能谱CT门静脉成像对肝硬化食管胃底静脉曲张出血的预测分析  

The predictive analysis of spectral CT portal vein imaging for esophageal-gastric variceal bleeding

作　　者：马雅丽 王贵生[2] 陈晓霞[2] 侯文文[2] 韩文娟 赵国全[2] MA Yali;WANG Guisheng;CHEN Xiaoxia;HOU Wenwen;HAN Wenjuan;ZHAO Guoquan(Jinzhou Medical University,Jinzhou 1210019 China;CT Room,General Hospital of Armed Police,Beijing 100039,China)

机构地区：[1]锦州医科大学,辽宁锦州121001 [2]武警总医院CT室,北京100039

出　　处：《实用放射学杂志》2019年第3期451-454,共4页Journal of Practical Radiology

基　　金：首都特色课题(Z151100004015148)。

摘　　要：目的探讨门静脉最佳CNR单能量图像预测肝硬化食管胃底静脉曲张出血的应用价值。方法 40例肝硬化门静脉高压症患者行腹部3期增强扫描,门静脉期应用能谱扫描模式,获得门静脉最佳CNR单能量图像及70 keV(相当于管电压为120 kVp的传统混合能量图像的平均能量)单能量图像,对2组门静脉图像质量进行评分比较;将门静脉最佳CNR单能量图像与胃镜检查对患者食管胃底静脉曲张分级诊断结果进行一致性比较;根据有无上消化道出血病史分为出血组及未出血组,绘制ROC曲线,评价门静脉及属支内径与食管胃底静脉曲张出血风险的关系。结果最佳CNR单能量图像组的CNR及图像质量显著高于70 keV单能量图像组,两者间差异有统计学意义(P<0.05);最佳CNR单能量图像与胃镜对食管胃底静脉曲张分级诊断结果一致性较好(k=0.769);门静脉主干(MPV)近端及远端、门静脉左支(LPV)、脾静脉(SV)和胃左静脉(LGV)内径在出血组及未出血组间的差异有统计学意义,ROC曲线分析,当LGV>6.1 mm时,发生食管胃底静脉曲张出血可能性最大,敏感度76.92%,特异度85.71%。结论能谱CT最佳CNR技术能够提高肝硬化门静脉高压症患者门静脉成像质量,并可将胃左静脉内径作为预测肝硬化食管胃底静脉曲张出血的风险指标。Objective To investigate the value of the optimal CNR monoenergetic images of portal vein in predicting esophageal-gastric variceal bleeding( EVB). Methods Forty patients with liver cirrhosis and portal hypertension underwent contrast-enhanced spectral CT scan.The optimal CNR monoenergetic images and 70 keV monoenergetic images of the portal vein phase were selected to compare the imaging quality.The consistency of the optimal CNR monoenergetic images with endoscopy for esophageal-gastric variceal was analyzed by Kappa test. According to the EVB history, the patients were divided into bleeding group and non-bleeding group.The ROC curves were calculated to assess the values of the main portal vein (MPV) and its tributaries diameters to predicting EVB.Results The CNR and objective score of the optimal CNR monoenergetic images were significantly higher than those of the 70 keV images (P<0.05 ). The optimal CNR monoenergetic images had good consistency with gastroscope in the classification of esophageal-gastric variceal (k = 0.769).There were significant differences of the diameters of MPV,intrahepatic left branch of portal vein (LPV).splenic vein (SV) and left gastric vein ( LGV) between the bleeding group and non -bleeding group ( P<0.05 ). ROC curve analysis showed that the incidence of EVB was highest with a sensitivity of 76.92% and a specificity of 85.71 %, when the LGV was greater than 6.1 mm. Conclusion The optimal CNR monoenergetic images of portal vein could improve the imaging quality,and LGV diameter should be a risk indicator for predicting EVB in liver cirrhosis.

关 键 词：能谱成像 门静脉 计算机体层成像 食管胃底静脉曲张出血 肝硬化 

分 类 号：R814.42[医药卫生—影像医学与核医学] R657.34[医药卫生—放射医学]