【摘要】 目的评价宝石CT能谱成像(GSI)对肝癌TACE术后疗效评估及随访中的应用价值。方法选取2013年2月至2014年10月经病理证实为肝癌经TACE术后患者30例进行回顾性分析。所有30例患者TACE术后1~3个月分别行宝石CT能谱扫描及DSA复查,两者平均间隔时间2~4 d。一次CT扫描得出混合能量(QC图)及能谱(Mono)图像,图像后处理采用ADW4.6工作站和GSI-viewer软件。采用2种方法观察,A法观察QC平扫、动脉期及门静脉期;B法观察最佳单能量、碘/水(iodine/water)基物质图及能谱特征。由2名从事腹部影像工作经验丰富的副主任医师分别对图像在后处理工作站上进行独立评价,结果与DSA对照,计算A、B 2种方法的敏感性、特异性等指标,采用χ2检验比较2种方法的诊断能力。结果 30例TACE术后复查患者共检出154个病灶,DSA明确其中100个病灶有强化,54个病灶无强化。A法灵敏度为72.0%(72/100),特异度为77.8%(42/54);B法灵敏度为97.0%(97/100),特异度为94.4%(51/54),两者灵敏度及特异度差异均有统计学意义(χ2=23.04,χ2=7.11,P<0.05)。A法与DSA一致性中等(κ=0.47,P<0.01),B法与DSA一致性良好(κ=0.91,P<0.01)。结论与常规CT相比,在不增加辐射剂量的前提下,GSI能明显提高小病灶及多发病灶的检出率;GSI根据能谱分析图的不同特征,反映肿瘤的同源性,客观地提示某一病灶是否为复发或转移灶,有效地鉴别肝脏乏血性肿瘤与其他病变,在肝癌TACE术后疗效评估及随访中更加准确。更多还原

【Abstract】 Objective To discuss the clinical application of CT gemstone spectral imaging(GSI) in assessing therapeutic efficacy and in follow-up evaluation of hepatocellular carcinoma(HCC) after transcatheter arterial chemoembolization(TACE) treatment. Methods The clinical data of 30 patients with pathologicallyproved HCC, who were encountered during the period from Feb. 2013 to Oct. 2014, were retrospectively analyzed. One to 3 months after TACE, CT GSI and DSA were performed in all patients; the average interval between the two examinations was 2-4 days. The mixed energy(QC) and energy spectrum(Mono) images were obtained by single CT scanning; ADW4.6 workstation and GSI- view software were used to make post-processing of images. The following two methods were adopted to make observation:(a) QC plain scan, the arterial phase and portal venous phase were used to make observation;(b) to observe the optimal single energy, iodine/water basis material image and spectrum characteristics. Two experienced assistant chief-physicians who engaged in abdominal imaging diagnosis separately and independently made the evaluation ofthe images on the post- processing workstation. The results were compared with DSA findings, and the sensitivity, specificity and other indicators of the two methods were calculated. The diagnostic abilities of the two methods were compared using Chi- square test. Results After TACE, reexamination detected 154 lesions in the 30 patients, among which DSA showed enhancement in 100 lesions and non- enhancement in 54 lesions. The sensitivity and specificity of(a) method were 72%(72/100) and 77.8%(42/54) respectively,while the sensitivity and specificity of(b) method were 97%(97/100) and 94.4%(51/54) respectively; the differences in the sensitivity and specificity between the two methods were statistically significant(χ2=23.04 and χ2=7.11 respectively,P<0.05). The coincidence rate of(a) method with DSA was medium(47.0%, K=0.47, P <0.01), while the coincidence rate of(b) method with DSA was good(91.0%, K =0.91,P <0.01).Conclusion Compared with conventional CT scan, GSI scan can significantly improve the detection rate of small and multiple lesions without increasing the radiation dose. Based on the different characteristics of the energy spectrum images, GSI can reflect the homology of the tumors, objectively indicate whether a lesion is a recurrence or a metastasis, and effectively differentiate the liver tumor that is lack of blood supply from other diseases, thus, more accurate evaluation of TACE efficacy can be made.更多还原