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首页> 外文期刊>Journal of Clinical and Diagnostic Research >Qualitative and Quantitative Assessment of Enhancement and Washout Characteristics of HCC and non HCC Hypervascular Liver Tumours
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Qualitative and Quantitative Assessment of Enhancement and Washout Characteristics of HCC and non HCC Hypervascular Liver Tumours

机译：HCC和非HCC高血管肝肿瘤增强和清除特征的定性和定量评估

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Introduction: The image based diagnosis of Hepatocellular Carcinoma (HCC) relies on assessment of arterial enhancement and venous or delayed phase washout. This assessment is based on visual analysis; however, studies quantifying such enhancement and washout are lacking.Aim: To qualitative assessment of the imaging characteristics of HCC and non HCC hypervascular liver tumours followed by quantitative assessment of the enhancement and washout kinetics, and also to derive objective values that may help in differentiating HCC from non HCC on Computed Tomography (CT).Materials and Methods: The present study was carried out in PSG hospitals, Coimbatore, Tamil Nadu, India. Retrospective analysis of hypervascular liver lesions was performed over a study period of four years (January 2012 to February 2016). These lesions were divided into two groups namely; HCC and non HCC. All non HCCs were pathologically proven, while HCC cases included those diagnosed on histopathology or typical imaging findings based on American Association for the Study of Liver Diseases (AASLD) (2010) and Liver Imaging Reporting and Data Systems (LIRADS) (2014) diagnostic criteria along with an elevated Alpha Fetoprotein (AFP) of more than 400 IU/mL. A qualitative analysis of the enhancement and washout patterns was done followed by quantitative analysis using Regions of Interest (ROI) measurement of attenuation in Hounsfield units (HU). The quantitative parameters assessed were; Mean Attenuation (MA) of lesions in different phases, Attenuation Gain Percentage (AGP) on arterial phase, Arterial Phase Attenuation Change (AAC), Attenuation Loss Percentage in venous and delayed phases (ALP-V, ALP-D), Percentage Attenuation Ratio in venous and delayed phases (PAR-V, PAR-D) and Relative Washout Ratios from arterial to venous/delayed (RWR A-V, RWR A-D) and from venous to delayed phases (RWR V-D). Sensitivity and specificity were calculated for qualitative washout. For quantitative variables comparative analysis between HCCs and non HCCs was done using Student?s t-test. ANOVA was used to compare different categories. ROC curves were drawn for values that were significantly different to establish a cutoff value.Results: A total of 120 lesions were evaluated consisting of HCCs (n=88) and non HCCs (n=32). Qualitatively majority (81) of HCCs demonstrated arterial enhancement and washout with eight cases of these demonstrating subtle washout requiring settlement by consensus. Washout were absent in seven cases. True mimics of HCC on qualitative analysis were hepatic adenomas, few cases of metastasis and hepatoblastoma were also there. The overall sensitivity of the washout appearance for predicting HCC was 92% while specificity was 78%. On quantitative analysis a PAR-V=106 has sensitivity of 70% and specificity of 75%, RWR-V-D=41.79 has sensitivity of 75% and specificity of 70% for HCC detection. Additionally significant difference was seen between RWR V-D of HCC when compared to cholangiocarcinomas (p-value 0.035) and metastasis (p-value 0.026) and also between PAR-V of HCC and metastasis (p-value 0.033).Conclusion: The qualitative analysis combined with quantitative assessment of washout using percentage attenuation ratio in venous phase and relative washout ratio from venous to delayed phase offers good sensitivity and specificity in image based diagnosis of HCC.
机译：简介：肝细胞癌（HCC）的基于图像的诊断依赖于对动脉增强和静脉或延迟期冲洗的评估。该评估基于视觉分析;目的：定性评估HCC和非HCC高血管性肝肿瘤的影像学特征，然后定量评估增强和清除动力学，并得出有助于区分的客观值。来自非HCC的计算机断层扫描（CT）上的HCC。材料与方法：本研究在印度泰米尔纳德邦Coimbatore的PSG医院中进行。在四年的研究期内（2012年1月至2016年2月）对高血管性肝病变进行了回顾性分析。这些病变分为两组，即： HCC和非HCC。所有非HCC均经过病理学证实，而HCC病例包括根据美国肝病研究协会（AASLD）（2010）和肝成像报告与数据系统（LIRADS）（2014）诊断标准根据组织病理学或典型影像学发现诊断的病例。以及超过400 IU / mL的甲胎蛋白（AFP）升高。对增强和洗脱模式进行了定性分析，然后使用Hounsfield单位（HU）中衰减的目标区域（ROI）测量进行定量分析。评估的定量参数为;不同阶段病变的平均衰减（MA），动脉阶段的衰减增益百分比（AGP），动脉阶段的衰减变化（AAC），静脉和延迟阶段的衰减损耗百分比（ALP-V，ALP-D），百分比衰减率在静脉和延迟阶段（PAR-V，PAR-D）以及从动脉到静脉/延迟（RWR AV，RWR AD）以及从静脉到延迟阶段（RWR VD）的相对洗脱比率。计算定性洗脱的敏感性和特异性。对于定量变量，使用Student's t检验对肝癌和非肝癌进行了比较分析。使用方差分析比较不同类别。绘制ROC曲线以获得明显不同的值以建立临界值。结果：总共评估了120个病变，包括HCC（n = 88）和非HCC（n = 32）。定性地，大多数（81）肝细胞癌显示出动脉增强和清除，其中8例表明需要通过共识解决的细微清除。七例无冲洗。定性分析中肝癌的真正模拟物是肝腺瘤，也很少有转移和肝母细胞瘤病例。洗脱外观预测HCC的总体敏感性为92％，而特异性为78％。在定量分析中，PAR-V = 106的敏感性为70％，特异性为75％，RWR-V-D = 41.79的HCC检测敏感性为75％，特异性为70％。与胆管癌相比（p值0.035）和转移（p值0.026），以及肝癌的PAR-V与转移（p值0.033）相比，在HCC的RWR VD之间存在显着差异。结合使用静脉相的衰减百分比和从静脉相到延迟相的相对洗脱比对洗脱进行定量评估，在基于图像的HCC诊断中具有良好的敏感性和特异性。

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