CAJ | 학술논문

目的探讨CT能谱成像定量分析鉴别胸腔积液性质的价值.方法将20例胸腔积液患者经胸腔穿刺术抽出的胸腔积液放在试管中进行能谱CT扫描,同时抽出的胸腔积液做胸水常规和生化检查.根据实验室检查结果,分为渗出液和漏出液.应用能谱分析软件,分析两组数据的常规混合能量140 kVp图像的CT值差异,以及两组数据的不同keV水平(40～140 keV)的CT值、能谱曲线斜率、有效原子序数、碘-水浓度、钙-水浓度、钙-脂肪浓度等CT能谱成像的定量参数间的差异.对渗出液和漏出液的CT能谱特征参数进行独立样本t检验.结果根据实验室检查结果,20例中11例渗出液、9例漏出液.渗出液组的常规混合能量140 kVp的图像CT值[(19.56±4.10)HU]高于漏出液组[(13.44±3.46)HU],差异有统计学意义(t=3.002,P=0.010).keV能量越低,其CT值差别越大.在40keV,其CT值差异最大,分别是(47.49±14.60)、(19.76±6.85)HU,差异有统计学意义(t=5.520,P=0.000),渗出液明显高于漏出液;而在140 keV,其CT值差异无统计学意义,平均值分别是(9.76±4.16)和(6.22±3.17)HU(t=2.107,P=0.050).渗出液能谱曲线斜率(0.51±0.23)明显大于漏出液(0.18±0.08),差异有统计学意义(t=4.287,P=0.001).渗出液的有效原子序数、碘(水)浓度、钙(水)浓度、钙(脂肪)浓度明显高于漏出液组,两组的值分别为7.89±0.16和7.67±0.07、(5.74±1.28)和(1.70±0.95)g/L、(7.89±1.78)和(2.53±1.37)g/L、(25.95±1.74)和(20.82±1.40)g/L,差异均有统计学意义(t值分别为4.080、6.998、6.546、6.301,P值均＜0.05).结论渗出液与漏出液具有不同的能谱曲线和能谱特征物质含量,低能量keV图像在渗出液的鉴别中起重要作用,能谱CT为鉴别胸腔积液的性质提供了一种多参数的方法.
목적 탐토CT능보성상정량분석감별흉강적액성질적개치.방법 장20례흉강적액환자경흉강천자술추출적흉강적액방재시관중진행능보CT소묘,동시추출적흉강적액주흉수상규화생화검사.근거실험실검사결과,분위삼출액화루출액.응용능보분석연건,분석량조수거적상규혼합능량140 kVp도상적CT치차이,이급량조수거적불동keV수평(40～140 keV)적CT치、능보곡선사솔、유효원자서수、전-수농도、개-수농도、개-지방농도등CT능보성상적정량삼수간적차이.대삼출액화루출액적CT능보특정삼수진행독립양본t검험.결과 근거실험실검사결과,20례중11례삼출액、9례루출액.삼출액조적상규혼합능량140 kVp적도상CT치[(19.56±4.10)HU]고우루출액조[(13.44±3.46)HU],차이유통계학의의(t=3.002,P=0.010).keV능량월저,기CT치차별월대.재40keV,기CT치차이최대,분별시(47.49±14.60)、(19.76±6.85)HU,차이유통계학의의(t=5.520,P=0.000),삼출액명현고우루출액;이재140 keV,기CT치차이무통계학의의,평균치분별시(9.76±4.16)화(6.22±3.17)HU(t=2.107,P=0.050).삼출액능보곡선사솔(0.51±0.23)명현대우루출액(0.18±0.08),차이유통계학의의(t=4.287,P=0.001).삼출액적유효원자서수、전(수)농도、개(수)농도、개(지방)농도명현고우루출액조,량조적치분별위7.89±0.16화7.67±0.07、(5.74±1.28)화(1.70±0.95)g/L、(7.89±1.78)화(2.53±1.37)g/L、(25.95±1.74)화(20.82±1.40)g/L,차이균유통계학의의(t치분별위4.080、6.998、6.546、6.301,P치균＜0.05).결론 삼출액여루출액구유불동적능보곡선화능보특정물질함량,저능량keV도상재삼출액적감별중기중요작용,능보CT위감별흉강적액적성질제공료일충다삼수적방법.
Objective To assess the feasibility of characterizing pleural fluid on the basis of spectral imaging features utilizing spectral CT imaging. Methods Gemstone spectral imaging(GSI) was used to examine 20 pleural fluids filled tubes (11 exudates and 9 transudates ) following diagnostic thoracentesis. Effusions were classified as transudates or exudates using laboratory markers based on Light criteria. CT values on 140 kVp QC image were compared between two groups. Using GSI viewer, various CT spectral imaging parameters (CT values on different energy level, effective-Z, iodine-water concentration,calcium-water concentration and calcium-fat concentration ) were calculated and compared between two groups. The difference of these spectral characteristic parameters was evaluated statistically by independent-samples t test. Results According to Light criteria, the mean CT value on QC image of exudates [ ( 19. 56 ±4. 10) HU ] was higher than that of transudates [ ( 13.44 ±3.46) HU] (t =3.002,P =0. 010).Difference of CT value was found more obvious in the lower keV. On 40 keV images, the difference of CT value of two groups was the largest, the mean value of exudates [ (47.49 ± 14. 60) HU ] was significantly higher than that of transudates[ ( 19. 76 ± 6. 85) HU ] ( t = 5.520, P = 0. 000). While On 140 keV, the mean CT value were (9.76 ±4. 16)and (6.22 ±3. 17) HU and the difference of the two group has no statistically significant difference (t =2. 107,P =0. 050). The mean slope rates of exudates (0.51 ± 0.23)was significantly larger than that of transudates (0. 18 ± 0. 08 ) ( t= 4. 287, P = 0. 001 ). The effective-Z (7. 89 ± 0. 16), iodine-water concentration [ (5. 74 ± 1.28 ) g/L], calcium-water concentration[ (7. 89 ±1.78) g/L] and calcium-fat concentration [ (25.95 ± 1.74) g/L] of exudates were significantly higher than those of transudates [ 7.67 ± 0. 07, ( 1.70 ± 0. 95 ) g/L, (2. 53 ± 1.37 ) g/L, ( 20. 82 ± 1.40 ) g/L ] ( t = 4. 080,6. 998,6. 546,6. 301 ,P ＜ 0. 05 ). Conclusions The spectral curve and spectral imaging parameters of exudates is found to be different from transudates. The low energy spectral imaging plays an important role in the characterization of pleural fluid. Gemstone spectral CT imaging provides a new multiparameter method to differentiate transudates and exudates.