基于双能CT的影像临床联合模型鉴别门静脉良恶性栓子的价值

田红斌; 杨孟于; 李晓光; 张伟国

doi:10.16016/j.2097-0927.202406074

您当前的位置：

首页 >

文章列表页 >

基于双能CT的影像临床联合模型鉴别门静脉良恶性栓子的价值

临床医学 | 更新时间：2026-01-09

- 基于双能CT的影像临床联合模型鉴别门静脉良恶性栓子的价值
- Value of combined model of clinical and imaging based on dual-energy CT for differentiating benign and malignant portal vein embolus
- 陆军军医大学学报 2024年46卷第22期页码：2554-2560
- 作者机构：
  
  400042 重庆，陆军特色医学中心放射科，重庆市影像医学与核医学临床研究中心
- 作者简介：
  
  [张伟国，E-mail：wgzhang01@tmmu.edu.cnZHANG Weiguo, E-mail: wgzhang01@tmmu.edu.cn
- 基金信息：
  
  重庆市临床重点专科建设项目(425Z41);重庆市影像医学与核医学临床研究中心科技计划项目(CSTC2015YFPT-gcjsyjzx0175)
- DOI：10.16016/j.2097-0927.202406074
  中图分类号： R364.15;R735.7;R814.42
- 收稿：2024-06-24，
  
  修回：2024-08-26，
  
  纸质出版：2024-11-30
- 稿件说明：
移动端阅览
田红斌, 杨孟于, 李晓光, 等. 基于双能CT的影像临床联合模型鉴别门静脉良恶性栓子的价值[J]. 陆军军医大学学报, 2024,46(22):2554-2560.

Hongbin TIAN, Mengyu YANG, Xiaoguang LI, et al. Value of combined model of clinical and imaging based on dual-energy CT for differentiating benign and malignant portal vein embolus[J]. Journal of Army Medical University, 2024, 46(22): 2554-2560.
田红斌, 杨孟于, 李晓光, 等. 基于双能CT的影像临床联合模型鉴别门静脉良恶性栓子的价值[J]. 陆军军医大学学报, 2024,46(22):2554-2560. DOI： 10.16016/j.2097-0927.202406074.

Hongbin TIAN, Mengyu YANG, Xiaoguang LI, et al. Value of combined model of clinical and imaging based on dual-energy CT for differentiating benign and malignant portal vein embolus[J]. Journal of Army Medical University, 2024, 46(22): 2554-2560. DOI： 10.16016/j.2097-0927.202406074.

摘要

目的

评估双能CT(dual-energy CT

DECT)定量参数联合临床实验室指标在鉴别门静脉癌栓(portal vein tumor thrombus，PVTT)和门静脉血栓(portal vein thrombosis

PVT)的价值。

方法

采用病例-对照研究设计方案，分析2022年5月至2024年3月在陆军特色医学中心放射科接受腹部双能CT增强检查并诊断有门静脉血栓或癌栓的65例患者的临床和影像资料，其中门静脉血栓患者39例，门静脉癌栓患者26例，记录患者年龄、性别，在后处理工作站重建线性融合图(linear blending，LB)、非线性融合图(non-linear blending

NLB)、40 keV及100 keV虚拟单能图(virtual monoenergetic image

VMI)、碘图(iodine concentration，IC)、电子云密度/有效原子系数图(electron density /effective atomic number，Rho/Zeff)

在LB图像上评估栓子影像特征，包括附栓处血管壁是否光滑、附栓处血管有无增宽、栓子有无新生血管。比较血栓和癌栓在双能CT定量参数及临床实验室指标的差异，实验室指标有甲胎蛋白(alpha-feto protein，AFP)、癌胚抗原(carcinoembryonic antigen，CEA)、谷丙转氨酶(alanine aminotransferase，ALT)、谷草转氨酶(aspartate aminotransferase，AST)，将双能CT定量参数、栓子影像特征及临床实验室指标进行单因素和多因素Logistic回归分析，再用ROC曲线评估双能CT定量参数及联合模型的诊断效能。

