Tesi di specializzazione (5 anni)
LAURETTI, DARIO LUCA
Image quality and diagnostic performance of dual-energy CT with spectral imaging in hepatocellular carcinoma: radiologic-pathologic correlation.
RICERCA TRASLAZIONALE E DELLE NUOVE TECNOLOGIE IN MEDICINA E CHIRURGIA
Corso di studi
relatore Prof. Bartolozzi, Carlo
- spectral imaging
- hepatocellular carcinoma
- dual-energy CT
Data inizio appello
Data di rilascio
Abstract<br>Purpose: To retrospectively evaluate image quality and diagnostic accuracy of dual-energy CT (DECT) in the diagnosis of hepatocellular carcinoma (HCC) in a series of transplanted cirrhotic patients.<br>Materials and Methods: Institutional Review Board approval was obtained. The study included all consecutive cirrhotic patients who underwent liver transplantation (LTx) <120 days after multiphasic DECT with spectral imaging in late arterial phase from March 2013 to December 2014. Three sets of images (A: 140kVp polychromatic; B: 70keV monochromatic; C: “iodine-based” material decomposition images) were reviewed, assessing image quality (scale 1-5), lesion conspicuity (scale 1-3) and lesion-to-liver contrast-to-noise ratio (CNR). Using the pathological findings on the explanted livers as gold standard, sensitivity, specificity, positive and negative predictive values and accuracy were assessed and compared by DeLong method. <br>Results: Fifty-three patients (41 males; mean age 54.4 ± 8.2 years) were included, with 31 HCC nodules identified at pathology in 23 (43.4%) patients (mean diameter 19.1 ± 8.5 mm). Group B showed significantly higher image quality (4.91 ± 0.35) compared to groups A (4.83 ± 0.54; P=.04) and C (4.70 ± 0.57; P=.0035). Lesion conspicuity scores were 2.58 ± 0.65, 2.83 ± 0.48 and 2.92 ± 0.28 for groups A, B and C, respectively; the difference was significant comparing group A and C (P=.03). CNR was significantly higher in group C (4.72 ± 2.94) compared to groups A (2.47 ± 1.5; P<.0001) and B (3.44 ± 1.63; P=.02). On the nodule-by-nodule and patient-by-patient analyses, group C had the highest diagnostic accuracy (area-under-the-curve, AUC 0.90 and 0.96, respectively), compared to groups A (AUC 0.81 and 0.87) and B (AUC 0.87 and 0.92); the difference was significant comparing groups A and C (P=.009 and .039).<br>Conclusions: DECT with spectral imaging provides high quality images; by increasing CNR, iodine-based images are able to increase sensitivity in HCC diagnosis with >90% diagnostic accuracy.<br>
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