双能量CT肺灌注成像对急性肺栓塞的诊断价值  

The diagnostic value of dual energy CT pulmonary perfusion imaging for acute pulmonary embolism

作　　者：苗娜 孟凡祺 黄浩 陈世光 温智勇 MIAO Na;MENG Fanqi;HUANG Hao;CHEN Shiguang;WEN Zhiyong(Department of Radiology,Capital Medical University Electric Power Teaching Hospital,Beijing 100073,China)

机构地区：[1]首都医科大学电力教学医院放射科,北京100073

出　　处：《分子影像学杂志》2025年第4期453-458,共6页Journal of Molecular Imaging

基　　金：国中康健医学影像科学科联盟机制建设与专科发展策略研究科学技术项目(GZK-KJXX-QTHT-20230431)。

摘　　要：目的探讨双源CT双能量肺灌注成像(DEPI)对急性肺栓塞(APE)的定性及定量诊断价值。方法回顾性分析2021年1月~2024年4月我院可疑急性肺栓塞的96例患者的双源CT肺动脉造影(CTPA)图像和DEPI的肺血流量容积(Lung PBV)重建图像,以专家组判读结果为参考标准,比较2位医师单独分析CTPA图像、结合DEPI分析CTPA图像对检出栓子的影响,评价2位医师的诊断一致性。定量分析周围型肺栓塞不同栓塞程度肺组织和正常肺组织灌注CT值及碘密度值的差异。使用ROC曲线比较定量参数对周围型APE的诊断效能,采用DeLong检验比较差异。结果2位医师结合Lung PBV图像回顾性分析CTPA图像较单独分析CTPA图像可发现更多的肺周围型栓子,对亚段栓子和总栓子数的检出差异均有统计学意义(P<0.05)。段及亚段完全性栓塞肺组织的平均灌注CT值、碘密度值低于部分性栓塞肺组织,部分性及完全性栓塞肺组织的平均灌注CT值、碘密度值均低于正常肺组织,两两比较差异均有统计学意义(P<0.01)。2位医师诊断一致性在CTPA图上较好,CTPA与PBV图像联合分析时极好(Kappa值分别为0.671和0.797)。定量参数的ROC曲线分析显示:平均灌注CT值、碘密度值可作为诊断APE的有效参考指标,诊断临界值灌注CT值≤40 HU,AUC为0.953,敏感度86.16%,特异度99.31%,约登指数0.8547。碘密度值临界值≤1.7 mg/mL,AUC为0.923,敏感度83.74%,特异度98.62%,约登指数0.8235。结论DEPI成像与CTPA联合应用可检出更多的周围型肺动脉栓子;DEPI肺组织的平均灌注CT值、碘密度值可作为诊断APE的有效参考指标,平均灌注CT值对APE的评价更具临床意义。Objective To investigate the qualitative and quantitative diagnostic value of dual-source CT dual-energy pulmonary perfusion imaging(DEPI)for acute pulmonary embolism(APE).Methods A retrospective analysis was conducted on the dual-source CT pulmonary angiogram(CTPA)and DEPI-based reconstructed lung perfusion blood volume(PBV)images of 96 patients with suspected APE treated at our hospital from January 2021 to April 2024.Using expert panel interpretations as the reference standard,the impact of two physicians independently analyzing CTPA images versus combining DEPI with CTPA analysis on thrombus detection,while also the diagnostic consistency between the two physicians were compared and evaluated.Quantitative analyses were performed to compare the differences in perfusion CT and iodine density between normal lung tissues and those with varying severities of peripheral pulmonary embolism.ROC curves were plotted to compare the diagnostic efficiency of quantitative parameters for peripheral APE,and the DeLong test was used to assess differences.Results The retrospective analysis of CTPA and reconstructed Lung PBV images identified more peripheral pulmonary emboli than that of CTPA alone,with statistically significant differences in the detection of subsegmental emboli and the total number of emboli(P<0.05).The mean perfusion CT and iodine density values of fully occluded pulmonary tissues at the segmental and subsegmental levels were lower than those of partially occluded pulmonary tissues;the values for partially and fully occluded pulmonary tissues were both lower than those for normal pulmonary tissues;these pairwise comparisons all exhibited statistically significant differences(P<0.01).The diagnostic consistency between the two physicians was good when analyzing CTPA alone and was excellent when correlations were made with PBV images(Kappa=0.671,0.797).The ROC curve analysis of quantitative parameters showed that mean perfusion CT value and iodine density were two effective diagnostic indicators for APE.The dia

关 键 词：肺栓塞 体层摄影术 X线计算机 双能量肺灌注成像 

分 类 号：R563.5[医药卫生—呼吸系统]