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Objectives <p>To evaluate the diagnostic performance of virtual monoenergetic images (VMIs) at 40&#xa0;keV obtained from dual-layer spectral CT (DLCT) for small HCC (sHCC, ≤ 30&#xa0;mm) using the LI-RADS version 2018 (i.e., LR-5) by intraindividual comparison with conventional CT images (CIs) and MRI.</p> Materials and methods <p>From February 2020 to December 2024, patients who were at high risk of HCC with at least one small noncystic observation (≤ 30&#xa0;mm) and who underwent both DLCT and multiphase MRI within one month were retrospectively enrolled. VMIs at 40&#xa0;keV derived from DLCT in the arterial and portal venous phases were reconstructed. Two blinded radiologists independently evaluated the LI-RADS imaging features and assigned categories to CIs, VMIs, and MRI. Sensitivities and specificities for sHCC were compared across modalities using generalized estimating equations.</p> Results <p>In total, 136 patients (median age, 56 years [IQR, 48–61 years]; 115 males) with 200 treatment-naïve small observations confirmed by pathology or clinical follow-up were studied. There were 118 HCCs, 23 non-HCC malignancies, and 59 benign observations. When the LR-5 criteria were used, VMIs had significantly higher sensitivity than CIs (reader 1, 76.3% vs. 64.4%, <i>p</i> = 0.002; reader 2, 78.0% vs. 66.9%, <i>p</i> = 0.008) for sHCC and comparable sensitivity to MRI (reader 1, 76.3% vs. 74.6%, <i>p</i> = 0.64; reader 2, 78.0% vs. 77.1%, <i>p</i> = 0.81). The specificities were not significantly different across modalities (<i>p</i> = 0.26–0.74).</p> Conclusions <p>VMIs derived from the arterial and portal venous phases at 40&#xa0;keV obtained from DLCT had a sensitivity comparable to MRI but superior to CIs for sHCC diagnosis, without impairing specificity. The comparable sensitivity between VMIs and MRI underscores the potential of DLCT as a viable alternative for HCC diagnosis when MRI is contraindicated or unavailable.</p>

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Diagnostic performance of dual-layer spectral detector CT derived from the arterial and portal venous phases in small HCC (≤ 30 mm): comparison with multiphase CT and MRI

  • 期刊论文

  • 发表日期：

    2025年12月12日

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  • Jingbiao Chen,
  • Wenqi Shi,
  • Lina Zhang,
  • Jinhui Zhou,
  • Wu Zhang,
  • Xin Gao,
  • Anqi Li,
  • Weiwei Deng,
  • Zhongping Zhang,
  • Weibin Mao,
  • Jin Wang

摘要

Objectives

To evaluate the diagnostic performance of virtual monoenergetic images (VMIs) at 40 keV obtained from dual-layer spectral CT (DLCT) for small HCC (sHCC, ≤ 30 mm) using the LI-RADS version 2018 (i.e., LR-5) by intraindividual comparison with conventional CT images (CIs) and MRI.

Materials and methods

From February 2020 to December 2024, patients who were at high risk of HCC with at least one small noncystic observation (≤ 30 mm) and who underwent both DLCT and multiphase MRI within one month were retrospectively enrolled. VMIs at 40 keV derived from DLCT in the arterial and portal venous phases were reconstructed. Two blinded radiologists independently evaluated the LI-RADS imaging features and assigned categories to CIs, VMIs, and MRI. Sensitivities and specificities for sHCC were compared across modalities using generalized estimating equations.

Results

In total, 136 patients (median age, 56 years [IQR, 48–61 years]; 115 males) with 200 treatment-naïve small observations confirmed by pathology or clinical follow-up were studied. There were 118 HCCs, 23 non-HCC malignancies, and 59 benign observations. When the LR-5 criteria were used, VMIs had significantly higher sensitivity than CIs (reader 1, 76.3% vs. 64.4%, p = 0.002; reader 2, 78.0% vs. 66.9%, p = 0.008) for sHCC and comparable sensitivity to MRI (reader 1, 76.3% vs. 74.6%, p = 0.64; reader 2, 78.0% vs. 77.1%, p = 0.81). The specificities were not significantly different across modalities (p = 0.26–0.74).

Conclusions

VMIs derived from the arterial and portal venous phases at 40 keV obtained from DLCT had a sensitivity comparable to MRI but superior to CIs for sHCC diagnosis, without impairing specificity. The comparable sensitivity between VMIs and MRI underscores the potential of DLCT as a viable alternative for HCC diagnosis when MRI is contraindicated or unavailable.