Abstract
Background This study aims to evaluate the application of dual-energy computed tomography (DECT) for multiparameter quantitative measurement in early-stage hepatocellular carcinoma (HCC). Methods The study retrospectively enrolled 30 patients with early-stage HCC and 43 patients with early-stage HCC who received radiofrequency ablation (RFA) and underwent abdomen enhanced CT scans in GSI mode. The GSI viewer was used for image display and data analysis. The regions of interest (ROIs) were delineated in the arterial phase and the venous phase. The optimal single energy value, CT values on different energy levels (40 keV, 70 keV, 100 keV, and 140 keV), the optimal energy level, the slope of the spectral attenuation curve, the effective atomic number (Zeff), iodine concentration (IC), water concentration (WC), normalized iodine concentration (NIC), and normalized water concentration (NWC) are measured and quantitatively analyzed. Results The CT values of early-stage HCC at different single energy levels in dual phases were significantly different, and the single energy values were negatively correlated with the CT values. In the arterial phase and the venous phase, the optimal energy values for the best contrast-to-noise ratio were (68.34 ± 3.20) keV and (70.14 ± 2.01) keV, respectively. The slope of the spectral attenuation curve showed a downward trend at 40 keV, 70 keV, 100 keV, and 140 keV, but there was no statistically significant difference (P > 0.05). Zeff was positively correlated with IC and standardized IC, but has no significant correlation with WC and NWC in dual phases. Conclusion DECT imaging contains multiparameter information and has different application values for early-stage HCC, and it is necessary to select the parameters reasonably for personalized and comprehensive evaluation.
Highlights
Liver cancer is still one of the most malignant tumors that endanger human health in the world
We retrospectively collected cases diagnosed with early-stage hepatocellular carcinoma (HCC) by dual-energy computed tomography (DECT) from October 2018 to January 2021 in the Second Hospital of Harbin Medical University, and all cases were confirmed by surgical pathology. is study was approved by the Ethics Committee of the Second Hospital of Harbin Medical University, and all participants signed informed consent forms for the application of iodine contrast agent
Studies had indicated that, compared with conventional CT, monochromatic energy images at 70 keV have the lowest noise and highest contrast-to-noise ratio (CNR), which can improve the CNR of abdominal organs by 13.8% to 24.7% [15, 16]. erefore, the energy images with optimized noise and contrast between tissues can be obtained by adjusting kiloelectron volts, thereby increasing the density difference between tissues
Summary
Liver cancer is still one of the most malignant tumors that endanger human health in the world. Primary hepatocellular carcinoma (HCC) is the main pathotype of liver cancer, with insidious onset and prolonged course for many years, and most patients with HCC have chronic hepatitis and cirrhotic background. Early-stage HCC patients are always asymptomatic and have negative signs, and early-stage HCC is difficult to be detected by imaging on cirrhotic background [4]. With the development of imaging technologies such as CT, MRI, and PET/CT, the early detection rate of HCC is gradually improving, but the early diagnosis of small HCC is still very challenging for radiologists. A pooled study pointed out that LI-RADS for CT/MRI was used to diagnose HCC with a sensitivity of 67% and a specificity of 93% [5]; in contrast, serum a-fetoprotein (AFP) is the most common screening method for HCC, with a specificity of 72%–90%, Contrast Media & Molecular Imaging but a sensitivity of only 9%–32% [6]. Due to the subjectivity of radiologists in diagnosing HCC, there is often variation in the results of different readers, which directly leads to a strong dependence of imaging evaluation on the experience and expertise of the readers [4]
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