| Part one The feasibility of one-stop spectral and perfusion CT in hepatocellular carcinoma examination Objective:The effects of different monochromatic image choices on the accuracy of CT perfusion valus for hepatocellular carcinoma perfusion parameters and the feasibility for hepatocellular carcinoma in one-stop spectral and perfusion CT.Materials and methods:Prospectively collected 30 patients with pathologically confirmed hepatocellular carcinoma from January 2018 to December 2018 in the First Affiliated Hospital of Zhengzhou University.All patients underwent one-stop spectral and perfusion CT scan in GE Revolution CT.Retrospectively collected 75 patients with pathologically confirmed hepatocellular carcinoma who performed normal liver volume perfusion scan ?multistage spectral CT enhanced scan and multistage dynamic CT enhanced scan and in our hospital during the same period.25 cases.Perfusion reconstruction was performed by one-stop spectral and perfusion CT with the original 19 perfusion images with the three-phase energy-enhanced images of 100kVp-like(equivalent to 68KeV)level,as group A,Monochromatic images with energy level from 40 to 90 keV(interval 10,group B1 to B6),generated from spectral CT during the three-phase energy-enhanced images,and the pancreatic volume perfusion imaging as group C.All the images were analyzed on the workstation of ADW 4.7.Measurement of perfusion parameters recorded for lesions: blood volume(BV),blood flow(BF),mean transit time(MTT),hepatic artery fraction(HAF),and surface permeability(PS).?Compare the perfusion parameters of each group.?Compare the image quality of one-stop spectral and perfusion scan with normal liver volume perfusion scan.?Compare the total amount of contrast agent,radiation dose and scan time of the four scan methods.Results:?There was a statistically significant difference between the parameters of the perfusion group(group A,group B1-B6)reconstructed by one-stop spectral and perfusion scan with different single energy levels(p<0.05),In the range of 40-80 KeV,as the single energy level increases,the BV and BF values decrease,and the MTT and HAF increase accordingly.?There was no significant difference in perfusion parameters between group A and group C(P>0.05).?One-stop spectral and perfusion scan image subjective quality score was higher than normal liver volume perfusion scan,and all images met the diagnostic criteria,the difference was not statistically significant(U values was 1.462,p<0.05).?The image noise of one-stop spectral and perfusion scan was higher than normal liver volume perfusion scan,the difference was not statistically significant,p<0.05).?The total amount of contrast agent and in one-stop spectral and perfusion CT was lower than that in multistage spectral CT enhanced scan and multistage dynamic CT enhanced scan,the difference was not statistically significant(P>0.05),higher than that in normal liver volume perfusion scan,the difference was statistically significant(p<0.05).?The radiation dose in one-stop spectral and perfusion CT was higher than that in multistage spectral CT enhanced scan and multistage dynamic CT enhanced scan,the difference was not statistically significant(P>0.05),higher than that in normal liver volume perfusion scan,the difference was statistically significant(p<0.05).?The scan time in one-stop spectral and perfusion CT was higher than that in multistage spectral CT enhanced scan and multistage dynamic CT enhanced scan,the difference was not statistically significant(P>0.05),lower than that in normal liver volume perfusion scan,the difference was statistically significant(p<0.05).Conclusions:1.Different single-energy horizontal energy spectrum data involved in perfusion reconstruction had an effect on the perfusion parameters of hepatocellular carcinoma.There parameters and the image quality were no statistical difference between one-stop spectral and perfusion with normal liver volume perfusion,which could be applied to clinical practice.2.one-stop spectral and perfusion imaging can obtain both spectral imaging and perfusion imaging,which reduces the amount of contrast agent,costs of inspection,and saves time.The radiation dose is reduced while ensuring image quality.Part two The application of one-stop spectral and perfusion CT in identification of hepatocellular carcinoma and atypical hemangiomaObjective: The application value of one-stop spectral and perfusion CT in differential diagnosis of hepatocellular carcinoma and atypical hemangioma was discussed was discussed.Materials and methods: Prospectively collected 30 patients and 22 patients with hepatocellular carcinoma and atypical hemangioma confirmed by pathology from January 20 to December 2018 in the First Affiliated Hospital of Zhengzhou University.The hepatocellular carcinoma group(16 males,14 females,45 ~76 years old,median age 62 years)and atypical hemangioma group(9 males,13 females,aged 43-64 years,median age 56 years),All patients underwent one-stop spectral and perfusion CT scan in GE Revolution CT.one-stop spectral and perfusion original perfusion images and three-phases energy-enhanced images were analyzed on the workstation of ADW 4.7.?Measurement of perfusion parameters of two groups of lesions: blood volume(BV),blood flow(BF),mean transit time(MTT),hepatic artery fraction(HAF),and surface permeability(PS).?Record the iodine concentrations in the arterial,portal,and delayed phases of the two groups,and the iodine concentration in the abdominal aorta and surrounding normal liver parenchyma at the same level.Calculate the standardized iodine concentration,NIC,and the ratio of iodine concentration between lesion and surrounding normal liver parenchyma,LNR.Two independent sample t-tests were used to compare the perfusion and spectral parameters of the two groups,and the ROC curve was used to analyze the individual diagnostic efficacy of each parameter and the combined diagnostic efficacy.Results:?The differences between BV,BF,MTT and HAF in perfusion parameters of hepatocellular carcinoma and atypical hemangioma were statistically significant.(p<0.05).?The difference between NIC and LNR with enhanced three-phases energy spectrum was statistically significant.(P<0.05).?The diagnostic efficiency of HAF and BV was higher in perfusion parameters.The AUC values were 0.922 and 0.860,respectively.The sensitivity of differential diagnosis was 90.9% and 89.3%,respectively,and the specificity was 87.9% and 75%,respectively.The diagnostic performance of PP-LNR and PP-NIC was higher in spectral parameters.The AUC values of the two parameters were 0.952 and 0.918,respectively.The sensitivity of differential diagnosis was 84.9% and 96.9%,respectively,and the specificity was 100% and 78.5%,respectively.?The combination of HAF and PP-LNR has the highest diagnostic efficiency,and the AUC value is 0.990.The sensitivity and specificity of the two groups were 93.9% and 96.4%,respectively.Conclusions:One-stop spectral and perfusion CT scan technology can provide more parameters,partial parameter(BV?BF?MTT?HAF? NIC?LNR)have a certain value in identifying liver cancer and atypical hemangioma,the combination of HAF and PP-LNR is the most effective.One-stop spectral and perfusion CT scan can improve the differential diagnosis of liver cancer and atypical hemangioma. |
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