CAJ | 학술논문

目的：评价肺栓塞双源双能量CT肺灌注成像(PBV)肺灌注缺损指数和肺动脉 CT血管成像(CTA)肺栓塞指数的一致性。方法对疑诊肺栓塞并排除其他基础性肺部病变的患者40例进行双能量 CT肺动脉成像扫描,数据经工作站处理后得到肺动脉血管成像和肺灌注图像,经医学影像质量控制中心判定合格后,由2位医师分别独立评价 CTA 图像显示肺栓塞及 PBV 图像显示肺灌注缺损的有无、部位及程度,对CTA成像肺栓塞指数和PBV成像肺灌注缺损指数进行双因素方差分析,对不同医师测量的肺栓塞指数和肺灌注缺损指数进行Person相关分析和Bland-Altman 一致性分析。结果肺灌注缺损指数和肺栓塞指数呈中度相关(医师1：r=0.5605,P=0.0002；医师2：r=0.5851,P=0.0001)。不同医师测量的肺灌注缺损指数(r=0.9689,P=0.0000)和肺栓塞指数(r=0.9733,P=0.0000)呈高度相关。相同医师测量的肺灌注缺损指数和肺栓塞指数之间差异大(医师1为8.025,可信区间6.247~9.803；医师2为7.475,可信区间5.670~9.280),不同医师测量的肺灌注缺损指数之间以及肺栓塞指数之间的差异小(肺灌注缺损指数为0.400,可信区间-0.106~0.906；肺栓塞指数为-0.150,可信区间-0.594~0.294)。相同医师测量的肺灌注缺损指数和肺栓塞指数之间的组内相关系数(ICC)低(医师1：0.0617±0.1575；医师2：0.1531±0.1544),而不同医师测量的肺灌注缺损指数之间(0.9646±0.0109)以及栓塞指数指数之间的 ICC相对较高(0.9727±0.0084)。结论肺灌注成像和肺动脉血管成像为双源双能CT 1次扫描后获得的2组不同数据,从不同的角度反映肺栓塞时双肺的受累范围,两者是2种不同的影像学检查方法,不能相互取代。
목적：평개폐전새쌍원쌍능량CT폐관주성상(PBV)폐관주결손지수화폐동맥 CT혈관성상(CTA)폐전새지수적일치성。방법대의진폐전새병배제기타기출성폐부병변적환자40례진행쌍능량 CT폐동맥성상소묘,수거경공작참처리후득도폐동맥혈관성상화폐관주도상,경의학영상질량공제중심판정합격후,유2위의사분별독립평개 CTA 도상현시폐전새급 PBV 도상현시폐관주결손적유무、부위급정도,대CTA성상폐전새지수화PBV성상폐관주결손지수진행쌍인소방차분석,대불동의사측량적폐전새지수화폐관주결손지수진행Person상관분석화Bland-Altman 일치성분석。결과폐관주결손지수화폐전새지수정중도상관(의사1：r=0.5605,P=0.0002；의사2：r=0.5851,P=0.0001)。불동의사측량적폐관주결손지수(r=0.9689,P=0.0000)화폐전새지수(r=0.9733,P=0.0000)정고도상관。상동의사측량적폐관주결손지수화폐전새지수지간차이대(의사1위8.025,가신구간6.247~9.803；의사2위7.475,가신구간5.670~9.280),불동의사측량적폐관주결손지수지간이급폐전새지수지간적차이소(폐관주결손지수위0.400,가신구간-0.106~0.906；폐전새지수위-0.150,가신구간-0.594~0.294)。상동의사측량적폐관주결손지수화폐전새지수지간적조내상관계수(ICC)저(의사1：0.0617±0.1575；의사2：0.1531±0.1544),이불동의사측량적폐관주결손지수지간(0.9646±0.0109)이급전새지수지수지간적 ICC상대교고(0.9727±0.0084)。결론폐관주성상화폐동맥혈관성상위쌍원쌍능CT 1차소묘후획득적2조불동수거,종불동적각도반영폐전새시쌍폐적수루범위,량자시2충불동적영상학검사방법,불능상호취대。
Objective To evaluate the agreement between perfusion deficient score derived from dual-energy CT perfusion imaging and obstruction score derived from pulmonary CT angiography in patients with pulmonary embolism.Methods 40 patients who sus-pected PE excluded basic lung disease accepted the dual-energy CT scanning.The data was post-processed on Siemens workstation to obtain the CTA and PBV images.The quality of images was evaluated by radiology quality control center.Two doctors observed ima-ges and obtain the data of obstruction score and perfusion deficient score,then the data were analysed with analysis of variance.The correlation between obstruction score and perfusion deficient score from different doctors were analyzed with Person and Bland-Alt-man methods.Results Perfusion deficient score had a moderate correlation with obstruction score (doctor 1:r=0.560 5,P=0.000 2;doctor 2:r=0.585 1,P=0.000 1).Perfusion deficient score and obstruction score from different doctors had a strong correlation(Perfusion deficient score :r=0.968 9,P=0.000 0;obstruction score:r=0.973 3,P=0.000 0).Perfusion deficient score and obstruction score from same doctor showed significantly different (doctor 1:8.025,95% CI:6.247~ 9.803 ;doctor 2:7.475,95% CI:5.670~9.280),but perfusion deficient score or obstruction score from different doctors showed no obviously difference(perfusion deficient score:0.400,95%CI:-0.106~0.906;obstruction score:-0.150,95% CI:-0.594~0.294).The ICC between perfusion deficient score and obstruc-tion score from same doctor was low (doctor 1:ICC=0.061 7±0.157 5;doctor 2:ICC=0.153 1±0.154 4),but the ICC of perfusion deficient score or obstruction score from different doctors was high (perfusion deficient score:ICC=0.964 6±0.010 9;obstruction score:ICC=0.972 7±0.008 4).Conclusion The pulmonary CT angiography and perfusion blood volume images were both derived from dual-energy CT scanning,which showed the scope of pul-monary embolism at different angles.CTA and PBV were two different examination methods, and could not replaced each other.