结果

双能CT各定量参数中，除Rho在血栓和癌栓之间差异无统计学意义外

其余参数在癌栓中均高于血栓，差异具有统计学意义(

＜0.05)。多因素Logistic回归分析中，LB、NLB、CEA、AST的差异具有统计学意义(

＜0.05)，以NLB的诊断效能较好(AUC：0.830，敏感性：53.85%，特异性：100.00%，准确率：81.54%)。基于双能CT定量参数与临床实验室指标结合构建的联合模型(LB+NLB+CEA+AST)诊断效能最佳(AUC：0.983，敏感性：96.15%，特异性：92.31%，准确率：93.85%)。

结论

基于双能CT的影像临床联合模型对门静脉良恶性栓子的鉴别诊断提供了可靠依据，具有潜在应用前景。

Abstract

Objective

To investigate the value of dual-energy CT (DECT) quantitative parameters combined with clinical laboratory indicators in differentiation of portal vein tumor thrombus (PVTT) from thrombosis (PVT).

Methods

A case-control study was conducted on 65 patients diagnosed with portal vein thrombosis (

=39) or tumor embolus (

=26) who underwent abdominal dual-energy enhanced CT examination in our department from May 2022 to March 2024. Their clinical and imaging data were collected. Linear blending image (LB)

non-linear blending image (NLB)

40 keV and 100 keV virtual monoenergetic image (VMI)

iodine image and electron density/effective atomic number image (Rho/Zeff) were reconstructed with the aid of post-processing workstation. The image characteristics of thrombus were evaluated in LB images

including whether the vessel wall at the thrombus was smooth

whether the vessel at the thrombus was widen

and whether the embolus was neovascularization. The quantitative parameters and clinical laboratory indicators of PVT and PVTT in DECT were compared. Laboratory indicators included apha-fetoprotein (AFP)

carcinoembryonic antigen (CEA)

alanine aminotransferase (ALT) and aspartate aminotransferase (AST). Univariate and multivariate logistic regression analyses were employed to analyze DECT quantitative parameters

embolus image characteristics and clinical laboratory indicators. Then receiver operating characteristic (ROC) curve was plotted to evaluate the diagnostic efficiency of the quantitative parameters and combined model of DECT.

Results

Among the DECT parameters

except for Rho

the other parameters in PVTT were significantly higher than those in PVT (

0.05). Multivariate logistic regression analysis showed that there were obvious differences in LB

NLB

CEA and AST (

0.05)

and NLB had better diagnostic efficacy (AUC: 0.830

sensitivity: 53.85%

specificity: 100.00%

accuracy: 81.54%). The combined model based on DECT quantitative parameters and clinical laboratory indicators (LB+NLB+CEA+AST) obtained the best diagnostic efficacy (AUC: 0.

983

sensitivity: 96.15%

specificity: 92.31%

accuracy: 93.85%).

Conclusion

The combined imaging and clinical model based on DECT provides a reliable reference for the differential diagnosis of benign and malignant portal vein embolus

and it has potential application prospects.

关键词

Keywords

references

MANTAKA A, AUGOUSTAKI A, KOUROUMALIS E A, et al . Portal vein thrombosis in cirrhosis: diagnosis, natural history, and therapeutic challenges[J ] . Ann Gastroenterol, 2018, 31(3): 315-329. DOI: 10.20524/aog.2018.0245.

LV Y, BAI W, ZHU X, et al . Association of nonmalignant portal vein thrombosis and clinical outcomes in patients with cirrhosis and acute variceal bleeding: a multicenter observational study[J ] . Hepatol Int, 2023, 17(5): 1192-1204. DOI: 10.1007/s12072-023-10493-1.

DENGZ J, LI L, TENG Y X, et al . Treatments of hepatocellular carcinoma with portal vein tumor thrombus: current status and controversy[J ] . J Clin Transl Hepatol, 2022, 10(1): 147-158. DOI: 10.14218/JCTH.2021.00179.

GAVRIILIDIS P, PAWLIKT M, AZOULAY D. Comprehensive review of hepatocellular carcinoma with portal vein tumor thrombus: State of art and future perspectives[J]. Hepatobiliary Pancreat Dis Int, 2024, 23(3): 221-227. DOI: 10.1016/j.hbpd.2023.10.009.

BENATATOS N, PAPADOPOULOU I, ASSIMAKOPOULOSS F, et al . Surgical management in hepatocellular carcinoma with portal vein tumour thrombosis: is this the end of the road or a chance to expand the criteria for resectability?[J ] . Prz Gastroenterol, 2022, 17(4): 257-265. DOI: 10.5114/pg.2022.118138.

