关键词:

小肝癌, 肝硬化结节, CT检查, 影像学表现, CT参数, 诊断价值

Abstract:

Objective　To explore the differences of CT findings between small liver cancer and cirrhotic nodules and its qualitative diagnostic value. Methods　A total of 164 patients with regenerated nodules of hepatitis B cirrhosis or small liver cancer who received CT examination in Xinyang Central Hospital from March 2021 to March 2024 were selected, and 157 cases were finally included as the study objects after screening according to the inclusion and exclusion criteria. There were 71 patients diagnosed with small liver cancer by surgical resection and histopathological examination (a small liver cancer group), including 38 males and 33 females who were (55.85±4.46) years old. There were 86 cases of cirrhotic reconstituted nodules (a regenerated nodules group), including 45 males and 41 females who were (56.28±4.27) years old. χ² test and independent sample t test were used to compare the genera data, imaging findings (morphology, lesion maximum diameter, density, and CT dynamic enhanced typing) and CT parameters [blood flow (BF), blood volume (BV), mean transit time (MTT), and hepatic arterial fraction (HAF)] of small liver cancer and regenerated nodules of hepatitis B cirrhosis were compared between the two groups. The pathological findings were set as the gold standards. The application values of CT in the diagnosis of regenerated nodules of hepatitis B cirrhosis and small liver cancer were evaluated. The Cohen's Kappa test was used to test the diagnoseis consistency. Results　In the regenerated nodules group, the liver parenchymal morphology was mainly uneven; the lesion maximum diameter was small; the density was mostly isodensity; the dynamic enhanced CT typing was dominated by the low volume and equivalent resistance type and the equivalent volume and equivalent resistance type. On the contrary, the small hepatocellular carcinoma group showed a variety of morphology, such as false envelope, liquefaction, and necrosis; the lesion maximum diameter was larger; the density was mainly low density; the dynamic enhanced CT typing was dominated by the high volume and low resistance type. There were statistical differences in CT imaging findings between the two groups (all P<0.001). The BF, BV, and HAF in the small liver cancer group were higher than those in the regenerated nodules group, while the MTT was lower (all P<0.001). The results of CT examination showed that there were 66 cases of small liver cancer; there were 84 patients with regenerated nodules of hepatitis B cirrhosis; 5 were misdiagnosed; 2 were missedly diagnosed. The accuracy, sensitivity, specificity, and positive and negative prediction rates of CT in the diagnosis of small liver cancer were 95.54% (150/157), 92.96% (66/71), 97.67% (84/86), 97.06% (66/68), and 94.38% (84/89), respectively. The accuracy, sensitivity, specificity, and positive and negative prediction rates of CT in the diagnosis of regenerated nodules of hepatitis B cirrhosis were 95.54% (150/157), 97.67% (84/86), 92.96% (66/71), 94.38% (84/89), and 97.06% (66/68), respectively. The Cohen's Kappa value of CT in the diagnosis of regenerated nodules of hepatitis B cirrhosis and small liver cancer compared with the pathological examination was 0.887, indicating a good consistency. Conclusions　By integrating lesion shape, lesion maximum diameter, density, and hemodynamic parameters, the accuracy of CT in the qualitative diagnosis of small liver cancer and regenerated nodules of hepatitis B cirrhosis  is high and in high agreement with pathological diagnosis.

Key words:

Small liver cancer, Cirrhosis nodules, CT examination, Imaging findings, CT parameters, Diagnostic value