能谱CT虚拟平扫在肾脏占位病变的应用探索  

The Exploration of Virtual Non-contrast CT Spectral Imaging in Detection of Renal Lesions

作　　者：刘东权 应碧伟 李强 

机构地区：[1]浙江省宁波市宁海县第一医院放射科,315600 [2]浙江省宁波市鄞州人民医院(宁波大学医学院附属鄞州医院)放射科,315175

出　　处：《临床放射学杂志》2017年第12期1831-1834,共4页Journal of Clinical Radiology

摘　　要：目的探讨在肾脏占位性病变诊断方面,能谱CT虚拟平扫(VNC)能否代替传统CT真实平扫(TNC)。方法回顾性分析本院2013年12月至2015年10月行常规肾脏平扫及能谱双期扫描的54例肾脏占位患者的影像资料。由两位具有多年腹部CT诊断经验的影像诊断医师采用双盲法分别对肾脏TNC、皮质期及髓质期VNC图像进行主观图像质量评分,测量病灶-正常肾实质的对比噪声比(CNR),以单因素方差分析进行组间两两比较。以病理结果为金标准,用χ~2检验分别比较TNC与皮质期或髓质期VNC图像对肾脏病灶检测的敏感性,计算有无统计学意义。结果 54例患者伴有肾脏占位病变72枚,其中肾单纯囊肿24枚,肾透明细胞癌15枚,肾转移瘤14枚,肾复杂囊肿11枚,肾脓肿8枚。两位诊断医师对三组图像评价结果的一致性较好(Kappa值均>0.80);TNC、皮质期及髓质期VNC三组图像间图像质量评分差异无统计学差异(P>0.05);三组图像病灶-正常肾实质CNR值分别为0.53±0.14、0.72±0.19、0.61±0.16,皮质期及髓质期VNC图像病灶-正常肾实质CNR值均高于TNC,差异均有统计学意义(P<0.05);TNC、皮质期及髓质期VNC图像的诊断敏感性分别为62.50%、63.89%及66.67%,差异无统计学意义(P>0.05)。结论皮质期及髓质期VNC与TNC图像质量评分并无显著性差异,均能准确地显示肾脏占位性病变。对肾脏占位性病变,能谱VNC图像在一定程度上可代替TNC图像。Objective To evaluate whether the virtual non-contrast（ VNC） spectral CT imaging can replace the true non-contrast（ TNC） CT imaging to diagnose renal lesions. Methods From December 2013 to October 2015,54 patients pathologically diagnosed with renal lesions underwent gemstone spectral imaging（ GSI） including pre-contrast,arterial and venous phase acquisitions. The quality of VNC images and TNC images were evaluated on a five-point scale by two radiologists who were specialized in abdominal CT diagnosis. Interobserver agreement with regards to image quality was evaluated by Cohen＇s kappa analysis. The contrast-to-noise ratio（ CNR） of lesion-normal renal parenchyma on the TNC and VNC images were calculated,and intergroup differences were comparied by one-way ANOVA analysis. The diagnostic accuracy of the TNC images and VNCs were calculated and compared by chi-square test. Results Among the 72 renal lesions of the54 patients,there were hypoattenuating cysts（ n = 24）,suprarenal epithelioma（ n = 15）,metastatic tumors（ n = 14）,hyperattenuating cysts（ n = 11） and nephrapostasis（ n = 8）. Interobserver agreement with regards to image quality was excellently coincident（ Kappa 0. 80）. There was no significant difference among the image quality of the TNC images,arterial and venous phase VNC images. The mean CNR of lesion-normal renal parenchyma in the TNC,arterial and venous phase VNC images were 0. 51 ± 0. 16,0. 77 ± 0. 21,0. 65 ± 0. 18,respectively. The mean CNR of arterial or venous phase VNC was significantly higher than that of TNC imaging（ P〈0. 05）. There was no significant difference of diagnostic accuracy between the TNC images and VNCs. Conclusion The VNC spectral CT imaging may seem as a surrogate for the conventional non-contrast scan in detection of renal lesions to some degree.

关 键 词：肾占位 体层摄影术 X线计算机 虚拟平扫 能谱成像 

分 类 号：R692[医药卫生—泌尿科学] R730.44[医药卫生—外科学] R737.11[医药卫生—临床医学]