CAJ | 학술논문

目的探讨双能CT双期增强结合虚拟平扫对肾脏透明细胞癌的诊断价值.方法对60例临床怀疑肾脏透明细胞癌的患者进行前瞻性研究,进行双能CT的单能平扫及双能皮髓交界早期、实质期增强扫描,采用虚拟平扫后处理软件生成虚拟平扫图像,分别根据虚拟平扫结合双期增强及单纯双期增强图像进行诊断,以病理结果为标准,计算两者诊断肾脏透明细胞癌的准确率,并以x2检验比较；以Wilcoxon秩和检验比较常规平扫和虚拟平扫图像对肿瘤的显示；以配对样本t检验比较患者所接受的单期X线辐射剂量和总辐射剂量差异、常规平扫与虚拟平扫图像肿瘤的CT值差异.结果虚拟平扫结合双能CT双期增强图像对透明细胞癌的诊断准确率高于单纯双期增强[分别为93.3％ (56/60)和78.3％ (47/60)；x2=5.6,P＜0.05].常规平扫显示42例肾透明细胞癌病灶,对肿瘤显示优、良、一般和差的分别为22、12、4和4例,虚拟平扫分别为26、10、3和3例,差异无统计学意义(Z=0.00,P=1.00).虚拟平扫的单期CTDIvol(8.85±1.28) mGy、DLP剂量(196.45±21.12) mGy·cm和总的CTDIvol( 17.69±2.35) mGy、DLP剂量(392.90±42.25) mGy·cm均低于常规平扫[分别为(10.20±1.44)mGy、(218.29±29.60) mGy·cm、(30.61±3.27) mGy和(654.86±88.81)mGy·cm],t值分别为4.21、3.58、23.63、16.12,P值均＜0.05.常规平扫和虚拟平扫的CT值分别为(34.94±7.00)和(39.37±6.35)HU,差异有统计学意义(t=-14.39,P＜0.05).结论双能CT皮髓交界早期及实质期双期增强结合虚拟平扫对肾脏透明细胞癌的诊断价值较大,对多数患者可以做出准确诊断,并明显降低辐射剂量.
목적 탐토쌍능CT쌍기증강결합허의평소대신장투명세포암적진단개치.방법 대60례림상부의신장투명세포암적환자진행전첨성연구,진행쌍능CT적단능평소급쌍능피수교계조기、실질기증강소묘,채용허의평소후처리연건생성허의평소도상,분별근거허의평소결합쌍기증강급단순쌍기증강도상진행진단,이병리결과위표준,계산량자진단신장투명세포암적준학솔,병이x2검험비교；이Wilcoxon질화검험비교상규평소화허의평소도상대종류적현시；이배대양본t검험비교환자소접수적단기X선복사제량화총복사제량차이、상규평소여허의평소도상종류적CT치차이.결과 허의평소결합쌍능CT쌍기증강도상대투명세포암적진단준학솔고우단순쌍기증강[분별위93.3％ (56/60)화78.3％ (47/60)；x2=5.6,P＜0.05].상규평소현시42례신투명세포암병조,대종류현시우、량、일반화차적분별위22、12、4화4례,허의평소분별위26、10、3화3례,차이무통계학의의(Z=0.00,P=1.00).허의평소적단기CTDIvol(8.85±1.28) mGy、DLP제량(196.45±21.12) mGy·cm화총적CTDIvol( 17.69±2.35) mGy、DLP제량(392.90±42.25) mGy·cm균저우상규평소[분별위(10.20±1.44)mGy、(218.29±29.60) mGy·cm、(30.61±3.27) mGy화(654.86±88.81)mGy·cm],t치분별위4.21、3.58、23.63、16.12,P치균＜0.05.상규평소화허의평소적CT치분별위(34.94±7.00)화(39.37±6.35)HU,차이유통계학의의(t=-14.39,P＜0.05).결론 쌍능CT피수교계조기급실질기쌍기증강결합허의평소대신장투명세포암적진단개치교대,대다수환자가이주출준학진단,병명현강저복사제량.
Objective To explore the diagnositic value of dual-phase contrast enhancement CT combined with virtual non-enhanced images by dual-energy CT in clear cell renal cell carcinoma.Methods Sixty patients who were suspected of clear cell renal cell carcinoma underwent non-enhanced CT and contrast enhancement CT of early interface-phase between cortex -medulla and parenchymal phase on a dual-energy CT.The true non-enhanced kidney CT(TNCT) was performed in a single-energy acquisition mode,but the dual-phase contrast enhancement CT were performed in a dual-energy mode of 80 kV and 140 kV respectively.The virtual non-enhanced CT ( VNCT ) images were derived from the data of early interfacephase using liver virtual non-contrast software.The diagnosises according to VNCT combined dual-phase contrast enhancement CT and dual-phase contrast enhancement CT only were made respeetively and compared with x2 test.Between the true non-contrast CT and the virtual non-contrast CT,the image quality was compared with Wilcoxon test ; The radiation dose of volume CT dose index ( CTDlvol ) and dose length product(DLP) in a single-phase and total examination,the mean CT HU values of the tumours werecompared with t test.Results The accuracy of VNCT combined dual-phase contrast enhancement CT was higher than that of dual-phase contrast enhancement CT only [93.3％ ( 56/60 ) vs.78.3％ ( 47/60 ) ; x2 =5.6,P ＜0.05].The detective ability (score) of VNCT was near to that of TNCT and the difference was not obvious( Z =0.00,P ＞ 0.05 ). The radiation dose of volume CT dose index ( CTDIvol ) and dose length product(DLP) in a single phase and total examination of VNCT[(8.85 ± 1.28) mGy,(196.45 ±21.12) mGy·cm,(17.69±2.35) mGy,(392.90±42.25) mGy · cm] were lower than that of TNCT [( 10.20 ± 1.44 ) mGy,( 218.29 ± 29.60 ) mGy · cm,( 30.61 ± 3.27 ) mGy and ( 654.86 ± 88.81 ) mGy ·cm],t =4.21,3.58,23.63,16.12 respectively,P ＜0.05.The mean CT HU values of tumours on VNCT images was higher than that on TNCT images and the difference was significant [(39.37 ± 6.35 ) vs.(34.94 ± 7.00 )HU,t =- 14.39,P ＜ 0.05].Conclusions The diagnositic value of dual-phase contrast enhancement CT combined virtual non-enhanced CT by dual-energy CT for clear cell renal cell carcinoma was obvious,most tumours can be diagnosed correctly,and the radiate dose can be decreased obviously,the normal single-energy non-enhanced and contrast enhancement CT might be replaced in the future.