Mohakud Sudipta, Sreejith Vimal, Bag Nerbadyswari Deep, Patra Susama, Panigrahi Manas Kumar, Kumar Pankaj, Pattnaik Brahmadatta, Dutta Tanmay, Naik Suprava, Tripathy Taraprasad, Patel Ranjan Kumar, Divya M, Muduly Dillip Kumar, Kar Madhabananda
All India Institute of Medical Sciences Bhubaneswar, Bhubaneswar, India.
Abdom Radiol (NY). 2025 Jun;50(6):2440-2452. doi: 10.1007/s00261-024-04688-9. Epub 2024 Nov 25.
Differentiating the various liver tumors is pivotal due to distinct treatments and prognoses. Sometimes, it is difficult to accurately differentiate hepatocellular carcinoma (HCC) from other hepatic neoplasms non-invasively because of overlap in the triple-phase contrast-enhanced computed tomography (CECT) features, contraindication of an invasive biopsy, particularly in multifocal lesions with cirrhosis or ascites or when an MRI is unavailable or not feasible.
To assess the utility of CT perfusion (CTP) parameters in differentiating HCC from other hepatic neoplasms.
Forty-eight patients with suspicious liver lesions underwent CTP imaging. Perfusion parameters were assessed within the tumor and the adjacent normal liver using the post-processing software. Statistical significance (p-value), sensitivity, and specificity value of the individual parameters were assessed. The receiver operating characteristic (ROC) curve analysis was done to threshold values of the parameters.
The mean values of perfusion parameters like HAP (hepatic arterial perfusion), PVP (portal venous perfusion), HPI (hepatic perfusion index), BF (blood flow), BV (blood volume), MTT (mean transit time), and TTP (time to peak) were statistically significant (p-value < 0.05) between HCC and other hepatic neoplasms. Among the parameters, BV had the greatest AUC of 0.938. With a threshold value of 8.3 ml/100 ml/min, the sensitivity and specificity were 96.6% and 80%, respectively, in distinguishing HCC from other hepatic neoplasms. HPI, BF, BV, and TTP were statistically significant in differentiating hypervascular metastases from HCCs. HAP, HPI, BF, BV, and TTP were statistically significant in differentiating HCC from hypovascular metastases. BF and BV were significant in differentiating hypervascular from hypovascular metastases. HAP, PVP, HPI, BF, BV, and TTP were statistically significant in differentiating HCCs from intrahepatic cholangiocarcinomas.
CTP provides a quantitative, non-invasive method to differentiate HCC from other hepatic neoplasms with high efficacy. It can be a problem-solving tool when a conventional CECT scan cannot characterize a lesion as HCC, where biopsy is not feasible.
由于治疗方法和预后不同，鉴别各种肝脏肿瘤至关重要。有时，由于三相对比增强计算机断层扫描（CECT）特征存在重叠、侵入性活检存在禁忌证，尤其是在伴有肝硬化或腹水的多灶性病变中，或者当无法进行磁共振成像（MRI）或不可行时，很难通过非侵入性方法准确区分肝细胞癌（HCC）与其他肝脏肿瘤。
评估CT灌注（CTP）参数在鉴别HCC与其他肝脏肿瘤中的作用。
48例肝脏可疑病变患者接受了CTP成像。使用后处理软件评估肿瘤及相邻正常肝脏内的灌注参数。评估各个参数的统计学意义（p值）、敏感性和特异性值。对参数的阈值进行了受试者操作特征（ROC）曲线分析。
HAP（肝动脉灌注）、PVP（门静脉灌注）、HPI（肝灌注指数）、BF（血流量）、BV（血容量）、MTT（平均通过时间）和TTP（达峰时间）等灌注参数的平均值在HCC与其他肝脏肿瘤之间具有统计学意义（p值<0.05）。在这些参数中，BV的曲线下面积（AUC）最大，为0.938。阈值为8.3 ml/100 ml/min时，在区分HCC与其他肝脏肿瘤方面，敏感性和特异性分别为96.6%和80%。HPI、BF、BV和TTP在鉴别高血供转移瘤与HCC方面具有统计学意义。HAP、HPI、BF、BV和TTP在鉴别HCC与低血供转移瘤方面具有统计学意义。BF和BV在鉴别高血供与低血供转移瘤方面具有统计学意义。HAP、PVP、HPI、BF、BV和TTP在鉴别HCC与肝内胆管癌方面具有统计学意义。
CTP提供了一种定量、非侵入性的方法，能够高效地鉴别HCC与其他肝脏肿瘤。当传统的CECT扫描无法将病变特征化为HCC且活检不可行时，CTP可以成为解决问题的工具。
