CAJ | 학술논문

目的：探讨双源CT虚拟平扫技术在颈部淋巴结病变中的诊断价值。资料与方法经病理证实的50例患者共126枚颈部肿大淋巴结，均行双能量扫描，比较淋巴结虚拟平扫和常规平扫图像的CT值、信噪比、对比噪声比、图像主观评价、病变显示、常规扫描与双能量扫描的辐射剂量等。结果①虚拟平扫结合双能量增强扫描对颈部肿大淋巴结6种典型病变的检出率一致性均较好（Kappa>0.7, P<0.01），其中非特异性淋巴结炎、淋巴瘤、甲状腺癌转移淋巴结的检出率（93.1%、86.7%、100.0%）较高（Kappa=0.983、0.893、1.000, P<0.01），对甲状腺癌转移淋巴结的检出率（100.0%）最高（Kappa=1.000, P<0.01）。②常规平扫与动、静脉期虚拟平扫图像间CT值、信噪比、对比噪声比差异无统计学意义（H=3.125、4.374、4.037, P>0.05）。③双能量二期扫描较常规三期扫描降低有效辐射剂量约19%。结论双源CT虚拟平扫结合增强扫描可以清晰地显示并诊断颈部肿大淋巴结，同时可以降低受检者的辐射剂量，有望取代真实平扫。
목적：탐토쌍원CT허의평소기술재경부림파결병변중적진단개치。자료여방법경병리증실적50례환자공126매경부종대림파결，균행쌍능량소묘，비교림파결허의평소화상규평소도상적CT치、신조비、대비조성비、도상주관평개、병변현시、상규소묘여쌍능량소묘적복사제량등。결과①허의평소결합쌍능량증강소묘대경부종대림파결6충전형병변적검출솔일치성균교호（Kappa>0.7, P<0.01），기중비특이성림파결염、림파류、갑상선암전이림파결적검출솔（93.1%、86.7%、100.0%）교고（Kappa=0.983、0.893、1.000, P<0.01），대갑상선암전이림파결적검출솔（100.0%）최고（Kappa=1.000, P<0.01）。②상규평소여동、정맥기허의평소도상간CT치、신조비、대비조성비차이무통계학의의（H=3.125、4.374、4.037, P>0.05）。③쌍능량이기소묘교상규삼기소묘강저유효복사제량약19%。결론쌍원CT허의평소결합증강소묘가이청석지현시병진단경부종대림파결，동시가이강저수검자적복사제량，유망취대진실평소。
Purpose To investigate the value of dual-source CT with dual-energy virtual non-contrast imaging in the diagnosis of cervical lymph node disease. Materials and Methods The dual-energy scan data of 126 lymph nodes from 50 patients confirmed pathologically were reviewed. The difference of average CT value, signal to noise ratio, contrast to noise ratio, image subjective assessment and lesion detectability between virtual non-contrast imaging and conventional non-contrast scan were analyzed. The radiation dose of virtual non-contrast imaging and real non-contrast imaging of cervical lymph node were also compared. Results ①The consistency of virtual plain scan combined with dual-energy contrast imaging in the diagnosis of six typical pathological types were all satisfactory (Kappa>0.7, P<0.01), and the detection rate of non-specific lymphadenitis, lymphomas and lymph node metastasis of thyroid carcinoma was higher among the six types (93.1%, 86.7% and 100.0%, respectively, Kappa=0.983, 0.893; P<0.01), and had the highest detection rate of lymph node metastasis of thyroid carcinoma (100.0%, Kappa=1.000, P<0.01). ②There was no significant difference among the average CT, signal to noise ratio and contrast to noise ratio of conventional scan and virtual non-contrast imaging during arterial phase and venous phase (H=3.125, 4.374, 4.037;P>0.05).③ Compared with conventional enhanced scan, dual-energy phases reduced radiation dose by about 19%. Conclusion Dual-energy virtual non-contrast imaging combined with contrast imaging can provide clear images in the diagnosis of enlarged cervical lymph nodes and reduce radiation dose of subjects, thus can be expected to replace real scan.