Qiu Qixuan, Ai Yingjie, Pan Yijun, Luo Wei, Xu Zhihan, Chen Shiyao, Lin Jiang
Department of Radiology, Zhongshan Hospital, Fudan University and Shanghai Institute of Medical Imaging, Shanghai, China.
Department of Gastroenterology and Hepatology, Zhongshan Hospital, Fudan University, Shanghai, China.
Abdom Radiol (NY). 2024 Nov 15. doi: 10.1007/s00261-024-04666-1.
To investigate the clinical value of dual-source dual-energy CT (dsDECT) quantitative parameters in evaluating hemodynamics and predicting high-risk gastroesophageal varices in cirrhotic patients.
98 consecutive patients were collected in this prospectively study and all patients underwent an abdominal triple-phase contrasted-enhanced examination with dsDECT. Iodine concentration (IC) and normalized iodine concentration (NIC) of the liver parenchyma, spleen parenchyma and aorta at different phases were recorded, and arterial iodine fraction (AIF), iodine washout rate (IWR), and extracellular volume (ECV) were calculated. Using upper gastrointestinal endoscopy as the reference standard, patients who met the inclusion and exclusion criteria were divided into groups with varices need treatment (VNT) and non-VNT. The clinical characteristics, traditional CT features and quantitative dsDECT parameters were compared between the VNT group and the non-VNT group using univariate analysis. The binary logistics analysis was used to build a model for diagnosing VNT. The receiver operating characteristic (ROC) curve was used for analysis and the DeLong test was used to compare different ROC curves.
Finally, 57 patients were included in this study. Univariate analysis showed statistically significant differences in NIC of the liver at the portal venous phase (NIC-L), IWR of the liver (IWR-L) and spleen volume between the VNT group and the non-VNT group (p < 0.05). The mixed-CT model was built by binary logistics analysis. The ROC curves of NIC-L, IWR-L, spleen volume and the mixed-CT model were statistically significant (p < 0.05) for predicting VNT in cirrhotic patients, among which the area under the ROC curve of the mixed-CT model was the highest.
Dual-source dual-energy CT has added clinical value in evaluating hepatic hemodynamics and diagnosing VNT in patients with liver cirrhosis.
探讨双源双能量CT（dsDECT）定量参数在评估肝硬化患者血流动力学及预测高危食管胃静脉曲张中的临床价值。
本前瞻性研究共纳入98例连续患者，所有患者均接受了腹部三相对比增强dsDECT检查。记录不同时期肝实质、脾实质和主动脉的碘浓度（IC）及标准化碘浓度（NIC），并计算动脉碘分数（AIF）、碘洗脱率（IWR）和细胞外容积（ECV）。以上消化道内镜检查为参考标准，将符合纳入和排除标准的患者分为需治疗的静脉曲张组（VNT）和非VNT组。采用单因素分析比较VNT组和非VNT组的临床特征、传统CT特征及dsDECT定量参数。采用二元逻辑回归分析建立诊断VNT的模型。采用受试者操作特征（ROC）曲线进行分析，并用DeLong检验比较不同的ROC曲线。
最终本研究纳入57例患者。单因素分析显示，VNT组和非VNT组在门静脉期肝脏NIC（NIC-L）、肝脏IWR（IWR-L）及脾脏体积方面差异有统计学意义（p<0.05）。通过二元逻辑回归分析建立了混合CT模型。NIC-L、IWR-L、脾脏体积及混合CT模型的ROC曲线对肝硬化患者VNT的预测具有统计学意义（p<0.05），其中混合CT模型的ROC曲线下面积最大。
双源双能量CT在评估肝硬化患者肝脏血流动力学及诊断VNT方面具有额外的临床价值。
