中华消化外科杂志
中華消化外科雜誌
중화소화외과잡지
Chinese Journal of Digestive Surgery
2015年
9期
741-745
,共5页
直肠肿瘤%动脉%体层摄影术,X线计算机%对比噪声比
直腸腫瘤%動脈%體層攝影術,X線計算機%對比譟聲比
직장종류%동맥%체층섭영술,X선계산궤%대비조성비
Rectal neoplasms%Arteries%Tomography,X-ray computed%Contrast noise ratio
目的 探讨单源双能CT最佳单能量成像技术在检查直肠癌供血动脉中的应用价值.方法 回顾性分析2012年7月至2014年7月大连医科大学附属第一医院收治的33例直肠癌患者的临床资料,通过单源双能CT扫描,采用混合能量和最佳单能量两种模式重建肿瘤供血动脉.由两位观察者盲法分别对两种图像直肠癌细小供血动脉进行5分制主观图像质量评分.对评分结果的一致性进行κ检验,对两种图像的主观评分进行t检验;由两位观察者分别测量两种图像直肠癌细小供血动脉和臀部肌肉的CT值以及图像噪声值,并计算对比噪声比(CNR),采用组内相关系数(ICC)检验两位观察者对两种图像测量数据的一致性,并采用独立样本Mann-Whitney U检验对两种重建模式的直肠癌细小供血动脉CT值、图像噪声值以及CNR进行比较.结果 33例患者中肠系膜下动脉均参与肿瘤供血;其中4例患者右侧直肠下动脉参与供血,2例患者双侧直肠下动脉参与供血.发现血管变异情况:8例患者左结肠动脉与乙状结肠动脉共干,4例患者左结肠动脉直接起自肠系膜上动脉,1例患者左结肠动脉缺如.两位观察者对直肠癌细小供血动脉混合能量图像评分0、1、2、3、4分分别为0、13、13、5、2例和0、11、14、6、2例;最佳单能量评分0、1、2、3、4分分别为0、0、7、7、19例和0、0、6、9、18例.两位观察者对混合能量和最佳单能量直肠癌细小供血动脉图像评分结果一致性很好(κ =0.864,0.897);混合能量与最佳单能量图像细小供血动脉图像主观质量评分分别为(1.9±0.9)分、(3.4±0.8)分,两者比较,差异有统计学意义(Z=-5.21,P＜0.05).最佳单能量图像的直肠癌细小供血动脉的主观评价优于混合能量图像.混合能量与最佳单能量直肠癌细小供血动脉CT值、臀部肌肉CT值、图像噪声值及CNR的ICC值分别为0.953、0.907、0.839、0.964和0.966、0.933、0.952、0.962,其一致性均很好.混合能量及最佳单能量直肠癌细小供血动脉CT值分别为(234±52)HU和(412 ±83)HU,臀部肌肉CT值分别为(57 ±9)HU和(71±15)HU,图像噪声值分别为(21 ±3)HU和(31 ±6)HU,CNR分别为9±3和11±4,两者比较,差异均有统计学意义(t=-18.65,-4.44,-14.14,-6.55,P＜0.05).33例患者的最佳单能量keV值为51 ～61,中位keV值为55.结论 单源双能CT最佳单能量成像技术能够提高直肠癌供血动脉血管成像的图像质量.
