| Purpose:Primary liver cancer is the most common malignant tumors in the liver with the common pathological type of hepatocellular carcinoma(HCC) and intrahepatic cholangiocarcinoma(ICC). Part of these two type has some difficult diagnosis dentification in clinical, and the treatment of those are different. Having a clear diagnosis can help to make identify treatment, and improve the survival rate of the patients with liver cancer. Mostly, diagnosis of HCC and ICC rely on the specific characteristics of enhancement of the tumors in routine CT and MRI. However, some tumors have no obviously characteristics methods, which give us a long way to tell them apart. Retrospectively analyzed the spectral parameters of HCC and ICC patients with spectral CT imagings, and compared the differences of them with mutilple spectral parameters to measure whether it is helpful to make the differential diagnosis in both by imaging. With the technology of spectral CT imaging, whether it can provide a new, important auxiliary examination and reference standards for clinical diagnosis to diagnosis ICC and HCC and try to find out the best method for identifying intrahepatic cholangiocarcinoma of hepatocellular carcinoma of liver.Material and Methods:From 2013 January to 2014 December,136 patients with hepatic lesions were enrolled including 100 HCC and 36 ICC which were all underwent abdominal tri-phase enhanced spectral CT imaging examinations before operations and all pathologically confirmed by operations and percutaneous liver biopsies in our hospital. The atypical hepatocellular carcinoma(AHCC) were picked in HCCs. And spectral parameters of the lesions were analyzed. The eages of lesion enhancement, the solid area of lesion, the center or the low density area of lesions, the normal liver tissue and the abdominal aorta of spectral parameters were measured. And the lesion liver contrast to noise ratio(CNR), the lesion to normal hepatic tissue iodine(water) concentration ratio(LNR), the normalized iodine(water) concentration(NIC), the iodine(water) concentration difference between equilibrium phase and arterial phase(EAD), the iodine(water) concentration difference between equilibrium phase and portal venous phase(EPD), the lesion and normal hepatic tissue iodine(water) concentration difference during equilibrium phase(LNDE), the slope of spectral curve AHu (A slope between Hu40keV-Hu100keV) were calculated. Compared two groups of lesions on both enhancement degree and difference of the strengthen eages, the difference of based material decomposition, the two groups of enhancement strengthen difference and based material decomposition of low density area or the center of the lesions, and the two groups of enhancement strengthen difference and based material decomposition of AHCC and ICC. Those two groups of parameters above were analyzed with two samples t test analysis. With groups statistical significance (P<0.05), the ROC curve analyzed to get the sensitivity and specificity of the corresponding.Results:The optimal CNR of ICC and HCC were all at low monochromatic images and revealed images of lesions more clearly. At arterial phase, portal venous phase and equilibrium phase, the best CNR of ICC and HCC were at 60keV,80keV and 60keV monochromatic, respectively.The spectral curves of ICC and HCC are different in tri-phases. At the arterial phase, the spectral curves of ICC was slightly lower than that of HCC, the ΔHu were 1.52±0.63 and 1.54±0.57, respectively, with no statistical significance (P>0.05). At portal venous phase, the curves of the slope of ICC and HCC were similar, but the AHu of ICC was a little bigger than that of HCC, respectively 2.52±0.63 and 2.18±0.54, with statistically significant (P<0.01). At equilibrium phase, the spectral curves of ICC was obviously higher than that of HCC, respectively 2.63±0.50 and 1.79±0.43, with statistically significant (P<0.01).The spectral curves of ICC and AHCC were not the same either. The spectral curves of ICC were higher than those of AHCC in tri-phase, the ΔHu of the curve of AHCC were 1.12±0.32,1.92±0.46 and 1.67±0.41, respectively at arterial phase, portal venous phase and equilibrium phase with statistically significant (P<0.01).The spectral curves of ICC and HCC of low density area(ICC-LD, HCC-LD) were different. The spectral curves of ICC-LD were higher than those of HCC-LD in tri-phases. The AHu of the curves of ICC-LD and HCC-LD were 0.35±0.31,0.65±0.36, 0.80±0.52 and 0.06±0.24,0.26±0.26,0.22±0.27, respectively, at arterial phase, portal venous phase and equilibrium phase with statistically significant (P<0.01).At arterial phase, the iodine(water) concentration of ICC was slightly lower than that of HCC with no statistically significant (P>0.05). The iodine(water) concentration of ICC were significantly higher than