| 【 Objiective 】 Extrahepatic cholangiocarcinoma(EHCC)is a common biliary malignant tumor,which divided into mass-forming,intraductal growth and infiltration type according to its general pathological morphology.Infiltration type and some intraductal growth showed only narrowing and thickening of the bile duct wall,did not see the tumor tissue,it is difficult to distinguish early-type and extrahepatic cholangitis(EHC)in some patients on radiographic.Their treatment are significantly different,a clear diagnosis can help determine the treatment program to avoid unnecessary surgery and treatment.Traditional diagnostic and differential diagnosis methods include CT,MRI,MRCP and so on;Early thickness extrahepatic cholangiocarcinoma was not specific,and difficult to identify with cholangiitis.In this study,Retrospectively analyzed the spectral parameters of infiltrating EHCC and EHC with spectral CT imaging,and compared them with spectral CT data to measure whether it is significant to make the diagnosis of both imaging and whether the energy spectrum CT can provide A new,important diagnostic criteria to identify infiltrating EHCC and EHC.then try to find out the best method for identifying them.And reconstructed by 3D reconstruction technique,transforming the two-dimensional energy spectrum CT image into dynamic spatial three-dimensional image.【Materials and Methods】 From January 2013 to December 2016,106 patients with lesions were enrolled before operations,66 patients with EHCC pathologically confirmed by operations and biopsies in our hospital.And 40 patients with EHC pathologically confirmed by operation and Followed at least six months.the three-phase spectral CT and spectral parameters of the lesions were analyzed.The eages of lesion enhancement,the abdominal aorta and erector spinae were measured,and calculate the iodine(water)concentration(IC)of the lesion,the iodine(water)concentration(Water)concentration ratio(LNR),iodine(water)concentration difference between equilibrium phase and arterial phase(EAD),iodine(water)concentration difference between portal venous phase and arterial phase(PAD),iodine(water)concentration difference between equilibrium phase and portal venous phase(EPD),normalized iodine(water)concentration(NIC),the slope of the energy spectrum curve ΔHu(the Δ slope between Hu40 ke V-Hu100 ke V),and the trend of three-stage intensification of the two groups were compared.Differences in the degree of enhancement between the two groups of lesions,the difference between the spectral parameters and so on.Statistical analysis of two independent samples using t test and repeated measurement data variance analysis.And then through the visualization of 3D reconstruction technology to transform two-dimensional images into 3D spatial motion images.1.The spectrum curves of EHCC and EHC were different in tri-phases.The ΔHu of the two phases were 2.38±0.65,3.91±0.89,3.48±0.73 and 1.32±0.39,2.00±0.49,2.18±0.42。Respectively,at arterial phase,portal venous phase and equilibrium phase with statistically significant(P <0.001).2.EHCC were significantly higher than those of the EHC with 40 Ke V、50Ke V、60Ke V and 70 Ke V CT.the difference were statistically significant(P <0.001).3.The IC of EHCC was higher than EHC,they were(20.02±5.45)100ug/cm3,(32.92±7.53)100ug/cm3,(29.25±6.17)100ug/cm3 and(11.11±3.29)100ug/cm3,(16.87±4.11)100ug/cm3,(18.43±3.57)100ug/cm3。 The difference of IC concentration between the two groups were statistically significant(P <0.001).The levels of NIC were significantly higher than those of EHC,they were0.21±0.07,0.72±0.15,0.86±0.15 and 0.12±0.05,0.38±0.10,0.56±0.13.respectively.There were aslo statistically significant difference in NIC values? ? between the two groups(P <0.001).The LNR values ? ? of the two groups were statistically significant at arterial phase and portal venous phase(P <0.005,P<0.001).There were no significant difference in the LNR value of EHCC and EHC at equilibrium phase(P> 0.05).EAD and PAD of EHCC are bigger than the value of the EHC,The difference between them were statistically significant(P<0.05).the EPD of EHC was bigger than that of EHCC,with statistically significant(P <0.001).4.Other energy spectrum quantification parameters The difference between the effective atomic numbers of the EHCC and EHC were statistically significant(P<0.001).HAP(water)and Calcium(water)of EHCC were higher than EHC at arterial phase,portal venous phase and equilibrium phase,the difference were statistically significant(P <0.001).5.ROC curve analysis The Portal period of △Hu,50 kev,60kev,IC and NIC have high accuracy in the differential of EHCC and EHC,the critical value,sensitivity and speciticity Were(2.73,87.9%、95.0%),(145.24 Hu,92.42%、92.50%),(106.99 Hu,90.91%、92.5%),(22.90 100ug/cm3,87.88%、95.0%),(0.52,87.9%、97.5%).6.Strengthening trend of three phase There were statistically significant differences(P <0.005)between 60 kev,70kev single-energy CT value,IC and NIC in the EHCC and EHC.NIC were continuously increased in both groups,other indexs of EHCC were the highest in the portal phase,of EHC were the highest in the equilibrium phase.7.Visualized 3D reconstruction 3D reconstruction can realize the dynamic spatial structure of two-dimensional image,clearly and intuitively observe the relationship between spatial position.【Conclusion】Energy spectrum of the CT,single energy images,iodine images and material decompositon image analysis can help diagnosis the extrahepatic cholangiocarcinoma and cholangitis,such as △Hu(2.73,87.9%、95.0%)、50Ke V value(145.24 Hu,92.42%、92.50%)、60ke V value(106.99 Hu,90.91%、92.5%)、IC(22.90100ug/cm3,87.88%、95.00%)、NIC(0.52,87.9%、97.5%)。The highest sensitivity index is 50 ke V CT value,92.42%(145.24Hu),the highest specificity index and Youden index for the NIC,reaching 97.5% and 0.854(0.52).Combined with visual dynamic3 D images,they bring great help and high guiding significance to the clinical diagnosis and treatment. |
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