双能CT多参数无创预测肝细胞癌VETC和MVI
回顾性纳入122例病理确诊HCC患者，分析双期增强DECT多参数（Zeff、ED、ID及归一化参数）预测VETC和MVI的效能。多参数AUC为0.64-0.77，归一化参数N1-ZeffAP和N1-IDAP预测VETC优于非归一化参数。整合DECT参数和影像特征的列线图预测VETC和MVI的AUC分别为0.80和0.83，优于常规模型。
要点
- N1-ZeffAP预测VETC的AUC为0.77，优于非归一化ZeffAP。
- 列线图VETC整合N1-ZeffAP、AST>40 IU/L和镶嵌外观，AUC为0.80。
- 列线图MVI整合N1-EDPVP、N1-IDPVP、边缘不光滑和瘤内动脉，AUC为0.83。
关键影像表现/征象
- 列线图VETC纳入N1-ZeffAP、AST>40 IU/L和镶嵌外观。
- 列线图MVI纳入N1-EDPVP、N1-IDPVP、边缘不光滑和瘤内动脉。
- N1-EDPVP和N1-IDPVP预测MVI的敏感度均为88.2%，特异度均为88.9%。
诊断标准与关键数值
- 多参数预测VETC和MVI的AUC范围为0.64-0.77（均p<0.01）。
- N1-ZeffAP预测VETC的AUC为0.77（p=0.01），N1-IDAP的AUC为0.70（p=0.01）。
- 列线图VETC与常规模型预测VETC的AUC分别为0.80和0.70（p<0.05）。
- 列线图MVI与常规模型预测MVI的AUC分别为0.83和0.77（p<0.05）。
临床应用与阅片要点
- 可关注动脉期归一化Zeff和ID辅助无创评估VETC状态。
- 门静脉期归一化ED和ID结合边缘不光滑、瘤内动脉有助于预测MVI。
局限性
- 回顾性研究设计。
- 单中心样本。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
英文原文（摘要）· 点击展开
OBJECTIVE: Vessels encapsulating tumor clusters (VETC) and microvascular invasion (MVI) are risk factors for early recurrence after hepatectomy in patients with hepatocellular carcinoma (HCC). This study aimed to assess the performance of multiparameters of dual-phase contrast-enhanced dual-energy CT (DECT) in identifying VETC and MVI statuses noninvasively.
METHODS: This retrospective study enrolled 122 patients with pathologically confirmed HCC (VETC +/-, N = 57/65; MVI +/-, N = 54/68) who underwent contrast-enhanced DECT examinations. Conventional clinical information and radiological features were collected. DECT-derived multiparameters in the arterial phase (AP) and portal venous phase (PVP) were analyzed, including non-normalized effective atomic number (Zeff), electron density (ED), and iodine density (ID), and their corresponding normalized parameters (N1-2 Zeff, N1-2 ED, N1-2 ID) based on two normalization approaches (N1 = tumor-to-aorta ratio; N2 = tumor-to-liver parenchyma). The slope of the energy spectrum curve (λ) was also evaluated. Univariate and multivariate logistic regression analyses were performed to construct nomograms and conventional models. The performance of each parameter, conventional model, and nomogram for assessing VETC and MVI was assessed using the area under the receiver operating characteristic curve (AUC).
RESULTS: Multiparameters predicted VETC and MVI with AUCs ranging from 0.64 to 0.77 (all p < 0.01). Compared with their non-normalized counterparts, the performances of N1-ZeffAP (AUC: 0.77, p = 0.01) and N1-IDAP (AUC: 0.70, p = 0.01) in predicting VETC were significantly improved, and N1-EDPVP and N1-IDPVP showed numerically higher sensitivity (88.2%) and specificity (88.9%) for predicting MVI, respectively. NomogramVETC-integrating N1-ZeffAP, AST > 40 IU/L, and mosaic appearance-for evaluating VETC, and nomogramMVI-integrating N1-EDPVP, N1-IDPVP, nonsmooth tumor margin, and intratumoral arteries-for evaluating MVI outperformed their corresponding conventional models (AUC: 0.80 vs. 0.70, and 0.83 vs. 0.77, respectively; both p < 0.05).
CONCLUSION: DECT-derived multiparameters can be used to noninvasively identify VETC and MVI statuses. Nomograms incorporating these parameters enhance VETC and MVI prediction in HCC.
引用
- Li M, You H, Luo M, et al. Dual-energy CT-derived multiparameters for noninvasive prediction of vessels encapsulating tumor clusters and microvascular invasion in hepatocellular carcinoma. Abdom Radiol (NY). 2026. PMID: 42118276. doi:10.1007/s00261-026-05533-x
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。