肝硬化合并原发性肝癌患者CT动态增强扫描变化及诊断价值

目的 观察肝硬化（HC）合并原发性肝癌（PLC）患者CT动态增强扫描变化，分析其诊断价值。方法 回顾性分析2020年4月—2022年7月我院125例HC患者资料，所有受试者均行病理组织学检测及CT动态增强扫描，统计所有患者病灶大小及分布情况，CT动态增强扫描动脉期、静脉期、延迟期病灶检出情况，以病理检查为金标准，分析CT动态增强扫描对HC患者PLC的诊断价值、HC患者与HC并PLC患者血流灌注参数大小及不同肝功能CTP分级下血流灌注参数变化。结果 125例HC患者共检出161个病灶，其中直径<1 cm 8个，1～3 cm 53个，4～5 cm 63个，>5 cm 37个，肝右前叶、肝右后叶者居多，分别为45及69个；CT动态增强扫描动脉期检出病灶149个，检出率92.55%；门脉期检出病灶134个，检出率83.23%；延迟期检出病灶142个，检出率88.20%；125例HC患者中病理学检查显示75例PLC阳性，50例PLC阴性，CT动态增强扫检测HC并PLC的敏感度为94.67%，特异度为94.00%，准确率为94.40%，阳性预测值为95.95%，阴性预测值为92.16%，Kappa值为0.884，具有较高的一致性；HC组HAP、HPI值均显著低于HC并PLC组，PVP、TLP值均显著高于HC并PLC组（P<0.05）；125例HC并PLC患者中CTP A级41例，CTP B级46例，CTP C级38例，CTP A级HAP、HPI值显著低于CTP B、C级（P<0.05），PVP、TLP值均显著高于CTP B、C级（P<0.05），CTP B级HPI值与CTP C级比较，差异均无统计学意义（P>0.05）。结论 CT动态增强扫描可多方位多角度显示HC病灶情况，且对PLC具有较好的诊断价值，其中肝脏血流灌注参数具有一定的特征性，可为PLC诊断和肝功能分级提供参考

Changes and diagnostic value of CT dynamic contrast-enhanced scan in patients with hepatic cirrhosis complicated with primary liver cancer

Objective To observe the changes of CT dynamic contrast-enhanced scan in patients with hepatic cirrhosis (HC) complicated with primary liver cancer (PLC) and analyze its diagnostic value. Methods The data of 125 patients with HC in the hospital from April 2020 to July 2022 were retrospectively analyzed. All subjects underwent histopathological examination and CT dynamic contrast-enhanced scan. The size and distribution of lesions in all patients were counted, and the detection status of lesions in arterial phase, venous phase and delayed phase of CT dynamic contrast-enhanced scan were analyzed. With pathological examination as the gold standard, the diagnostic value of CT dynamic contrast-enhanced scan on PLC in patients with HC, blood perfusion parameters of patients with HC and patients with HC and PLC and the changes of blood perfusion parameters under different liver functions were analyzed.Results A total of 161 lesions were detected among 125 patients with HC, of which 8 were <1 cm in diameter, 53 were 1-3 cm, 63 were 4-5cm and 37 were >5cm. Most of the lesions were located in the liver right anterior lobe (45 lesions) and liver right posterior lobe (69 lesions). 149 lesions were detected by CT dynamic contrast-enhanced scan in arterial phase, with a detection rate of 92.55%. 134 lesions were detected in portal phase, with a detection rate of 83.23%. 142 lesions were detected in delayed phase, with a detection rate of 88.20%. Among 125 patients with HC, 75 cases were with positive PLC and 50 cases were with negative PLC by pathological examination. The sensitivity, specificity, accuracy rate, positive predictive value and negative predictive value of CT dynamic contrast-enhanced scan in detecting HC with PLC were 94.67%, 94.00%, 94.40%, 95.95% and 92.16%, respectively, and its Kappa value was 0.884, which showed high consistency. The HAP and HPI in HC group were significantly lower than those in HC with PLC group while the PVP and TLP were significantly higher than those in HC with PLC group (P<0.05). There were 41 cases of CTP grade A, 46 cases of CTP grade B, and 38 cases of CTP grade C among 125 patients with HC and PLC. The HAP and HPI values of CTP grade A were significantly lower than those of CTP grade B and C (P<0.05), PVP and TLP values were significantly higher than those of CTP B and C (P<0.05), there was no significant difference in HPI value between CTP grade B and CTP grade C (P>0.05). Conclusion CT dynamic contrast-enhanced scan can show multi-directional and multi-angle display of HC lesions, and has a good diagnostic value on PLC. The liver blood perfusion parameters have certain characteristics, and can provide reference for PLC diagnosis and liver function grading