能谱CT虚拟平扫在肝癌TACE术后病灶碘油沉积评价中价值  

Value of energy spectrum CT virtual non-contrast in evaluation of iodine oil deposits in hepatocellular carcinoma after TACE

作　　者：李代欣[1] 付志浩 许传军[1] 田玉亭 杜超[1] LI Dai-xin;FU Zhi-hao;XU Chuan-jun;TIAN Yu-ting;DU Chao(Department of Radiology,Nanjing Second Hospital,Nanjing University of Chinese Medicine,Nanjing 210003,Jiangsu,China)

机构地区：[1]南京市第二医院(南京中医药大学附属南京医院)放射科,江苏南京210003

出　　处：《生物医学工程与临床》2020年第5期581-585,591,共6页Biomedical Engineering and Clinical Medicine

摘　　要：目的探讨基于双层探测器能谱CT虚拟平扫(VNC)在肝细胞癌(HCC)经动脉化学治疗栓塞(TACE)术后随访评价中价值。方法选择行TACE治疗HCC患者30例,其中男性25例,女性5例;年龄29~71岁,平均年龄56岁。回顾性分析患者TACE术后腹部能谱CT扫描的影像资料,在后处理工作站中获得门静脉期VNC图像。测量病灶、正常肝实质、腹主动脉、脾脏、腹膜后脂肪和脊柱旁肌肉的CT值,并计算常规平扫(TNC)和VNC图像CT值之差的绝对值及信噪比(SNR)。采用5分法对TNC和VNC图像质量进行评价。记录平扫、动脉期及门静脉期扫描的剂量长度乘积(DLP)并计算有效剂量(ED)。结果 TACE术后病灶VNC与TNC图像比较,CT值和标准差(s)值减低,SNR值增高,差异有统计学意义(Z=-5.322、-5.300、-4.081,P <0.05)。TACE术后病灶VNC与TNC图像CT值差值<15 HU和10 HU的比例分别为20.00%(6/30)、16.67%(5/30)。腹部脏器及组织VNC图像CT值与TNC比较均升高,除腹主动脉以外,差异均有统计学意义(P <0.05)。各脏器和组织VNC图像s值和SNR值与TNC比较,s值增高,SNR值减低,差异均有统计学意义(P <0.05)。肝实质、腹主动脉、脾脏、腹膜后脂肪和脊柱旁肌肉VNC与TNC图像CT值差值<15 HU和10 HU的比例分别为95.33%(143/150)、84.67%(127/150)。TNC和VNC两组图像的主观评分比较,差异有统计学意义(χ~2=48.502,P=0.000)。TNC、动脉期和门静脉期的DLP分别为(323.55±89.28) mGy·cm、(327.17±93.51) mGy·cm、(316.43±87.19) mGy·cm,ED分别为(4.85±1.34) mSv、(4.91±1.40)mSv、(4.75±1.31) mSv,总ED为(14.51±4.04) mSv,其中TNC的ED占总ED的33.48%。结论基于双层探测器能谱CT所获取的HCC患者TACE术后随访的VNC图像不能还原TNC状态下病灶中的碘油沉积情况,因此VNC不能代替TNC。Objective To investigate the value of dual-layer detector energy spectrum based CT virtual non-contrast(VNC) in the follow-up evaluation of hepatocellular carcinoma(HCC) after transarterial chemoembolization(TACE). Methods A total of 30 HCC patients underwent TACE were enrolled, which included 25 males and 5 females, aged 29-71 years old with mean age of 56 years old. The abdominal energy spectrum CT scan images after TACE were retrospectively analyzed to obtain portal vein phase VNC image in post-processing workstation. The CT values of lesions, normal liver parenchyma, abdominal aorta,spleen, retroperitoneal fat and paraspinal muscles were measured. CT difference absolute value between true non-contrast(TNC) and VNC, as well as signal-to-noise ratio(SNR) were calculated. The 5-point scale was used to evaluate image quality of TNC and VNC, The dose length product(DLP) of plain scan, arterial phase and portal vein phase scan were recorded, and the effective dose(ED) were calculated. Results The VNC and TNC imaging of lesions after TACE were compared. The CT and standard deviation(s) values of VNC were decreased, and SNR value was statistically significantly increased than TNC(Z =-5.322,-5.300,-4.081, P < 0.05). The ratio of CT value difference < 15 HU and 10 HU in VNC and TNC of lesions after TACE was20.00 %(6/30) and 16.67 %(5/30). Compared with TNC, CT values of VNC image of abdominal organs and tissues were all statistically significantly increased(P < 0.05), except for abdominal aorta. Compared with TNC, s value was statistically significantly increased and SNR value was statistically significantly decreased in organs and tissues of VNC image(P < 0.05). The ratio of CT value difference < 15 HU and 10 HU in VNC and TNV of liver parenchyma, abdominal aorta, spleen, retroperitoneal fat, and paraspinal muscles was 95.33 %(143/150) and 84.67 %(127/150). The subjective scores of TNC and VNC images were compared, and the difference was statistically significant(χ~2= 48.502, P = 0.000). The DLP of TNC, arterial phas

关 键 词：经动脉化学治疗栓塞 肝细胞癌 能谱CT 虚拟平扫 碘油 

分 类 号：R735.7[医药卫生—肿瘤] R814.42[医药卫生—临床医学]