目的 探討單源雙能CT最佳單能量成像技術在檢查直腸癌供血動脈中的應用價值.方法 迴顧性分析2012年7月至2014年7月大連醫科大學附屬第一醫院收治的33例直腸癌患者的臨床資料,通過單源雙能CT掃描,採用混閤能量和最佳單能量兩種模式重建腫瘤供血動脈.由兩位觀察者盲法分彆對兩種圖像直腸癌細小供血動脈進行5分製主觀圖像質量評分.對評分結果的一緻性進行κ檢驗,對兩種圖像的主觀評分進行t檢驗;由兩位觀察者分彆測量兩種圖像直腸癌細小供血動脈和臀部肌肉的CT值以及圖像譟聲值,併計算對比譟聲比(CNR),採用組內相關繫數(ICC)檢驗兩位觀察者對兩種圖像測量數據的一緻性,併採用獨立樣本Mann-Whitney U檢驗對兩種重建模式的直腸癌細小供血動脈CT值、圖像譟聲值以及CNR進行比較.結果 33例患者中腸繫膜下動脈均參與腫瘤供血;其中4例患者右側直腸下動脈參與供血,2例患者雙側直腸下動脈參與供血.髮現血管變異情況:8例患者左結腸動脈與乙狀結腸動脈共榦,4例患者左結腸動脈直接起自腸繫膜上動脈,1例患者左結腸動脈缺如.兩位觀察者對直腸癌細小供血動脈混閤能量圖像評分0、1、2、3、4分分彆為0、13、13、5、2例和0、11、14、6、2例;最佳單能量評分0、1、2、3、4分分彆為0、0、7、7、19例和0、0、6、9、18例.兩位觀察者對混閤能量和最佳單能量直腸癌細小供血動脈圖像評分結果一緻性很好(κ =0.864,0.897);混閤能量與最佳單能量圖像細小供血動脈圖像主觀質量評分分彆為(1.9±0.9)分、(3.4±0.8)分,兩者比較,差異有統計學意義(Z=-5.21,P＜0.05).最佳單能量圖像的直腸癌細小供血動脈的主觀評價優于混閤能量圖像.混閤能量與最佳單能量直腸癌細小供血動脈CT值、臀部肌肉CT值、圖像譟聲值及CNR的ICC值分彆為0.953、0.907、0.839、0.964和0.966、0.933、0.952、0.962,其一緻性均很好.混閤能量及最佳單能量直腸癌細小供血動脈CT值分彆為(234±52)HU和(412 ±83)HU,臀部肌肉CT值分彆為(57 ±9)HU和(71±15)HU,圖像譟聲值分彆為(21 ±3)HU和(31 ±6)HU,CNR分彆為9±3和11±4,兩者比較,差異均有統計學意義(t=-18.65,-4.44,-14.14,-6.55,P＜0.05).33例患者的最佳單能量keV值為51 ～61,中位keV值為55.結論 單源雙能CT最佳單能量成像技術能夠提高直腸癌供血動脈血管成像的圖像質量.
목적 탐토단원쌍능CT최가단능량성상기술재검사직장암공혈동맥중적응용개치.방법 회고성분석2012년7월지2014년7월대련의과대학부속제일의원수치적33례직장암환자적림상자료,통과단원쌍능CT소묘,채용혼합능량화최가단능량량충모식중건종류공혈동맥.유량위관찰자맹법분별대량충도상직장암세소공혈동맥진행5분제주관도상질량평분.대평분결과적일치성진행κ검험,대량충도상적주관평분진행t검험;유량위관찰자분별측량량충도상직장암세소공혈동맥화둔부기육적CT치이급도상조성치,병계산대비조성비(CNR),채용조내상관계수(ICC)검험량위관찰자대량충도상측량수거적일치성,병채용독립양본Mann-Whitney U검험대량충중건모식적직장암세소공혈동맥CT치、도상조성치이급CNR진행비교.결과 33례환자중장계막하동맥균삼여종류공혈;기중4례환자우측직장하동맥삼여공혈,2례환자쌍측직장하동맥삼여공혈.발현혈관변이정황:8례환자좌결장동맥여을상결장동맥공간,4례환자좌결장동맥직접기자장계막상동맥,1례환자좌결장동맥결여.량위관찰자대직장암세소공혈동맥혼합능량도상평분0、1、2、3、4분분별위0、13、13、5、2례화0、11、14、6、2례;최가단능량평분0、1、2、3、4분분별위0、0、7、7、19례화0、0、6、9、18례.량위관찰자대혼합능량화최가단능량직장암세소공혈동맥도상평분결과일치성흔호(κ =0.864,0.897);혼합능량여최가단능량도상세소공혈동맥도상주관질량평분분별위(1.9±0.9)분、(3.4±0.8)분,량자비교,차이유통계학의의(Z=-5.21,P＜0.05).최가단능량도상적직장암세소공혈동맥적주관평개우우혼합능량도상.혼합능량여최가단능량직장암세소공혈동맥CT치、둔부기육CT치、도상조성치급CNR적ICC치분별위0.953、0.907、0.839、0.964화0.966、0.933、0.952、0.962,기일치성균흔호.혼합능량급최가단능량직장암세소공혈동맥CT치분별위(234±52)HU화(412 ±83)HU,둔부기육CT치분별위(57 ±9)HU화(71±15)HU,도상조성치분별위(21 ±3)HU화(31 ±6)HU,CNR분별위9±3화11±4,량자비교,차이균유통계학의의(t=-18.65,-4.44,-14.14,-6.55,P＜0.05).33례환자적최가단능량keV치위51 ～61,중위keV치위55.결론 단원쌍능CT최가단능량성상기술능구제고직장암공혈동맥혈관성상적도상질량.
