能谱CT多材料分离技术重建虚拟平扫对儿童肝肿瘤的诊断价值  

Application of virtual unenhanced images generated using multimaterial decomposition technology from dual-energy CT in pediatric CT with liver tumors

作　　者：魏伟安 易婷 杨吉钱 陈雁 金科 Wei Weian;Yi Ting;Yang Jiqian;Chen yan;Jin Ke(Department of Radiology,Affiliated Children’s Hospital of Xiangya School of Medicine,Central South University(Hunan Children’s Hospital),Changsha 410007,China;Department of Radiology,Zhuzhou Second’s Hospital,Zhuzhou 412000,China)

机构地区：[1]中南大学湘雅医学院附属儿童医院(湖南省儿童医院)放射科,长沙410007 [2]株洲市二医院放射科,株洲412000

出　　处：《临床小儿外科杂志》2025年第1期58-64,共7页Journal of Clinical Pediatric Surgery

基　　金：湖南省卫生健康委科研计划项目(D202309016291);湖南省卫生健康委科研计划项目(C202309018652)。

摘　　要：目的探讨能谱CT虚拟平扫(virtual unenhance,VUE)技术对儿童肝肿瘤的诊断价值。方法回顾性分析2021年1月至2022年12月于湖南省儿童医院确诊的96例肝肿瘤患儿能谱CT扫描结果,分别重建真实平扫(true unenhance,TUE)、动脉期虚拟平扫(virtual unenhanced artery,VUEa)和门脉期虚拟平扫(virtual unenhanced portal vein,VUEpv)图像。图像质量客观评价参数包括肝实质、肝肿瘤、右侧竖脊肌3个部位的CT值、信噪比(signal-to-noise ratio,SNR)、肝肿瘤对比噪声比(contrast-to-noise ratio,CNR)以及背景噪声(standard deviation,SD)。采用随机区组方差分析和Friedman秩和检验比较TUE、VUEa和VUEpv图像质量客观参数和主观评分的差异。分析三组图像CT值的相关性与一致性,采用χ^(2)检验比较肝肿瘤和钙化灶的检测能力。结果VUE与TUE图像的肝实质CT值、肝肿瘤CNR值差异均无统计学意义(P>0.05)。VUE的图像背景噪声SD值均低于TUE,VUE的肝实质SNR值、肝肿瘤CT值和SNR值、右侧竖脊肌CT值和SNR值均高于TUE,差异均有统计学意义(P<0.001)。VUEa、VUEpv分别与TUE图像的CT值相关性较高(肝实质:r=0.816、0.797,P均<0.001;肝肿瘤:r=0.769、0.839,P<0.001;右侧竖脊肌:r=0.664、0.687,P<0.001)。除肝肿瘤外,其他组织CT值的临床诊断一致性界限为10 HU时,界外数据点占比均<5%。VUEpv肝肿瘤的主观评分和检出率均高于VUEa,差异具有统计学意义(P<0.05),但与TUE的差异无统计学意义(P>0.05)。而VUEa和VUEpv的钙化灶检出率明显低于TUE,差异有统计学意义(P<0.001)。三期CT扫描剂量DLP总计为513.94(375.00,652.86)mGy,TUE的DLP占总DLP的30.14%。结论多材料分离(multi-material decomposition,MMD)技术重建的VUEpv图像质量、病灶检测能力均优于VUEa,可明显降低长期肝肿瘤患儿CT随访的辐射剂量,但仍不能完全替代TUE图像的临床价值。Objective To explore the diagnostic value of virtual unenhanced(VUE)technique using dual-energy CT for pediatric liver tumors.Methods The energy spectrum CT images were retrospectively reviewed for children with liver tumors or liver metastases diagnosed at Hunan Children’s Hospital from January 2021 to 2022.True unenhance(TUE),virtual unenhanced arterial phase(VUEa)and virtual unenhanced portal venous phase(VUEpv)images were separately reconstructed.Objective evaluation parameters of image quality included CT values of liver parenchyma,liver tumors,right vertical spinal muscles,signal-to-noise ratio(SNR),contrast-to-noise ratio(CNR)of liver tumors and background noise(SD).Randomized block variance analysis and Friedman rank sum test were utilized for comparing the differences in image quality and lesion display scores among TUE,VUEa and VUEpv.The correlation of CT values among three groups was analyzed and Bland-Altman plots were generated for illustrating the agreement between VUE and TUE CT value measurements.Chi-square test was utilized for comparing the detection capabilities for liver tumors and calcifications.Results No significant difference existed in CT values of liver parenchyma and CNR of liver tumors between TUE and VUE groups(P>0.05).SD values of background noise in VUE were lower than those in TUE and SNR of liver parenchyma and liver tumor and right erector spinae muscle.And CT values of liver tumors and right erector spinae muscles inVUE were all significantly higher than those in TUE(P<0.001).The correlation of CT values between VUEa,VUEpv and TUE images was relatively high(liver parenchyma:r=0.816,0.797,P<0.001 for both),(liver tumor:r=0.769,0.839,P<0.001 for both),(right paraspinal muscle:r=0.664,0.687,P<0.001 for both).Bland-Altman scatter plot indicated that the proportion of data points outside the limits of agreement was less than 5%when clinical diagnostic threshold was set at 10HU for tissues other than liver tumors.Subjective display scores and detection rates of lesions on VUEpv were

关 键 词：光电子光谱法 肝肿瘤 外科手术 儿童 

分 类 号：R73[医药卫生—肿瘤]