those of HCC, respectively (21.22±5.26)100μg/cm3, (22.15±4.21)100μg/cm3 and (18.43±4.52)100μg/cm3, (15.08±3.59)100μg/cm3 at portal venous phase and equilibrium phase with statistically significant (P<0.01).The value of EAD, EPD, LNDE of ICC were bigger than those of HCC with statistically significant (P<0.01).The NIC value of ICC was slightly smaller than that of HCC at arterial phase and similar with that of HCC at portal venous phase. And the NIC value of ICC was significantly bigger than that of HCC,0.67±0.12 and 0.51±0.12 respectively, with statistically significant in equilibrium phase (P<0.000).The LNR values of ICC and HCC had no statistically significant at arterial phase, portal venous phase. The LNR values of ICC and HCC were 1.34±0.29 and 0.97±0.27 respectively at equilibrium phase, and there was statistically significant in equilibrium phase (P<0.000).The iodine(water) concentration of AHCC were (9.07±2.33)100μg/cm3, (15.35±3.00)100μg/cm3 and (13.48±2.84)100μg/cm3, respectively at arterial phase, portal venous phase and equilibrium phase, which were compared with ICC with statistically significant (P<0.01).The EAD, EPD and LNDE of ICC were significantly higher than those of AHCC, with all statistically significant (P<0.000).The NIC values of ICC and AHCC had no statistically significant at arterial phase and portal venous phase. And there was statistically significant in equilibrium phase with two groups (P<0.000).The LNR values of ICC and AHCC had no statistically significant at arterial phase and portal venous phase. And there was statistically significant in equilibrium phase with two groups (P<0.000).The iodine(water) concentration of ICC-LD were significantly higher than those of HCC-LD, (3.06±2.66)100μg/cm3, (5.66±3.11)100μg/cm3, (6.77±4.33)100μg/cm3 and (0.9±1.98)100μg/cm3, (2.56±2.21)100μg/cm3, (1.88±2.31)100μg/cm3, respectively, at the arterial phase, portal venous phase and equilibrium phase with statistically significant (P<0.01).The EAD, EPD, LNDE of ICC-LD were significantly bigger than those of HCC-LD, were (3.70±3.37)100μg/cm3 and (0.98±1.92)100μg/cm3, (1.24±2.33)100μg/cm3 and (-0.37±1.90)100μg/cm3, (-10.6±4.17)100μg/cm3 and (-14.14±2.27)100μg/cm3, respectively, with statistically significant (P<0.000).The fat(calcium) concentration of ICC were significantly lower than those of HCC at arterial phase, portal venous phase and equilibrium phase.The calcium(fat) concentration of ICC were significantly higher than those of HCC at arterial phase, portal venous phase and equilibrium phase with all statistically significant (P<0.05).The fat(calcium) and calcium(fat) concentration of ICC and AHCC had no statistically difference in tri-phase. However, there was statistically significant at equilibrium phase with the calcium(fat) concentration of ICC and AHCC (P<0.000).The fat(calcium) concentration of ICC-LD were slightly higher than those of HCC-LD with no statistically significant (P>0.05) at arterial phase, portal venous phase and equilibrium phase. The calcium(fat) concentration of ICC-LD were higher than those of HCC-LD, respectively, (23.20±4.06)mg/cm3, (26.71±4.82)mg/cm3, (28.21±6.10)mg/cm3 and (20.33±3.66)mg/cm3, (21.57±3.20)mg/cm3, (21.52±3.53)mg/cm3 with statistically significant (P<0.05).The water(iodine) concentration of ICC and HCC had no statistically significant (P>0.05) at arterial phase, portal venous phase and equilibrium phase.The water(iodine) concentration of ICC-LD were significantly bigger than those of HCC-LD with statistically significant difference (P<0.05) at arterial phase, portal venous phase and equilibrium phase.ROC curve analysis showed that ΔHu, iodine(water) concentration at equilibrium phase have high accuracy in the differential ICC and HCC, with sensitivity and specificity for (87.9%,89%), (78.8%,98.8%). ΔHu, iodine(water) concentration at equilibrium phase showed higher accuracy in the differential ICC and AHCC, with sensitivity and specificity for (87.9%,96.8%), (90.9%,93.5%). The iodine(water) concentration and calcium(fat) concentration at equilibrium phase showed high accuracy in the differential ICC-LD and HCC-LD, with sensitivity and specificity for (80%,96%), (85%,88%).Conclusion:There are multi parameters and multiple aspects can analyze in differential hepatocellular carcinoma and intrahepatic cholangiocarcinoma such as the spectral CT imaging, the monochromatic imaging, iodine-based material decomposition images, spectral curve and material decomposition. And it is helpful for the clinical diagnosis. Through data validation, spectral parameters such as ΔHu, the iodine(water) concentration and the calcium(fat) concentration have high diagnostic value for differential diagnosis of intrahepatic cholangiocarcinoma and hepatocellular carcinoma. |
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