能谱CT静脉成像在下肢深静脉血栓显示和分期中的应用价值  

The application value of spectral CT venography in the display and staging of deep venous thrombosis in the lower extremity

作　　者：王诗耕 刘义军[1] 方鑫[1] 李贝贝 王旭[1] 马志明 童小雨 范勇 魏巍 陈安良[1] WANG Shigeng;LIU Yijun;FANG Xin;LI Beibei;WANG Xu;MA Zhiming;TONG Xiaoyu;FAN Yong;WEI Wei;CHEN Anliang(Department of Radiology,the First Affiliated Hospital of Dalian Medical University,Dalian,Liaoning Province 116011,China)

机构地区：[1]大连医科大学附属第一医院放射科,辽宁大连116011

出　　处：《实用放射学杂志》2024年第3期478-482,共5页Journal of Practical Radiology

摘　　要：目的探讨能谱CT静脉成像(CTV)在下肢深静脉血栓(DVT)显示和分期中的应用价值.方法选取行下肢CTV检查患者82例,随机分为A组(42例)和B组(40例).A组:管电压120 kVp;B组:宝石能谱成像(GSI)模式,重建50 keV单能量图和碘(水)图.在A组120 kVp图和B组50 keV图中测量静脉CT值和标准差(SD)值,计算静脉信噪比(SNR)和对比噪声比(CNR).2名观察者对图像主观评分并行Kappa一致性检验.DVT依病程时间分期,在A组120 kVp图和B组碘(水)图中分别测量DVT的CT值和碘浓度(IC),绘制受试者工作特征(ROC)曲线比较CT值和IC诊断DVT分期的效能.结果B组静脉CT值、SNR和CNR均高于A组(P<0.05).2组图像主观评分一致性好(Kappa值=0.926~0.955,P<0.05).B组静脉显示情况和血栓清晰度的评分为5(4,5)分,优于A组评分4(3,4)分(P<0.05).IC诊断DVT分期的效能[曲线下面积(AUC)=0.973]优于CT值(AUC=0.891).结论能谱CTV可以提高下肢深静脉对比度和血栓清晰度,为判断血栓分期提供了更为客观的依据,有利于临床的精准诊疗.Objective To investigate the application value of spectral computed tomography venography(CTV)in the display and staging of deep venous thrombosis(DVT)in the lower extremity.Methods Eighty-two patients with CTV were selected and ran-domly divided into group A(42 patients)and group B(40 patients).Group A:tube voltage 120 kVp.Group B:gemstone spectral ima-ging(GSI)mode,reconstruction of 50 keV and iodine(water)maps.The CT and standard deviation(SD)values of the veins were measured,signal-to-noise ratio(SNR)and contrast-to-noise ratio(CNR)were calculated in 120 kVp images of group A and in 50 keV images of group B.Two observers scored the image quality of the 2 groups subjectively,and Kappa test was used to examine the con-sistency.Based on the duration from the occurrence of clinical symptoms,the DVTs were classified.The CT values and iodine con-centration(IC)of DVT were measured in the 120 kVp images of group A and in the iodine(water)maps of group B,respectively.The receiver operating characteristic(ROC)curve was drawn to compare the effectiveness of CT values and IC in diagnosing DVT staging.Results CT values,SNR,and CNR of veins in group B were higher than those in group A(P<0.05).The subjective scores of the two groups were consistent(Kappa=0.926-0.955,P<0.05).The score for the display of veins and thrombus clarity in group B was 5(4,5),which was better than the score of 4(3,4)in group A(P<0.05).The efficiency of IC in diagnosing DVT staging[area under the curve(AUC)=0.973]was better than that of CT values(AUC=0.891).Conclusion The spectral CTV can improve the contrast of lower extremity deep veins and the clarity of thrombus,and can provide more objective indicators for the diagnosis of thrombus staging,which is conducive to accurate clinical diagnosis and treatment.

关 键 词：单能量成像 碘(水)图 CT静脉成像 

分 类 号：R814.42[医药卫生—影像医学与核医学] R543.6[医药卫生—放射医学]