Retrospective Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Apr 28, 2019; 25(16): 1986-1996
Published online Apr 28, 2019. doi: 10.3748/wjg.v25.i16.1986
Dual energy computed tomography for detection of metastatic lymph nodes in patients with hepatocellular carcinoma
Yu-Rong Zeng, Qi-Hua Yang, Qing-Yu Liu, Jun Min, Hai-Gang Li, Zhi-Feng Liu, Ji-Xin Li
Yu-Rong Zeng, Qi-Hua Yang, Qing-Yu Liu, Ji-Xin Li, Department of Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, Guangdong Province, China
Jun Min, Department of Hepatobiliary Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, Guangdong Province, China
Hai-Gang Li, Department of Pathology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, Guangdong Province, China
Zhi-Feng Liu, Department of Radiology, Zengcheng District People’s Hospital of Guangzhou, Guangzhou 511300, Guangdong Province, China
Author contributions: Zeng YR and Yang QH contributed equally to this work; Zeng YR, Yang QH, and Liu QY designed the research; Zeng YR, Yang QH, Min J, Li HG, and Liu ZF performed the research; Li JX contributed technical guidance and operation; Zeng YR, Yang QH, Min J, and Liu ZF analyzed the data; Zeng YR, Yang QH, and Liu QY wrote the paper.
Institutional review board statement: The study was reviewed and approved by the institutional review board of Sun Yat-sen Memorial Hospital.
Informed consent statement: Informed consent was waived by the ethics committee of Sun Yat-sen Memorial Hospital.
Conflict-of-interest statement: There is no conflict of interest associated with any of the senior author or other coauthors who contributed their efforts in this manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Qing-Yu Liu, PhD, Attending Doctor, Professor, Department of Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 West Yanjiang Road, Guangzhou 510120, Guangdong Province, China. liuqy@mail.sysu.edu.cn
Telephone: +86-13694201711 Fax: +86-20-81332702
Received: February 2, 2019
Peer-review started: February 6, 2019
First decision: March 5, 2019
Revised: March 14, 2019
Accepted: March 24, 2019
Article in press: March 24, 2019
Published online: April 28, 2019
Abstract
BACKGROUND

Regional lymph node metastasis in patients with hepatocellular carcinoma (HCC) is not uncommon, and is often under- or misdiagnosed. Regional lymph node metastasis is associated with a negative prognosis in patients with HCC, and surgical resection of lymph node metastasis is considered feasible and efficacious in improving the survival and prognosis. It is critical to characterize lymph node preoperatively. There is currently no consensus regarding the optimal method for the assessment of regional lymph nodes in patients with HCC.

AIM

To evaluate the diagnostic value of single source dual energy computed tomography (CT) in regional lymph node assessment for HCC patients.

METHODS

Forty-three patients with pathologically confirmed HCC who underwent partial hepatectomy with lymphadenectomy were retrospectively enrolled. All patients underwent dual-energy CT preoperatively. Regional lymph nodes (n = 156) were divided into either a metastatic (group P, n = 52) or a non-metastasis group (group N, n = 104), and further, according to pathology, divided into an active hepatitis (group P1, n = 34; group N1, n = 73) and a non-active hepatitis group (group P2, n = 18; group N2, n = 31). The maximal short axis diameter (MSAD), iodine concentration (IC), normalized IC (NIC), and the slope of the spectral curve (λHU) of each group in the arterial phase (AP), portal phase (PP), and delayed phase (DP) were analyzed.

RESULTS

Analysis of the MSAD, IC, NIC, and λHU showed statistical differences between groups P and N (P < 0.05) during all three phases. To distinguish benign from metastatic lymph nodes, the diagnostic efficacy of IC, NIC, and λHU in the PP was the best among the three phases (AP, PP, and DP), with a sensitivity up to 81.9%, 83.9%, and 81.8%, and a specificity up to 82.4%, 84.1% and 84.1%, respectively. The diagnostic value of combined analyses of MSAD with IC, NIC, or λHU in the PP was superior to the dual energy CT parameters alone, with a sensitivity up to 84.5%, 86.9%, and 86.2%, and a specificity up to 83.0%, 93.6% and 89.8%, respectively. Between groups P1 and P2 and groups N1 and N2, only IC, NIC, and λHU between groups N1 and N2 in the PP had a statistically significant difference (P < 0.05).

CONCLUSION

Dual-energy CT contributes beneficially to regional lymph node assessment in HCC patients. Combination of MSAD with IC, NIC, or λHU values in the PP is superior to using any single parameter alone. Active hepatitis does not deteriorate the capabilities for characterization of metastatic lymph nodes.

Keywords: Computed tomography, Hepatocellular carcinoma, Lymph node, Metastasis, Hepatitis, Dual energy

Core tip: Dual-energy computed tomography (CT) contributes beneficially to regional lymph node assessment in hepatocellular carcinoma (HCC) patients, which can differentiate metastatic and non-metastatic lymph nodes for improving regional lymph node staging of HCC. Combination of maximal short axis diameter with dual-energy CT quantifiable parameters (iodine concentration, normalized iodine concentration, or the slope of the spectral curve) in the portal phase can be more advantageous in regional lymph node assessment. Active hepatitis does not deteriorate the detection and characterization of metastatic lymph nodes in HCC.