Department of Radiology, Institute of Liver and Biliary Sciences, Sector D-1, Vasant Kunj, New Delhi, 110070, India.
Department of HPB Surgery and Liver Transplantation, Institute of Liver & Biliary Sciences, Sector D-1, Vasant Kunj, New Delhi, 110070, India.
Eur Radiol Exp. 2021 May 28;5(1):22. doi: 10.1186/s41747-021-00220-6.
There is limited scientific evidence on the potential of spectral computed tomography (SCT) for differentiation of nodules in the cirrhotic liver. We aimed to assess SCT-generated material density (MD) parameters for nodule characterisation in cirrhosis.
Dynamic dual-energy SCT scans of cirrhotic patients performed over 3 years were retrospectively reviewed. They were classified as hepatocellular carcinoma (HCC), regenerative or indeterminate, according to the European Association for the Study of the Liver criteria. MD maps were generated to calculate the area under the curve (AUC) and cutoff values to discriminate these nodules in the hepatic arterial phase (HAP) and portal venous phase (PVP). MD maps included iodine concentration density (ICD) of the liver and nodule, lesion-to-normal liver ICD ratio (LNR) and difference in nodule ICD between HAP and PVP.
Three hundred thirty nodules belonging to 300 patients (age 53.0 ± 12.7 years, mean ± standard deviation) were analysed at SCT (size 2.3 ± 0.8 cm, mean ± SD). One hundred thirty-three (40.3%) nodules were classified as HCC, 147 (44.5%) as regenerative and 50 (15.2%) as indeterminate. On histopathology, 136 (41.2%) nodules were classified as HCC, 183 (55.5%) as regenerative and 11 (3.3%) as dysplastic. All MD parameters on HAP and the nodule difference in ICD could discriminate pathologically proven HCC or potentially malignant nodules from regenerative nodules (p < 0.001). The AUC was 82.4% with a cutoff > 15.5 mg/mL for nodule ICD, 81.3% > 1.8 for LNR-HAP and 81.3% for difference in ICD > 3.5 mg/mL.
SCT-generated MD parameters are viable diagnostic tools for differentiating malignant or potentially malignant from benign nodules in the cirrhotic liver.
关于光谱 CT（SCT）在肝硬化肝脏结节中的潜在应用，目前仅有有限的科学证据。本研究旨在评估 SCT 生成的物质密度（MD）参数，以对肝硬化中的结节进行特征描述。
对过去 3 年中进行的肝硬化患者的动态双能 SCT 扫描进行回顾性研究。根据欧洲肝脏研究协会（EASL）标准，将这些结节分类为肝细胞癌（HCC）、再生性或不确定。生成 MD 图以计算曲线下面积（AUC）和临界值，以区分这些在肝动脉期（HAP）和门静脉期（PVP）的结节。MD 图包括肝脏和结节的碘浓度密度（ICD）、病变与正常肝脏 ICD 比值（LNR）以及 HAP 和 PVP 之间结节 ICD 的差值。
共分析了 300 名患者（年龄 53.0 ± 12.7 岁，均值 ± 标准差）的 330 个结节（大小 2.3 ± 0.8cm，均值 ± SD）。其中 133 个（40.3%）结节被归类为 HCC，147 个（44.5%）为再生性结节，50 个（15.2%）为不确定结节。组织病理学检查显示，136 个（41.2%）结节为 HCC，183 个（55.5%）为再生性结节，11 个（3.3%）为发育不良结节。HAP 上的所有 MD 参数和 ICD 差值均可区分经病理证实的 HCC 或潜在恶性结节与再生性结节（p < 0.001）。当结节 ICD 的截断值＞15.5mg/mL、LNR-HAP 的截断值＞1.8 以及 ICD 差值的截断值＞3.5mg/mL 时，AUC 分别为 82.4%、81.3%和 81.3%。
SCT 生成的 MD 参数是区分肝硬化中恶性或潜在恶性与良性结节的有效诊断工具。
