双能CTA虚拟成像对急性缺血性脑卒中的评估  

Assessment of Acute Ischaemic Stroke with Dual-Energy CTA Virtual Imaging

作　　者：田莉萍 逯瑶[1,3] 张苗 於帆[1,3] 费晓璐 卢洁[1,3] TIAN Liping;LU Yao;ZHANG Miao(Department of Radiology,Xuanwu Hospital Capital Medical University,Beijing 100053,P.R.China)

机构地区：[1]首都医科大学宣武医院放射与核医学科,北京100053 [2]首都医科大学宣武医院信息中心,北京100053 [3]首都医科大学磁共振成像脑信息学北京市重点实验室,北京100053

出　　处：《临床放射学杂志》2025年第2期226-231,共6页Journal of Clinical Radiology

摘　　要：目的比较双能CT血管造影(CTA)衍生的虚拟平扫(VNC)与常规CT平扫(NCCT)在图像质量、病变对比度以及Alberta卒中项目早期CT评分(ASPECTS)差异,评价基于VNC图像进行ASPECTS评分的准确性,以探究VNC对于急性缺血性脑卒中(AIS)的应用价值。方法选取2023年11月至2024年1月接受常规头颅CT平扫和双能CTA扫描的AIS患者,获得颅脑NCCT和VNC图像。对两组图像进行客观及主观图像质量评价:客观图像质量评价选取半卵圆中心、放射冠、内囊、尾状核头、丘脑和静脉窦区域为感兴趣区(ROI),测量CT值、噪声,计算信噪比(SNR)、灰白质间对比噪声比(CNR);主观图像质量评价由两名放射诊断医师采用李克特(Likert)5分量表法独立进行。选取梗死病变和相应健侧区域测量平均组织密度,计算梗死灶CNR和对比度临床差异(CID),并由两名放射科医师独立对NCCT图像和VNC图像进行ASPECTS评分。结果共87例患者纳入影像分析,平均年龄65.8岁,其中女性27例,男性60例。VNC图像的半卵圆中心、放射冠、内囊、尾状核头、丘脑和静脉窦区域的SNR和CNR均显著低于NCCT图像(P<0.05)。VNC图像的主观图像质量评分显著低于NCCT图像(3.29±0.73 vs 4.95±0.21;P<0.01)。VNC图像的病变临床对比度较NCCT降低54.87%。VNC组、NCCT组图像ASPECTS分别为9.03±1.08、8.86±1.47,差异无统计学意义(P=0.29)。结论AIS患者VNC图像ASPECTS评分与NCCT图像一致,虽图像质量相对较差,但必要时可作为临床评价参考。Objective The objective of this study was to assess the differences in image quality,lesion contrast,and ASPECTS score between dual-energy CTA-derived virtual plain scanning(VNC)and conventional CT plain scanning(NCCT).Additionally,the accuracy of ASPECTS scoring based on VNC images was evaluated to investigate the value of VNC for acute ischaemic stroke.Methods Patients diagnosed with AIS between November 2023 and January 2024 were included in this retrospective study.VNC images were generated from spectrum CT angiography scans using the GE AW workstation(GE Healthcare,USA).The attenuation of infarcted areas,corresponding contralateral regions,and various anatomical structures(includingthe centrum semiovale,corona radiata,internal capsule,head of caudate nucleus,thalamus,and sinus venosus),as well as image noise,were objectively measured on both VNC and conventional non-contrast CT images.Signal-to-noise ratio(SNR)and gray matter-white matter contrast-to-noise ratio(CNR)were calculated.The overall image quality was subjectively assessed using a 5-point scale.The Alberta Stroke Program Early CT Score(ASPECTS)was independently assessed by two neuroradiologists who were blinded to the patients'information.Results A total of 87 patients(27 women,60 men)with an average age of 65.8 years were included in this study.The SNRs of the centrum semiovale,corona radiata,internal capsule,head of caudate nucleus,thalamus,and sinus venosus,as well as thegray matter-white matter SNR and CNR were significantly higher on conventional non-contrast CT than VNC(all P<0.05).The image quality score was significantly greater in conventional non-contrast CT than in VNC(4.95±0.21 vs 3.29±0.73;P<0.01).However,there was no significant difference in the ASPECTS between VNC and conventional non-contrast CT(9.03±1.08 vs 8.86±1.47;P=0.29).Conclusion The image quality of VNC derived from spectrum CTA is slightly lower than that of conventional non-contrast CT.Nevertheless,it produces comparable ASPECTS scores in acute ischemic stroke patient

关 键 词：双能CT 虚拟成像 脑卒中 ASPECTS 

分 类 号：R743.3[医药卫生—神经病学与精神病学] R816.1[医药卫生—临床医学]