Quantitative Analysis In Evaluating The Hepatic Iron Deposition Among Patients With Hepatic Alveolar Echinococcosis By Energy Spectrum CT Imaging

Objective:This work aimed to study the value of energy spectrum CT imaging combined with serum ferritin(SF)in the measurement of hepatic iron deposition among patients with hepatic alveolar echinococcosis(HAE),the changes of hepatic iron deposition under different Child-pugh liver function grades and the correlation of Child-pugh score,so as to provide a new idea for comprehensive treatment and the evaluation of liver function in patients with alveolar echinococcosis.Methods: 49 patients with HAE and 41 patients with Primary hepatic carcinoma(PHC)diagnosed by clinical and imaging examination in the affiliated Hospital of Qing Hai University from September 2019 to November 2021 were collected,and another 30 healthy subjects were selected to form the control group.All participants were scanned with energy spectrum CT mode.The energy spectrum CT images based on water and iron were reconstructed by GSI post-processing software,and the virtual iron concentration and slope of energy spectrum curve of all patients were obtained on the iron-based images.The relevant clinical data were collected and the indexes such as the virtual iron concentration,serum ferritin level and liver function were analyzed.The differences in the virtual iron concentration,SF,liver function and other indicators of HAE patients(HAE group),PHC patients(PHC group),and healthy subjects(control group)were analyzed among the three groups,and the correlation between the virtual iron concentration and SF,liver function in HAE group was analyzed by Spearman correlation analysis,and the correlation between SF and lesion maximum diameter and liver function in HAE group was analyzed.Then the HAE group was divided into two groups according to the grading standard of Child-Pugh and the actual situation of clinical cases,including group A(n = 36)and group B(n = 13).The liver function score was recorded at the same time.The virtual iron concentration and SF were analyzed by one-way ANOVA,and the correlation between the virtual iron concentration,SF and Child-pugh score was analyzed by Spearman method.Results: 1.The values of the virtual iron concentration in control group,HAE group and PHC group were 1.09(0.87,1.25),1.70(1.34,1.91)and 1.59(1.27,2.01),respectively,and SF were 70.72(33.91,138.57),224.19(59.69,529.20),464.54(244.96,1067.26)respectively.55.1% of HAE patients and 80.4% of PHC patients had SF beyond the reference range,and 93.8% of HAE patients and 95.1% of PHC patients had abnormal liver function indicators.There were significant differences in the slope of energy spectrum curve,virtual iron concentration,SF,Alanine aminotransferase(ALT),Total bilirubin(TBIL),Direct bilirubin(DBIL),Indirect bilirubin(IBIL),Total protein(TP),Albumin(ALB),Globulin(GLB),Alkaline phosphatase(ALP),Glutamyl transferase(GGT)and Aspartate aminotransferase(AST)among the three groups.Among them,there were statistical differences in SF and GGT in every two of the three groups;there were statistical differences in the virtual iron concentration,the slope of energy spectrum curve,ALB,GLB and ALP between control group and HAE group,between control group and PHC group,but there were no statistical differences between HAE group and PHC group;there were statistical differences in ALT,TBIL,DBIL,IBIL and AST between PHC group and control group,PHC group and HAE group,and there were no statistical differences between control group and HAE group.There was statistical difference in TP between HAE group and control group,HAE group and PHC group,but there was no statistical difference between control group and PHC group.There was no significant difference in the maximum diameter of lesion between HAE group and PHC group.2.The virtual iron concentration was positively correlated with SF,maximum diameter of lesion,TBIL,DBIL and IBIL,and the correlation coefficient was r=0.732,r=0.285,r=0.425,r=0.376,r=0.407.There was a negative correlation between The virtual iron concentration and TP and ALB,and the correlation coefficient was r=-0.314,r=-0.425 respectively.There was correlation between SF and GGT,TBIL,DBIL,IBIL,ALB and ALP,and the correlation coefficient was r=0.400,r=0.420,r=0.422,r=0.358,r=-0.403,r=0.327.3.The comparison of The virtual iron concentration and SF between different liver function groups found that the control group was the lowest,followed by group A,and group B was relatively high,and there were significant differences between different groups.There was a positive correlation between The virtual iron concentration,SF and Child-pugh score in different HAE liver function grading groups,and the correlation degree was strong,the correlation coefficient was r=0.476,r=0.322 respectively.Conclusion: Most HAE patients have abnormal iron deposition in the liver,and the degree of liver function damage among patients with HAE is not weaker than that in patients with PHC.With the deterioration of liver function,hepatic iron deposition in HAE will gradually aggravate.Hepatic iron deposition has a certain indirect correlation with the degree of liver damage and the state of liver function reserve in patients with HAE.Energy spectrum CT material separation combined with SF detection can be used to non-invasively evaluate abnormal iron deposition in the liver of patients with HAE.Energy spectrum CT is expected to be a valuable functional imaging technique for evaluating liver iron deposition in HAE.