CT能谱技术定量参数与AFP、DCP的关系及诊断肝细胞肝癌的效能研究

doi:10.7517/issn.1674-0475.210908

摘要/Abstract

摘要： 探讨计算机断层扫描(CT)能谱技术定量参数与甲胎蛋白(AFP)、异常凝血酶原(DCP)的关系及诊断肝细胞肝癌(HCC)的效能。选取61例HCC患者(HCC组)与61例肝良性病变患者(良性组)为研究对象,比较两组动脉期和门静脉期40～140 keV单能量水平下,病灶-肝脏对比噪声比(CNR)、钙(脂肪)浓度、脂肪(钙)浓度、水碘浓度、病灶与正常肝组织碘浓度比值(LNR)、标准化碘浓度(NIC)。结果显示,动脉期两组至50 keV均具有最佳的CNR,门静脉期HCC组至70 keV具有最佳的CNR;HCC组动脉期和门静脉期钙(脂肪)浓度、LNR、NIC低于良性组,脂肪(钙)浓度高于良性组(P<0.05),各指标均与AFP、DCP显著相关(P<0.05);动脉期50 keV的CNR联合动脉期NIC诊断HCC的AUC为0.935。因此,通过CT能谱检测最佳CNR可获得最佳单能量图像,动脉期50 keV的CNR和NIC等与AFP、DCP相关,联合检测可作为诊断HCC的无创性方法。

关键词: 计算机断层扫描(CT)能谱技术, 甲胎蛋白, 异常凝血酶原, 肝癌

Abstract: This study investigated the relationship between the quantitative parameters of computed tomography (CT) spectroscopy technology and alpha-fetoprotein (AFP), abnormal prothrombin (des-γ-carboxyprothrombin, DCP) and the diagnostic efficiency of hepatocellular carcinoma (HCC). Sixty-one patients with HCC (HCC group) and 61 patients with benign liver lesions (benign group) were selected as the study subjects. The lesion-liver contrast noise ratio (CNR), calcium (fat) concentration, fat (calcium) concentration, water iodine concentration, lesion-to-normal hepatic tissue ratio (LNR) and normalized iodine concentration (NIC) were compared between the two groups at a single energy level of 40-140 keV in arterial phase and portal vein phase. The results showed that the arterial phase two groups had the best CNR up to 50 keV, and the portal phase HCC group had the best CNR up to 70 keV. The arterial phase and portal phase calcium (fat) concentration, LNR, and NIC of the HCC group were lower than those of the benign group. The concentration of fat (calcium) was higher than that of the benign group (P<0.05), and each index was significantly correlated with AFP and DCP (P<0.05). The AUC of the CNR of 50 keV in the arterial phase combined with the arterial NIC for the diagnosis of HCC was 0.935. Therefore, the best single-energy image can be obtained by detecting the best CNR by CT spectroscopy. The 50 keV CNR and NIC in the arterial phase are related to AFP and DCP. The combined detection can 301 be used as a non-invasive method for diagnosing HCC.

Key words: CT spectroscopy, alpha-fetoprotein, abnormal prothrombin, liver cancer

杜林, 王宇. CT能谱技术定量参数与AFP、DCP的关系及诊断肝细胞肝癌的效能研究[J]. 影像科学与光化学, 2022, 40(2): 301-305.

DU Lin, WANG Yu. Study on the Relationship between Quantitative Parameters of CT Spectroscopy Technology and AFP, DCP and the Efficacy of Diagnosing Liver Cancer[J]. IMAGING SCIENCE AND PHOTOCHEMISTRY, 2022, 40(2): 301-305.

参考文献

[1] 全国多中心前瞻性肝癌极早期预警筛查项目(PreCar)专家组. 中国肝癌早筛策略专家共识[J]. 中华肝脏病杂志,2021,26(8):825-831.
[2] Greffier J,Dabli D,Hamard A,et al. Impact of dose reduction and the use of an advanced model-based iterative reconstruction algorithm on spectral performance of a dual-source CT system:A task-based image quality assessment[J]. Diagnostic and Interventional Imaging,2021,102(7-8):405-412.
[3] Greffier J,Si-Mohamed S,Dabli D,et al. Performance of four dual-energy CT platforms for abdominal imaging:A task-based image quality assessment based on phantom data[J]. European Radiology,2021,31(7):5324-5334.
[4] Wu M,Liu Z,Zhang A,et al. Associated measurement of fucosylated levels of AFP,DCP,and GPC3 for early diagnosis in hepatocellular carcinoma[J]. The International Journal of Biological Markers,2019,34(1):20-26.
[5] Wei R R,Wang C C,Li D J,et al. Diagnostic value of abnormal prothrombin in HBV-related AFP-negative hepatocellular carcinoma[J].Journal of Sichuan University (Medical Science Edition),2020,51(3):411-415.
[6] Lim T S,Rhee H,Kim G M,et al. Alpha-fetoprotein,des-gamma-carboxy prothrombin,and modified RECIST response as predictors of survival after transarterial radioembolization for hepatocellular carcinoma[J]. Journal of Vascular and Interventional Radiology,2019,30(8):1194-1200.e1.
[7] 中华人民共和国卫生和计划生育委员会医政医管局. 原发性肝癌诊疗规范(2017年版)[J]. 中华消化外科杂志,2017,16(7):635-647.
[8] Zhou L,Rui J G,Ye D X,et al. Edmondson-Steiner grading increases the predictive efficiency of TNM staging for long-term survival of patients with hepatocellular carcinoma after curative resection[J]. World Journal of Surgery,2008,32(8):1748-1756.
[9] Tsurusaki M,Sofue K,Hori M,et al. Dual-energy computed tomography of the liver:Uses in clinical practices and applications[J]. Diagnostics (Basel),2021,11(2):161.
[10] Ren L Q,Rajendran K,McCollough C H,et al. Quantitative accuracy and dose efficiency of dual-contrast imaging using dual-energy CT:A phantom study[J]. Medical Physics,2020,47(2):441-456.
[11] Laroia S T,Yadav K,Kumar S,et al. Material decomposition using iodine quantification on spectral CT for characterising nodules in the cirrhotic liver:A retrospective study[J]. European Radiology Experimental,2021,5(1):22.
[12] 杜娟. 能谱CT成像对肝癌与肝脏局灶性结节性增生的鉴别诊断[J]. 实用医学影像杂志,2020,21(3):319-320.
[13] Shao C C,Zhao F,Yu Y F,et al. Value of perfusion parameters and histogram analysis of triphasic computed tomography in pre-operative prediction of histological grade of hepatocellular carcinoma[J].Chinese Medical Journal,2021,134(10):1181-1190.
[14] Xu R,Wang J,Huang X Y,et al. Clinical value of spectral CT imaging combined with AFP in identifying liver cancer and hepatic focal nodular hyperplasia[J]. Journal of BUON,2019,24(4):1429-1434.
[15] Pang G,Shao C,Lv Y,et al. Tumor attenuation and quantitative analysis of perfusion parameters derived from tri-phasic CT scans in hepatocellular carcinoma:Relationship with histological grade[J]. Medicine (Baltimore),2021,100(16):e25627.