| Objective:Energy spectrum CT multi-parameters(iodine/water separation,curve and slope,single energy map)were used to study the spectral imaging characteristics of different tissues of primary liver cancer after TACE,and to explore the value of energy spectrum CT in the evaluation of short-term curative effect after TACE of primary liver cancer.Methods:Collect one or more primary liver cancers from Ningxia Hui Autonomous People's Hospital from November 2017 to 2019 after TACE,35 patients were treated with TACE again,with total 101 lesions and 30 males(85.71%)and 5 females(14.28%).The age was 36 to 79,with an average of(45.4±13.1)years.After one or more times of TACE treatment,enhanced scanning of energy spectrum CT were performed 1 to 3 days before operation.The images of mixed energy QC(120k Vp-like)and energy spectrum information GSI(Data file)were obtained at the same time,and the images were transmitted to the postprocessing workstation for data measurement and analysis.In this study,the mixed energy image is used to represent the conventional CT image [1],and DSA is used as the gold standard[2].(1)The CNR curve of spectral analysis software was used to analyze the ke V value when the contrast of the lesion was maximum.At the same time,the ke V value was quantitatively calculated,and the lesions were observed by different physicians.Finally,the optimal single energy image was determined by taking into account.(2)Different physicians observed the blood supply of lipiodol defect area on QC and GSI,and calculated the sensitivity,specificity,accuracy,positive and negative predictive value of the two results.The statistical method was?2test,the difference was statistically significant(P<0.05).(3)The IC,NIC,WC,NWC ICD,LNR,AIF,40-140 ke V CT values,slope of spectral curve(40-70 ke V,70-100 ke V,100-140 ke V)in different phases of blood supply area,necrotic area and normal liver tissue were measured and calculated by post-processing software.When the data conformed to the normal distribution and the variance was homogeneous,the independent sample t test and the one-way ANOVA were used for the comparison,otherwise the MannWhitney U or Kruskal-Wallis rank sum test were used for the comparison.The ROC curve was drawn and the efficiency of multi-parameter diagnosis of three groups was analyzed.Results:(1)The CNR curve between the lesion and normal liver tissue showed and calculated that the maximum contrast value was at 40 ke V.But 90 ke V was the most suitable image for observing lipiodol defect area.(2)Taking DSA as the gold standard,the results of QC and GSI images detected lesions were as follows:sensitivity80.00%,93.85%,Specificity77.78%,91.67%,accuracy79.21%,93.07%,positive negative predictive value86.67%,95.31%;68.29%,89.19%.(2)In arterial and portal phase,the IC of three groups was(11.39±5.51,4.84±3.88,5.04±1.88)(15.76 ±6.43,6.54 ±4.95,18.22 ±6.31),and In arterial phase,there was significant difference between blood supply and necrotic area and normal liver tissue(P<0.05),In portal phase,there was significant difference between necrotic and blood supply area and normal liver tissue,but there was no significant difference between other two groups(P>0.05).The ICD of three groups were3.52±4.09,1.69±2.97,13.18±6.03,and there were significant differences among the three groups.There was no statistical difference among the three groups of WC and NWC.The AIF of three groups was 0.85±0.38,0.74±0.30,0.29±0.12.There was significant difference in AIF between blood supply,necrotic area and normal liver tissue,but there was no significant difference between other two groups.The LNR of blood supply and necrotic area in arterial and portal phase were 1.64±0.83,0.83±0.47,1.05±0.82,0.37±0.24,respectively.There were significant differences.There was significant difference in 40-60 100-140 ke V between arterial phase blood supply area and normal liver tissue,there was no significant difference in 70-90 ke V.There was significant difference in 60-140 ke V between arterial phase necrotic area and normal liver tissue,but there was no statistical significance in 40-50 ke V.The difference of CT value between arterial phase blood supply area and necrotic area was statistically significant.There were significant differences in CT among the three groups in portal phase.There were significant differences between arterial and portal blood supply area,necrotic area and normal liver tissue in the three slope intervals.There was no significant difference between the blood supply area and the necrotic area in the arterial phase,but there was significant difference in portal phase.(4)The area under the AIF ROC curve of blood supply area,necrotic area and normal liver tissue was 0.913 and 0.917 and the area under the curve of blood supply area and normal liver tissue diagnosed by AP IC and NIC was 0.846.The areas under the curve of PP IC,NIC,AP IC,NIC,ICD and arteriovenous LNR were 0.861,0.860,0.829,0.823,0.852,0.676 and 0.789,respectively.Conclusion:(1)compared with conventional mixed energy images,energy spectrum CT single energy images and iodine base images showed the lesions and areas of lipiodol defects more clearly,and the recognition rate of recurrence was higher.(2)The iodine uptake in the iodine base map in the lipiodol defect area of liver cancer after TACE truly reflects the blood supply of the lesion,which has a certain value in evaluating the curative effect of liver cancer after TACE. |
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