JIANG J X, GU H M, LI M D, et al . The value of dual-energy computed tomography angiography-derived parameters in the evaluation of clot composition[J ] . Acad Radiol, 2023, 30(9): 1866-1873. DOI: 10.1016/j.acra.2022.12.023.

PANYAPING T, UDOMKAEWKANJANA N, KEANDOUNGCHUN J. Utility of dual energy CT in differentiating clot in acute ischemicstroke[J]. Neuroradiol J, 2023, 36(4): 435-441. DOI: 10.1177/19714009221147234.

HONG Y J, SHIM J, LEE S M, et al . Dual-energy CT for pulmonary embolism: current and evolving clinical applications[J ] . Korean J Radiol, 2021, 22(9): 1555-1568. DOI: 10.3348/kjr.2020.1512.

LI Q, TAN H, LV F R. Molecular characterization of solitary pulmonary nodules in dual-energy CT nonlinear image fusion technology[J]. J Recept Signal Transduct Res, 2022, 42(1): 95-99. DOI: 10.1080/10799893.2020.1853158.

PAN C, DAI F, SHENG L, et al . Clinical application of spectral CT perfusion scanning in evaluating the blood supply source of portal vein tumor thrombus in hepatocellular carcinoma[J ] . Front Oncol, 2024;13: 1348679. DOI: 10.3389/fonc.2023.1348679.

SARSWAT S, KHAN D, SAGAR S, et al . Role of 18 F-FDG PET/CT in the diagnosis of benign vs . malignant tumor thrombus[J ] . Nucl Med Commun, 2023, 44(8): 726-731. DOI: 10.1097/MNM.0000000000001708..

ABOELEZZ AHMAD A F, ELSAWY A A, OMAR H M, et al . The role of shear wave elastography in differentiation between benign and malignant portal vein thrombosis in hepatocellular carcinoma[J ] . Egypt J Radiol Nucl Med, 2022, 53(1): 188. DOI: 10.1186/s43055-022-00872-3.

GENG C Z, SONG L H, MI Y C, et al . The usefulness of diffusion-weighted imaging for differentiating portal vein thrombus from tumour embolus[J ] . Imag Sci J, 2016, 64(5): 279-284. DOI: 10.1080/13682199.2016.1177293.

MARTIN S S, KOLANECI J, CZWIKLA R, et al . Dual-energy CT for the detection of portal vein thrombosis: improved diagnostic performance using virtual monoenergetic reconstructions[J ] . Diagnostics, 2022, 12(7): 1682. DOI: 10.3390/diagnostics12071682.

ASCENTI G, SOFIA C, MAZZIOTTI S, et al . Dual-energy CT with iodine quantification in distinguishing between bland and neoplastic portal vein thrombosis in patients with hepatocellular carcinoma[J ] . Clin Radiol, 2016, 71(9): 938. e1-938. e9. DOI: 10.1016/j.crad.2016.05.002.

SHERMAN C B, BEHR S, DODGEJ L, et al . Distinguishing tumor from bland portal vein Thrombus in liver transplant candidates with hepatocellular carcinoma: the A-VENA criteria[J ] . Liver Transpl, 2019, 25(2): 207-216. DOI: 10.1002/lt.25345..

YUAN X, QUAN X, CHEX L, et al . Preoperative prediction of the lymphovascular tumor thrombus of colorectal cancer with the iodine concentrations from dual-energy spectral CT[J ] . BMC Med Imaging, 2023, 23(1): 103. DOI: 10.1186/s12880-023-01060-z.

CAO Y T, ZHANG G J, BAO H H, et al . Development of a dual-energy spectral CT based nomogram for the preoperative discrimination of mutated and wild-type KRAS in patients with colorectal cancer[J ] . Clin Imaging, 2021, 69: 205-212. DOI: 10.1016/j.clinimag.2020.08.023.

WANG P, TANG Z H, XIAO Z B, et al . Dual-energy CT in differentiating benign sinonasal lesions from malignant ones: comparison with simulated single-energy CT, conventional MRI, and DWI[J ] . Eur Radiol, 2022, 32(2): 1095-1105. DOI: 10.1007/s00330-021-08159-3.

浏览量

下载量

CSCD

文章被引用时，请邮件提醒。

提交

工具集

关联资源

经颈静脉肝内门体分流术对肝硬化合并严重门静脉血栓患者生存的影响