256排Revolution CT多参数能谱成像在胆囊阴性结石诊断中的应用价值  

Application Value of 256-Slice Revolution CT Muti-parametric Spectral Imaging in the Diagnosis of Gallbladder Negative Stone

作　　者：祁冬[1] 马静[2] 姜研[1] 费翔 王进广[3] 田欧[1] 姚传顺[1] QI Dong;MA Jing;JIANG Yan;FEI Xiang;WANG Jinguang;TIAN Ou;YAO Chuanshun(Department of Medical Image,Bengbu First People’s Hospital,Bengbu Anhui 233000,China;Department of General Surgery,Bengbu First People’s Hospital,Bengbu Anhui 233000,China;Department of Gastroenterology,Bengbu First People’s Hospital,Bengbu Anhui 233000,China)

机构地区：[1]蚌埠市第一人民医院医学影像科,安徽蚌埠233000 [2]蚌埠市第一人民医院普外科,安徽蚌埠233000 [3]蚌埠市第一人民医院消化科,安徽蚌埠233000

出　　处：《中国医疗设备》2021年第10期165-168,176,共5页China Medical Devices

基　　金：蚌埠市级科技创新指导类项目(20190336)。

摘　　要：目的探讨256排Revolution CT多参数能谱成像在胆囊阴性结石诊断中的临床价值。方法回顾性收集30例本院经能谱扫描诊断为疑似胆囊阴性结石患者的影像学资料,且所有患者均行胆囊切除术,以手术结果为参考标准。采用能谱软件进行多参数分析,观察阴性结石、腹腔脂肪及胆汁的能谱曲线分布特征并计算其曲线斜率,测量并记录不同能级(40~140keV)单能量图像阴性结石及邻近胆汁CT值,并比较其差异。采用物质分离技术(脂/水图、碘/水图)观察阴性结石显示效果,测量阴性结石、皮下脂肪及邻近胆汁有效原子序数并比较其差异。以胆囊手术结果为参考标准,计算能谱扫描诊断胆囊阴性结石的敏感性、特异性及诊断符合率,并采用Kappa检验评价其诊断结果的一致性。结果阴性结石与皮下脂肪能谱曲线均呈反弓缓慢上升型,二者曲线斜率相近(P>0.05),胆汁能谱曲线呈水平直线型或轻微下降型,其曲线斜率与阴性结石差异较大(P<0.05);低keV单能量图像(40~60 keV)及高keV单能量图像(90~140 keV)阴性结石及邻近胆汁CT值差异均有统计学意义(P<0.05);阴性结石及其邻近胆汁有效原子序数分别为6.17±1.09、8.76±0.34,差异有统计学意义(P<0.05);基物质密度图脂/水图、碘/水图均可显示出阴性结石,在脂/水图呈高密度影,碘/水图呈低密度影,以脂/水图显示效果最好。能谱扫描诊断胆囊阴性结石的敏感性、特异性及诊断符合率分别为93.10%、100%、90.00%,其诊断结果与胆囊手术结果一致性较好(Kappa=0.817)。结论256排Revolution CT多参数能谱分析为临床诊断胆囊阴性结石提供了一种全新的方法,能够显著提高对阴性结石的检出率,具有较高的敏感性和特异性,为临床制定下一步治疗方案提供参考依据,具有重要的临床应用价值。Objective To explore the application value of 256-slice Revolution CT multi-parameter spectrum imaging in the diagnosis of gallbladder negative stone.Methods The imaging data of 30 patients with suspected gallbladder negative stone diagnosed by energy spectrum in our hospital were retrospectively collected.All patients underwent cholecystectomy with surgical results as the reference standard.The energy spectrum software was used to observe the distribution of energy spectrum curves of negative stone,abdominal fat and bile,and calculate the slope of the curve,to measure and record the CT values of gallbladder negative stones and adjacent bile in the monochromatic images with energy levels ranging from 40 to 140 keV,and the differences were compared.Material separation technique(fat/water imaging,iodine/water imaging)were used to observe the negative stone display effect,the effective atomic numbers of negative stones,abdominal fat and adjacent bile were measured and compared.Based on the results of gallbladder surgery,the sensitivity,specificity and diagnostic coincidence rate of energy spectrum scanning in the diagnosis of gallbladder negative stone were calculated,and the consistency of diagnostic results was evaluated by Kappa test.Results Both negative stones and abdominal fat spectrum curves showed a slow ascending reverse arch.Both curves had similar slope(P>0.05).The bile energy spectrum curve was horizontal or slightly descending.The curve slope was significantly different from the negative stone(P<0.05);CT values of negative stone and adjacent bile in low keV single energy images(40~60 keV)and high keV single energy images(90~140 keV)were significantly different(P<0.05).The effective atomic numbers of negative stones and adjacent bile were 6.17±1.09 and 8.76±0.34,the difference was statistically significant(P<0.05);Both base substance density imaging fat/water imaging and iodine/water imaging showed negative stones.The fat water imaging showed a high density shadow,while the iodine/water imaging showed

关 键 词：计算机体层成像 多参数能谱成像 阴性结石 单能量 能谱曲线 

分 类 号：R445[医药卫生—影像医学与核医学]