能谱CT对门脉高压伴多发侧枝循环形成的诊治指导作用  

The guiding effects of energy spectrum CT in diagnosis and treatment of portal hypertension complicated by multiple collateral circulation formation

作　　者：夏远舰[1] 刘海静 李娜[1] 吴国华[1] 袁仲强 王丽坤 申兵 丁芳芳 XIA Yuanjian;LIU Haijing;LI Na(Central Hospital of Handan City,Hebei,Handan 056001,China)

机构地区：[1]河北省邯郸市中心医院,056001

出　　处：《河北医药》2019年第9期1380-1383,共4页Hebei Medical Journal

摘　　要：目的探讨宝石能谱CT成像(GSI)对门脉高压伴多发侧枝循环形成的诊治的指导作用。方法选取2015年1月至2017年6月收治的肝硬化门静脉高压伴多发侧枝循环患者80例,行GSI、常规CT增强扫描检查各40例,比较2种检查方法下门脉图像噪声、对比噪声比(CNR)、信噪比(SNR)、CT容量剂量指数(CTDIvol)、有效辐射剂量(ED),治疗后随访6个月并定期复查,依据Rentrop分级将行GSI检查患者分为A组(侧枝循环良好)、B组(侧枝循环不良),比较2组GSI参数[肝脾动脉期浓度比率(LSA)、肝脾静脉期碘浓度比率(LSV)、肝碘浓度比率(SIC)、胃左静脉指数(GLI)],并以X线数字减影血管造影(DSA)为金标准,评估GSI与常规CT诊断门脉高压伴多发侧枝循环的效能。结果 GSI检查时CNR、SNR均高于常规CT增强扫描,而噪声、CTDIvol、ED低于常规CT(P<0.05);DSA显示随访末80例患者中39例侧枝循环不良占48.75%(39/80),低于治疗前的67.50%(45/68)(P<0.05);A组治疗后LSA、LSV、SIC大于B组(P<0.05);GSI诊断肝硬化伴多发侧枝循环的灵敏度、特异度、准确度、ROC曲线下面积、Kappa一致性、ROC曲线下面积高(大于)常规CT(P<0.05)。结论 GSI在提高门静脉影像质量同时,对肝硬化门脉高压伴多发侧枝循环有较高诊断价值,结合数字减影血管造影(DSA)可指导临床进行诊治,值得临床推广。Objective To explore the guiding effects of gemstone energy spectrum CT imaging(GSI) in diagnosis and treatment of portal hypertension complicated by multiple collateral circulation formation.Methods A total of 80 patients with liver cirrhosis and portal hypertension complicated by multiple collateral circulation formation who were admitted and treated in our hospital from January 2015 to June 2017 were enrolled in the study,who were examined by GSI(n=40) or routine CT enhanced scan examination(n=40). The portal vein image noise ratio, contrast noise ratio(CNR), signal to noise ratio(SNR), CT dose index volum(CTDIvol) and the effective radiation dose(ED) were observed and compared between the two examination methods. The patients were followed up for 6 months and were reviewed regularly after treatment. According to the Rentrop classification, the patients who underwent GSI examination were redivided into group A(with good collateral circulation) and group B(with poor collateral circulation). The GSI parameters including hepatic and splenic artery phase concentration ratio(LSA), hepatic and splenic venous phase iodine concentration ratio(LSV), hepatic iodine concentration ratio(SIC), left gastric vein index(GLI)] were observed and compared between the two groups. The efficiency of GSI and routine CT in diagnosis of portal hypertension complicated by multiple collateral circulation formation was assessed according to the golden standard of X ray digital subtraction angiography(DSA).Results The CNR and SNR by GSI examination were significantly higher than those by routine CT enhancement scan, however the noise, CTDIvol and ED were significantly lower than those by routine CT(P<0.05). DSA showed that there were 41 cases of poor collateral circulation among the 80 cases of patients at the end of follow-up, which was significantly lower than that before treatment(48.75% vs 67.50%, P<0.05). After treatment the LSA, LSV and SIC in group A were significantly greater than those in group B(P<0.05). The sensitivity, specifi

关 键 词：能谱CT 门脉高压 侧枝循环 诊治 

分 类 号：R814.42[医药卫生—影像医学与核医学]