Objective To explore the application value of optimal energy imaging technique of monoenergetic dual-energy computed tomography (DECT) in feeding arteries examination of rectal cancer.Methods The clinical data of 33 patients with rectal cancer who were admitted to the First Affiliated Hospital of Dalian Medical University from July 2012 to July 2014 were analyzed retrospectively.The polychromatic and monochromatic images of feeding arteries of tumors were reconstructed and evaluated using a subjective image quality score of 5-point scale by 2 observers.The consistency and scores of evaluation were analyzed by the κ test and MannWhitney U test.The CT value of feeding arteries of tumors and hip muscle,image noise and contrast to noise ratio (CNR) were measured and calculated by 2 observers,and were compared by the independent sample t test.The consistency of data between the 2 observers were measured by the intra-class correlation coefficients (ICC).Results Inferior mesenteric arteries were contributor of blood supply of tumors in all the 33 patients,including 4 cases with right inferior rectal artery as contributor of blood supply of tumors,2 cases with bilateral inferior rectal artery.Among patients with abnormal blood vessels,there were 8 patients with left colic artery and sigmoid artery having common trunk,4 patients with left colic artery originated from Inferior mesenteric artery,1 patient with absence of left colic artery.The 0-,1-,2-,3-,4-score polychromatic image quality of feeding arteries of tumors were detected in 0,13,13,5,2 patients and 0,11,14,6,2 patients by 2 observers,respectively.The 0-,1-,2-,3-,4-score monochromatic image quality of feeding arteries of tumors were detected in 0,0,7,7,19 patients and 0,0,6,9,18 patients by 2 observers,respectively.Good interobserver agreement was found for the evaluation of subjective scores (κ =0.864,0.897).The subjective scores of image quality of feeding arteries in the polychromatic images and in the monochromatic images were 1.9 ± 0.9 and 3.4 ± 0.8,with significant difference (Z =-5.21,P ＜ 0.05).The latter was superior to the former.The ICC values of the CT values of feeding arteries of tumor,hip muscle,image noise and CNR were 0.953,0.907,0.839,0.964 and 0.966,0.933,0.952,0.962 from the 2 observers,with a good consistency.The CT values of feeding arteries of tumor,gluteal muscles,image noise and CNR in the polychromatic images and in the monochromatic images were (234 ± 52)HU and (412±83)HU,(57±9)HU and (71 ±15)HU,(21 ±3)HU and (31 ±6)HU,9 ±3 and 11 ±4,respectively,with significant differences (t =-18.65,-4.44,-14.14,-6.55,P ＜ 0.05).The levels of monochromatic images of 33 patients were 51-61 keV,with a median of 55 keV.Conclusion The optimal energy imaging technique of monoenergetic DECT can improve the angiographic quality of feeding arteries in patients with rectal cancer.
