64层螺旋CT扫描对早期诊断肝癌、局灶性结节增生的特异性及敏感性分析

目的 探讨64层螺旋CT在早期诊断原发性肝癌（HCC）与局灶性结节增生（FNH）中的应用及敏感性、特异性分析。方法 选取2016年1月至2017年1月与我院就诊高度怀疑HCC的56例患者及高度怀疑FNH的45例患者作为可研究对象。所有患者均接受64层螺旋CT平扫及增强扫描，并与术后病理证实结果比较，分析螺旋CT对HCC、FNH早期诊断的敏感性与特异性，并对比二者在CT增强扫描时不同能量水平下的对比噪声比（CNR）情况以及能谱定量参数值情况。结果 64层螺旋CT对HCC早期诊断的敏感性为96.23%，特异性为66.67%，准确性为92.86%；对FNH早期诊断的敏感性为92.68%，特异性为75.00%，准确性为86.67%。增强扫描动脉期时HCC、FNH患者CNR均呈明显的下降状态，并且能量越高则CNR越低，HCC与FNH患者的CNR值比较存在显著差异（P<0.05）；门脉期FNH患者CNR逐渐降低，而在40 keV时获取最佳CNR，HCC患者则表现为CNR先升后降，80 keV时获取最佳CNR，HCC、FNH患者在80~120keV间的CNR值比较存在显著差异（P<0.05），但在40 keV时比较无显著差异（P>0.05）。结论 64层螺旋CT在早期诊断及鉴别诊断HCC、FNH中具有重要的临床价值，检出效能、敏感性、特异性较高，具有临床应用及推广价值。

Analysis of the specificity of 64-slice spiral CT scan in early diagnosis of hepatocelluar carcinoma and focal nodular hyperplasia

Objective To investigate the application of 64-slice spiral CT in the early diagnosis of primary hepatocellular carcinoma (HCC) and focal nodular hyperplasia (FNH) and sensitivity and specificity analysis.Methods From January 2016 to January 2017, 56 patients with highly suspected HCC and 45 patients with highly suspected FNH were selected as research objects. All patients underwent 64-slice spiral CT scan and enhanced scan, and the sensitivity and specificity of spiral CT in the early diagnosis of HCC and FNH were compared with postoperative pathological findings, and compared the contrast-to-noise ratio(CNR) and energy dispersive spectrum(EDS) quantitative parameter values under different energy levels both in CT enhancement scan.Results The sensitivity of 64-slice spiral CT in the early diagnosis of HCC was 96.23%, the specificity was 66.67%, and the accuracy was 92.86%; and the sensitivity of the early diagnosis of FNH was 92.68%, the specificity was 75.00%, and the accuracy was 86.67%. In the enhanced arterial phase, the CNR of HCC and FNH patients showed a significant decline, and the higher the energy, the lower CNR, and there were a significant difference in CNR between HCC and FNH patients(P<0.05); the CNR of FNH patients in the portal phase gradually decreased, and obtained the best CNR at 40 keV. HCC patients showed a rise first and then a decrease in CNR, and the best CNR was obtained at 80 keV. There was a significant difference in CNR between patients with FNH and patients with HCC at 80-120 keV(P<0.05), but no significant difference at 40 keV (P>0.05).Conclusion 64-slice spiral CT in early diagnosis and differential diagnosis of HCC and FNHhas important clinical value, and detection efficiency, sensitivity, specificity are high.It has clinical application and promotion value.