纳入了40例肝硬化患者和28例非肝硬化患者，这些患者均接受了肝脏多期扫描DECT检查。所有三期（动脉期、门静脉期（PVP）和平衡期）均在DE模式下进行。通过在肝脏、主动脉、肝总动脉和门静脉（PV）中放置感兴趣区来获取碘（I）值（mg I/ml）。碘斜率（λ）的计算方法如下：(I-I)/时间和(I-I)/时间。评估λ与终末期肝病模型（MELD）评分之间的Spearman相关性，并计算受试者操作特征曲线下面积（AUROC）以区分肝硬化和非肝硬化患者。
结果
肝硬化和非肝硬化患者的尾状叶（λ = 2.08 [1.39 - 2.98] 对比 1.46 [0.76 - 1.93]，P = 0.007）、左叶（λ = 2.05 [1.50 - 2.76] 对比 1.51 [0.59 - 1.90]，P = 0.002）和右叶（λ = 1.72 [1.12 - 2.50] 对比 1.13 [0.41 - 0.43]，P = 0.003）以及PV（λ = 3.15 [2.20 - 5.00] 对比 2.29 [0.85 - 2.71]，P = 0.001）的λ [四分位距] 存在显著差异。右叶（λ = 0.11 [-0.45 - 1.03] 对比 -0.44 [-0.83 - 0.12]，P = 0.045）和左叶（λ = 0.30 [-0.25 - 0.98] 对比 -0.10 [-0.35 - 0.24]，P = 0.001）的λ也存在显著差异。尾状叶的MELD评分与λ之间存在显著正相关（ρ = 0.34，P = 0.004），尾状叶（ρ = 0.26，P = 0.028）和右叶（ρ = 0.33，P = 0.
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