title: Spectral CT imaging in the differential diagnosis of necrotic hepatocellular carcinoma and hepatic abscess.
abstract: OBJECTIVE
  To explore the value of CT spectral imaging in the differential diagnosis of necrotic hepatocellular carcinoma (nHCC) and hepatic abscess (HA) during the arterial phase (AP) and portal venous phase (PP).
  
  
  METHODS
  Sixty patients with 36 nHCCs and 24 HAs underwent spectral CT during AP and PP. Iodine or water concentration were measured and the normalized iodine concentration (NIC) and lesion-normal parenchyma iodine concentration ratio (LNR) were calculated. The two-sample t-test was used to compare quantitative parameters. Two readers qualitatively assessed lesion types according to imaging features. Sensitivity and specificity were compared between the qualitative and quantitative studies.
  
  
  RESULTS
  NIC and LNR in the AP for the wall of nHCC (0.14 ± 0.04 mg/ml; 2.77 ± 0.74) were higher than those of HA (0.13 ± 0.02 mg/ml; 1.4 ± 0.9). NIC and LNR in the PP for the wall of HA (0.66 ± 0.05 mg/ml; 1.2 ± 0.2) were higher than those of nHCC (0.5 ± 0.11 mg/ml; 0.94 ± 0.12). The differences in NIC in the AP were not significant but the differences in LNR in AP, and NIC and LNR in the PP were significant. The best quantitative parameter was LNR in AP, and a threshold of 1.52 would yield a sensitivity and specificity of 100% and 91.7%, respectively, for differentiating nHCC from HA.
  
  
  CONCLUSIONS
  CT spectral imaging with quantitative iodine concentration analysis may help to increase the accuracy of differentiating nHCC from HA.
authors.affiliation: Department of Radiology, The First Affiliated Hospital of Soochow University, No. 188, Shi Zi Street, Suzhou 215006, Jiangsu, China.
authors.forename: Y
authors.initials: Y
authors.lastname: Yu
authors.affiliation: Department of Radiology, The First Affiliated Hospital of Soochow University, No. 188, Shi Zi Street, Suzhou 215006, Jiangsu, China.
authors.forename: L
authors.initials: L
authors.lastname: Guo
authors.affiliation: Department of Radiology, The First Affiliated Hospital of Soochow University, No. 188, Shi Zi Street, Suzhou 215006, Jiangsu, China.
authors.forename: C
authors.initials: C
authors.lastname: Hu
authors.affiliation: Department of Radiology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, No. 197, Rui Jin Er Road, Shanghai 200025, China. Electronic address: chenkemin2012@163.com.
authors.forename: K
authors.initials: K
authors.lastname: Chen
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging* / Q000473:pathology; D003287:Contrast Media; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007479:Iopamidol; D008099:Liver / Q000000981:diagnostic imaging / Q000473:pathology; D008100:Liver Abscess / Q000000981:diagnostic imaging*; D008113:Liver Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009336:Necrosis / Q000000981:diagnostic imaging; D015588:Observer Variation; D011169:Portal Vein / Q000000981:diagnostic imaging; D011446:Prospective Studies; D011856:Radiographic Image Enhancement / Q000379:methods; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D036542:Tomography, Spiral Computed / Q000379:methods; D014057:Tomography, X-Ray Computed / Q000379:methods*; D055815:Young Adult
chemical_list: D003287:Contrast Media; D007479:Iopamidol