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

摘要：

目的　探究小肝癌、肝硬化结节CT表现差异及定性诊断价值。方法　选取2021年3月至2024年3月信阳市中心医院收治的接受CT检查的乙肝肝硬化再生结节或小肝癌患者164例，经纳入排除标准筛选后最终纳入157例为研究对象。患者经手术切除病理组织学检查确诊为小肝癌者71例（小肝癌组）［男38例，女33例，年龄（55.85±4.46）岁］，肝硬化再生结节86例（再生结节组）［男45例，女41例，年龄（56.28±4.27）岁］。采用χ²检验和独立样本t检验比较两组一般资料，小肝癌、乙肝肝硬化再生结节的影像学表现（形态、病灶长径、密度、CT动态增强分型）和CT参数指标［血流量（blood flow，BF）、血容量（blood volume，BV）、对比剂平均通过时间（mean transit time，MTT）、肝动脉分数（hepatic arterial fraction，HAF）］。以病理检查结果为金标准，评估CT检查在小肝癌、乙肝肝硬化再生结节诊断中的应用价值，并采用Cohen’s Kappa检验诊断一致性。结果　再生结节组主要呈现肝实质不均匀的形态，且病灶长径较小，密度多为等密度，CT动态增强分型以低容等阻型、等容等阻型为主。小肝癌组表现出多样的形态，如假包膜、液化、坏死，病灶长径较大，密度以低密度为主，CT动态增强分型以高容低阻型占主导地位；两组CT影像学表现比较，差异均有统计学意义（均P<0.001）。小肝癌组BF、BV及HAF均高于再生结节组，MTT低于再生结节组（均P<0.001）。CT检查结果显示：小肝癌患者66例，乙肝肝硬化再生结节患者84例，误诊5例，漏诊2例。CT检查诊断小肝癌的准确率、灵敏度、特异度、阳性预测率、阴性预测率依次为95.54%（150/157）、92.96%（66/71）、97.67%（84/86）、97.06%（66/68）、94.38%（84/89），CT检查诊断乙肝肝硬化再生结节的准确率、灵敏度、特异度、阳性预测率、阴性预测率依次为95.54%（150/157）、97.67%（84/86）、92.96%（66/71）、94.38%（84/89）、97.06%（66/68）。CT检查对小肝癌、乙肝肝硬化再生结节诊断与病理检查结果的Cohen’s Kappa值为0.887，提示一致性较好。结论　CT检查通过综合病灶形态、病灶长径、密度及血流动力学参数，对小肝癌与乙肝肝硬化再生结节的定性诊断准确率较高，与病理诊断一致性高。

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