能谱CT最佳单能量成像结合低碘含量对比剂在肝细胞癌诊断中的初步应用  

A Preliminary Application of Energy Spectrum CT on Diagnosing Hepatocellular Carcinoma with Low Concentration Contrast Medium

作　　者：郑应心 李伟[1] 史浩[1] 郭文彬[1] 葛亚平[1] 曹鑫[1] 方强 王新怡[1] ZHENG Yingxin;LI Wei;SHI Hao(Department of Radiology, Qianfoshan Hospital of Shandong University, Jinan, Shandong Province 250014, P. R. China)

机构地区：[1]山东大学附属千佛山医院影像科,济南250014 [2]山东省济南市章丘区人民医院(济南市第六人民医院)影像科,250200

出　　处：《临床放射学杂志》2018年第4期660-665,共6页Journal of Clinical Radiology

基　　金：山东省科技发展计划项目(编号:2014GSF118091);山东省科技公关项目(编号:2011GSF11828)

摘　　要：目的探讨能谱CT最佳单能量成像结合低碘含量对比剂扫描方案在肝细胞癌诊断中的可行性和应用价值。方法采用质量评价标准成人男性体模,对其体模肝区部分分别进行能谱成像模式和常规剂量模式扫描,并比较两种扫描模式的SD值、CT值、CDTIvol、DLP数值。前瞻性连续随机搜集临床怀疑肝细胞癌需行上腹部动态增强CT扫描的63例患者,根据扫描方式和对比剂浓度分为能谱扫描低浓度对比剂组（A组,对比剂含碘270 mgI/ml）与常规扫描高浓度对比剂组（B组,对比剂含碘370 mg I/ml）,两组对比剂用量均为1.2 ml/kg,采用独立样本t检验对A、B两组的病灶SD值,信噪比（SNR）,对比噪声比（CNR）,最大强化率（CER）,CT剂量容积指数（CDTIvol）,剂量长度乘积（DLP）,辐射有效剂量（ED）,对比剂注射总量及碘摄取量,进行测量并分析。按4分制对所得图像进行总体图像质量评价,并进行组间比较。结果 （1）体模实验GSI-23模式（375 mA）的辐射剂量低于常规非能谱扫描模式,但两者的SNR、SD值差别不大,结合临床经验,可以选择GSI-23作为扫描条件。（2）63例患者中A组28例,B组24例纳入研究。A组图像的病灶SD值、SNR、CNR和CER（动脉期分别为8.11±2.05,15.65±2.42,4.81±2.93,72.44±24.88;门静脉期分别为6.54±2.18,17.08±4.64,4.47±2.25,53.97±22.87）与B组（动脉期分别为8.33±2.50,15.96±2.73,4.68±2.55,78.25±22.13;门静脉期分别为7.26±2.06,17.10±3.78,4.21±1.20,58.59±20.18）间差异无统计学意义（P值均〉0.05）。两组主观图像质量评分（A组：动脉期4.52±0.49,门静脉期4.51±0.48;B组：动脉期4.64±0.48,门静脉期4.63±0.47）间差异无统计学意义（P值均〉0.05）。A组对比剂注射总量与B组间差异无统计学意义（P值均〉0.05）。A组辐射剂量（CTDIvol、ED）明显低于B组[A组（15.81±0.68）mGy,（5.52±1.24）mSv;B组（20.37±6.89）mGy,（6.23±2.11）mSv],差异�Objective To determine the value and feasibility of the application of low concentration contrast medium combined with optimal single energy image of spectral CT in diagnosing hepatocellular carcinoma. Methods Place the dosimetry verification phantoms under routine CT scan and energy spectrum CT scan respectively,compare the SD value,CT value,CDTlvol and DLP value of the model＇s liver area with each scanning mode. Select 63 patients with clinical suspicion of liver cancer and put them under abdominal dynamic contrast enhanced CT scan. Divide them into two groups based on scanning methods and contrast medium concentration,namely,group A with energy spectrum CT scan（ iodine concentration270 mgl/ml） and group B with routine CT scan（ iodine concentration 370 mgl/ml）,contrast medium dosage of both groups is 1. 2 ml/kg. The independent sample t test was used to spot the difference of SD value,SNR,CNR,CER,CDTlvol,DLP,ED,Contrast agent injection and iodine intake of two groups. Evaluate image quality under four systems and compare them between two groups. Results（ 1） Phantom experiment GSI-23 mode（ 375 m A） radiation dose is lower than the conventional non spectral scanning mode,but the difference between the SNR,SD value is not large,combined with work experience,you can choose GSI-23 as a scanning setting.（ 2） All 63 patients＇ data is qualified for research. The SD value,SNR,CNR and CER of group A is 8. 11 ± 2. 05,15. 65 ± 2. 42,4. 81 ± 2. 93,72. 44 ± 24. 88（ arterial phase） and 6. 54 ± 2. 18,17. 08 ± 4. 64,4. 47 ± 2. 25,53. 97 ± 22. 87（ portal phase） respectively. The SD value,SNR,CNR and CER of group B is8. 33 ± 2. 50,15. 96 ± 2. 73,4. 68 ± 2. 55,78. 25 ± 22. 13（ arterial phase） and 7. 26 ± 2. 06,17. 10 ± 3. 78,4. 21 ± 1. 20,58. 59 ± 20. 18（ portal phase） respectively. The two groups ＇ difference was found not to be statistically significant（ P〈0. 05）. The quality scores of group A are 4. 52 ± 0. 49（ arterial phase） and 4. 51 ± 0. 48（ portal phas

关 键 词：体层摄影术 X线计算机 对比剂 辐射剂量 肝脏 

分 类 号：R730.44[医药卫生—肿瘤] R735.7[医药卫生—临床医学]