CAJ | 학술논문

目的：探讨CT能谱成像不同评估参数在肝细胞癌与肝转移瘤间的差异。方法回顾性分析行能谱CT 三期对比剂增强扫描的肝肿瘤患者31例（肝细胞癌15例，肝转移瘤16例），分别在三期能谱图像上对病灶边缘与腹主动脉、门静脉及下腔静脉的能谱参数进行测量，并计算50～70keV下的标准化CT 值、标准化碘（水）浓度、铁（水）浓度、水（碘）浓度、有效原子序数、能谱曲线斜率及动静脉碘浓度差等。分析肝细胞癌与肝转移瘤之间、肝细胞癌转移灶与肝转移瘤之间各测量和统计参数的差异。结果肝细胞癌组在门脉期50、60、70keV 下 CT 值分别为142．500±29．106、112.010±20．864、93．727±15．331，碘浓度值为17．235±5．089（100ug／ml），有效原子序数为8．594±0．266，明显高于肝转移瘤组，并具有统计学差异（ P ＜0．05），且门脉期较动脉期差异更为明显。肝细胞癌转移灶组与肝转移瘤组相比较，50～70keV下的CT值、碘（水）浓度、铁（水）浓度、水（碘）浓度、有效原子序数及标化后CT值、标准化碘（水）浓度、铁（水）浓度、有效原子序数肝细胞癌转移灶组明显高于肝转移瘤组，也具有统计学差异（ P ＜0．05），且随着扫描时间延长，两组差异逐渐变小。结论肝细胞癌与肝转移瘤、肝细胞癌转移灶与肝转移瘤的C T 能谱成像具有不同的特征，低能量keV可以对两组病变进行定量鉴别。
목적：탐토CT능보성상불동평고삼수재간세포암여간전이류간적차이。방법회고성분석행능보CT 삼기대비제증강소묘적간종류환자31례（간세포암15례，간전이류16례），분별재삼기능보도상상대병조변연여복주동맥、문정맥급하강정맥적능보삼수진행측량，병계산50～70keV하적표준화CT 치、표준화전（수）농도、철（수）농도、수（전）농도、유효원자서수、능보곡선사솔급동정맥전농도차등。분석간세포암여간전이류지간、간세포암전이조여간전이류지간각측량화통계삼수적차이。결과간세포암조재문맥기50、60、70keV 하 CT 치분별위142．500±29．106、112.010±20．864、93．727±15．331，전농도치위17．235±5．089（100ug／ml），유효원자서수위8．594±0．266，명현고우간전이류조，병구유통계학차이（ P ＜0．05），차문맥기교동맥기차이경위명현。간세포암전이조조여간전이류조상비교，50～70keV하적CT치、전（수）농도、철（수）농도、수（전）농도、유효원자서수급표화후CT치、표준화전（수）농도、철（수）농도、유효원자서수간세포암전이조조명현고우간전이류조，야구유통계학차이（ P ＜0．05），차수착소묘시간연장，량조차이축점변소。결론간세포암여간전이류、간세포암전이조여간전이류적C T 능보성상구유불동적특정，저능량keV가이대량조병변진행정량감별。
Objective To explore the differences of spectral CT multi‐parameter imaging in hepatic carcinoma and liver metastasis ,intrahepatic metastasis of hepatic carcinoma and liver metastasis .Methods Thirty‐one patients with hepatic tumors underwent gemstone spectral imaging (GSI) scans ,including 15 patients with hepatic carcinoma and 16 ones with liver metastases ,in order to obtain spectral serial images in triple contrast‐enhanced phases .The spectral parameters of the lesions ,aorta ,portal vein and inferior vena cava were measured .Then ,the normalized parameters including CT values in different energy 1evels (50~70) keV ,iodine (water) concentration ,water (iodine) concentration ,iron (water) concen‐tration ,effective atomic number (Eff‐Z) ,and the spectral curves and iodine concentration differences (ICD) between arte‐rial and the portal venous phases were calculated .The above measurement results were analyzed with two samples t test . Results The CT values of hepatic carcinoma in different energy levels were (142 .500 ± 29 .106) HU (50keV) ,(112 .010 ± 20 .864) HU (60keV) and (93 .727 ± 15 .331) HU (70keV) ,while ,the iodine concentrations were 17 .235 ± 5 .089 (100ug/ml) and Eff‐Z were 8 .594 ± 0 .266 ,which were significantly higher than those of liver metastasis .The CT value of intrahepatic metastasis of hepatic carcinoma in different energy levels (50~70) keV ,iodine (water) concentration ,iron (water) concentration ,water (iodine) concentration ,Eff‐Z ,and some normalized parameters including CT value in the different energy 1evels (50~70) keV ,iodine (water) concentration ,iron (water) concentration and effective atomic num‐ber (Eff‐Z) were significantly higher than those of liver metastasis ( P<0 .05) .Conclusion The spectral CT imaging pa‐rameters of hepatic carcinoma are different from those of liver metastasis .Gemstone spectral CT imaging provides an effec‐tive method for differentiating hepatic carcinoma ,its intrahepatic metastasis and liver metastasis .