CAJ | 학술논문

目的探讨单源双能CT成像虚拟平扫技术在肾细胞癌中应用的可行性.方法回顾性分析2012年8月至2014年9月大连医科大学附属第一医院行单源双能CT(Discovery CT750 HD)能谱扫描并经手术病理证实为肾细胞癌的患者36例.所有患者均行平扫(TUE)及动脉期、皮质期、髓质期增强的能谱成像(GSI)扫描,通过对三期增强图像进行水-碘基物质分离,生成相应的虚拟平扫(VUE)图像.由两位放射科医生对四组平扫图像(TUE及三期VUE)分别进行主观图像质量评分,对两位医生评价结果的一致性行Kappa检验,并对四组图像的评分进行单因素方差分析.分别计算四组图像的病灶-肾实质对比噪声比(CNR),以单因素方差分析四组是否有差异.结果两位医生对四组平扫图像评价结果的一致性较好(Kappa值均＞0.600).皮质期VUE、髓质期VUE、延迟期VUE及TUE四组图像质量间差异均无统计学意义(均P＞0.05);皮质期VUE、髓质期VUE、延迟期VUE图像病灶-肾实质CNR(分别为1.7±1.0,1.9±1.2,2.5±1.4)均高于TUE(0.7±0.6)图像,差异均有统计学意义(均P＜0.05).结论皮质期VUE、髓质期VUE及延迟期VUE与TUE图像质量无区别,且皮质期VUE、髓质期VUE、延迟期VUE的病灶-肾实质CNR均高于TUE,有望取代TUE用于肾细胞癌病灶的检出.
목적 탐토단원쌍능CT성상허의평소기술재신세포암중응용적가행성.방법 회고성분석2012년8월지2014년9월대련의과대학부속제일의원행단원쌍능CT(Discovery CT750 HD)능보소묘병경수술병리증실위신세포암적환자36례.소유환자균행평소(TUE)급동맥기、피질기、수질기증강적능보성상(GSI)소묘,통과대삼기증강도상진행수-전기물질분리,생성상응적허의평소(VUE)도상.유량위방사과의생대사조평소도상(TUE급삼기VUE)분별진행주관도상질량평분,대량위의생평개결과적일치성행Kappa검험,병대사조도상적평분진행단인소방차분석.분별계산사조도상적병조-신실질대비조성비(CNR),이단인소방차분석사조시부유차이.결과 량위의생대사조평소도상평개결과적일치성교호(Kappa치균＞0.600).피질기VUE、수질기VUE、연지기VUE급TUE사조도상질량간차이균무통계학의의(균P＞0.05);피질기VUE、수질기VUE、연지기VUE도상병조-신실질CNR(분별위1.7±1.0,1.9±1.2,2.5±1.4)균고우TUE(0.7±0.6)도상,차이균유통계학의의(균P＜0.05).결론 피질기VUE、수질기VUE급연지기VUE여TUE도상질량무구별,차피질기VUE、수질기VUE、연지기VUE적병조-신실질CNR균고우TUE,유망취대TUE용우신세포암병조적검출.
Objective To qualitatively and quantitatively evaluate the feasibility of CT virtual unenhanced (VUE) spectral imaging in renal cell carcinoma.Method Thirty-six patients with histopathologically proven renal cell carcinoma underwent gemstone spectral imaging (GSI) including ture unenhanced (TUE),arterial,cortex and medullary phase acquisitions.The triphasic GSI dataset was sent to workstation and 3 sets of VUE images (including VUE a,VUE c,VUE m) were obtained by subtract iodine from iodine-water images in the triphasic enhanced GSI images,respectively.The quality of VUE s and TUE images was evaluated on a five-point scale.Interobserver agreement with regard to image quality was assessed using Cohen's Kappa,and four groups of image quality was compared with ANOVA analysis.The contrast-to-noise ratio (CNR) of mass-to-kidney in the TUE and VUE s images was calculated,and difference between these four datasets was compared with ANOVA analysis.Using appearance of masses on triphasic images as a standard,the masses detection ratio of four groups was calculated and compared with chi-square test.Results Interobserver agreement with regard to image quality was excellent (κ ＞ 0.600).There was no significant difference among the image quality of TUE and triphasic images of VUEs (P ＞ 0.05).The CNR of TUE (0.7 ± 0.6) was significant worse than that of triphasic images (1.7 ± 1.0,1.9 ± 1.2,2.5 ± 1.4,respectively) (P ＜ 0.05).There was no significant difference among the CNR of triphasic images (P ＞ 0.05).Conclusion VUE images obtain from triphasic phases may be a surrogate for conventional unenhanced scan in renal cell carcinoma diagnosis.