双层光谱 CT 多参数特征在预测肝细胞癌微血管侵犯中的临床应用。

Clinical application of dual-layer spectral CT multi-parameter feature to predict microvascular invasion in hepatocellular carcinoma.

机构信息

The First Clinical Medical of Lanzhou University, Lanzhou, China.

Department of Radiology, The First Hospital of Lanzhou University, Lanzhou, China.

出版信息

Clin Hemorheol Microcirc. 2024;88(1):97-113. doi: 10.3233/CH-242175.

DOI:10.3233/CH-242175

PMID:38848171

Abstract

OBJECTIVE

This study aimed to investigate the feasibility of using dual-layer spectral CT multi-parameter feature to predict microvascular invasion of hepatocellular carcinoma.

METHODS

This retrospective study enrolled 50 HCC patients who underwent multiphase contrast-enhanced spectral CT studies preoperatively. Combined clinical data, radiological features with spectral CT quantitative parameter were constructed to predict MVI. ROC was applied to identify potential predictors of MVI. The CT values obtained by simulating the conventional CT scans with 70 keV images were compared with those obtained with 40 keV images.

RESULTS

50 hepatocellular carcinomas were detected with 30 lesions (Group A) with microvascular invasion and 20 (Group B) without. There were significant differences in AFP,tumer size, IC, NIC,slope and effective atomic number in AP and ICrr in VP between Group A ((1000(10.875,1000),4.360±0.3105, 1.7750 (1.5350,1.8825) mg/ml, 0.1785 (0.1621,0.2124), 2.0362±0.2108,8.0960±0.1043,0.2830±0.0777) and Group B (4.750(3.325,20.425),3.190±0.2979,1.4700 (1.4500,1.5775) mg/ml, 0.1441 (0.1373,0.1490),1.8601±0.1595, 7.8105±0.7830 and 0.2228±0.0612) (all p < 0.05). Using 0.1586 as the threshold for NIC, one could obtain an area-under-curve (AUC) of 0.875 in ROC to differentiate between tumours with and without microvascular invasion. AUC was 0.625 with CT value at 70 keV and improved to 0.843 at 40 keV.

CONCLUSION

Dual-layer spectral CT provides additional quantitative parameters than conventional CT to enhance the differentiation between hepatocellular carcinoma with and without microvascular invasion. Especially, the normalized iodine concentration (NIC) in arterial phase has the greatest potential application value in determining whether microvascular invasion exists, and can offer an important reference for clinical treatment plan and prognosis assessment.

摘要

目的

本研究旨在探讨双层光谱 CT 多参数特征预测肝细胞癌微血管侵犯的可行性。

方法

本回顾性研究纳入了 50 例术前接受多期对比增强光谱 CT 研究的 HCC 患者。结合临床资料、影像学特征和光谱 CT 定量参数构建预测 MVI 的模型。应用 ROC 识别 MVI 的潜在预测因子。通过模拟 70keV 图像的常规 CT 扫描获得 CT 值，并与 40keV 图像的 CT 值进行比较。

结果

50 例肝癌中 30 例（A 组）有微血管侵犯，20 例（B 组）无微血管侵犯。A 组 AFP、肿瘤大小、IC、NIC、斜率和 AP 中的有效原子数以及 VP 中的 ICrr 差异有统计学意义（（1000(10.875,1000)、4.360±0.3105、1.7750(1.5350,1.8825)mg/ml、0.1785(0.1621,0.2124)、2.0362±0.2108、8.0960±0.1043、0.2830±0.0777），B 组差异有统计学意义（4.750(3.325,20.425)、3.190±0.2979、1.4700(1.4500,1.5775)mg/ml、0.1441(0.1373,0.1490)、1.8601±0.1595、7.8105±0.7830、0.2228±0.0612）（均 P<0.05）。以 0.1586 作为 NIC 的阈值，在 ROC 中可以获得区分有微血管侵犯和无微血管侵犯肿瘤的曲线下面积（AUC）为 0.875。以 70keV 的 CT 值作为诊断阈值，AUC 为 0.625，以 40keV 的 CT 值作为诊断阈值，AUC 为 0.843。