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中华肝脏外科手术学电子杂志

中华肝脏外科手术学电子杂志 ›› 2022, Vol. 11 ›› Issue (05) : 463 -468. doi: 10.3877/cma.j.issn.2095-3232.2022.05.008

临床研究

TIPS术后支架评估中的光谱CT最佳单能级图像研究
汤朝晖1, 张建生1,†(), 陈其龙1, 邓薇薇2, 王劲1   
  1. 1. 510630　广州，中山大学附属第三医院放射科
    2. 200072　上海，飞利浦医疗临床科研部
  • 收稿日期:2022-05-09 出版日期:2022-10-10
  • 通信作者: 张建生

Optimal single-energy image of spectral CT in stent evaluation after TIPS

Zhaohui Tang1, Jiansheng Zhang1,†(), Qilong Chen1, Weiwei Deng2, Jin Wang1   

  1. 1. Department of Radiology, the Third Affiliated Hospital of Sun Yat-senUniversity, Guangzhou 510630, China
    2. Clinical Research Department, Philips Healthcare, Shanghai 200072, China
  • Received:2022-05-09 Published:2022-10-10
  • Corresponding author: Jiansheng Zhang
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引用本文：

汤朝晖, 张建生, 陈其龙, 邓薇薇, 王劲. TIPS术后支架评估中的光谱CT最佳单能级图像研究[J]. 中华肝脏外科手术学电子杂志, 2022, 11(05): 463-468.

Zhaohui Tang, Jiansheng Zhang, Qilong Chen, Weiwei Deng, Jin Wang. Optimal single-energy image of spectral CT in stent evaluation after TIPS[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2022, 11(05): 463-468.

目的

探讨IQon双层探测器光谱CT在经颈静脉肝内门体分流术（TIPS）后支架评估中的最佳单能级图像。

方法

回顾性分析2020年3月至2020年9月在中山大学附属第三医院行上腹部光谱CT检查的30例门静脉高压症TIPS术后随访患者影像学资料。其中男18例，女12例；年龄38~72岁，中位年龄46岁。患者均签署知情同意书，符合医学伦理学规定。采用门静脉期光谱CT数据在后处理工作站重建出40~100 keV（间隔10 keV）、100~200 keV（间隔20 keV）单能级图像。在常规图像和12组单能级图像上进行支架曲面重建，测量管腔内及同层竖脊肌的CT值和噪声值。计算13组图像的对比噪声比（CNR）。两名10年以上诊断经验的医师对图像的腔内伪影程度及诊断信心进行主观评分。图像质量评价指标比较采用单因素方差分析和LSD-t检验，或Friedman检验。图像质量主观评价的一致性采用Kappa检验。

结果

随着能级降低，TIPS支架管腔内CT值逐渐升高，其中80~200 keV能级图像的CT值均明显低于常规图像（LSD-t=-2.6，-5.3，-7.1，-9.2，-10.4，-11.1，-11.6，-12.1；P<0.05）；40~60 keV能级图像的管腔内CT值明显高于常规图像（LSD-t=36.7，18.5，7.8；P<0.05）。随着能级降低，管腔内SD值逐渐升高，其中80~200 keV能级图像的SD值均明显低于常规图像（LSD-t=-4.4，-5.1，-6.0，-6.6，-6.1，-6.3，-6.3，-6.3；P<0.05）；40 keV能级图像的管腔内SD值明显高于常规图像（LSD-t=4.5，P<0.05）。随着能级降低，支架的CNR逐渐升高。其中90~200 keV能级图像的支架CNR值均明显低于常规图像（LSD-t=-2.2，-3.6，-5.4，-6.1，-6.0，-6.1，-6.2；P<0.05）；40~70 keV能级图像的支架CNR值均明显高于常规图像（LSD-t=22.7，16.7，8.4，3.4；P<0.05）。各组图像诊断信心评分显示，90~140 keV组的主观评分均明显高于常规图像组（χ2=292.1，302.8，343.7，270.8；P<0.05），其中120 keV组评分最高，两位医师的主观评分一致性好（κ=0.81）。腔内伪影主观评分显示，90~200 keV组的主观评分均明显高于常规组（χ2=207.2，240.1，260.5，281.6，302.0，322.4，322.6；P<0.05），两位医师的主观评分一致性好（κ=0.85）。

结论

基于光谱CT重建的单能级图像能有效减少TIPS术后支架腔内伪影，提高诊断信心，并提升图像质量，其中120 keV单能级图像为最佳的单能级图像。

关键词: 计算机体层摄影, 光谱法, 单能级图像, 门体分流术，经颈静脉肝内, 支架, 高血压，门静脉
Objective

To investigate the optimal single-energy image of IQon dual-layer spectral detector CT in stent evaluation after transjugular intrahepatic portosystemic shunt (TIPS).

Methods

Imaging data of 30 patients with portal hypertension who underwent spectral CT scan of the upper abdomen in the Third Affiliated Hospital of Sun Yat-sen University from March to September 2020 were retrospectively analyzed. Among them, 18 patients were male and 12 female, aged from 38 to 72 years, with a median age of 46 years. The informed consents of all patients were obtained and the local ethical committee approval was received. The single-energy images of 40-100 keV (interval of 10 keV) and 100-200 keV (interval of 20 keV) were reconstructed at the post-processing workstation using the spectral CT data of portal venous phase. The stent curved planar reconstruction was performed with the conventional images and 12 groups of single-energy images. The CT value and noise value in the lumen and erector spinae of the same layer were measured. The contrast-to-noise ratio (CNR) of images of 13 groups was calculated. The degree of intraluminal artifacts and diagnostic confidence were scored subjectively by 2 radiologists with more than10 years' experience. The image quality evaluation indexes were compared by one-way ANOVA, LSD-t test or Friedman test. The consistency of subjective evaluation of image quality was assessed by Kappa test.

Results

With the decrease of energy level, the intraluminal CT value of TIPS stent was gradually increased. The CT values of 80-200 keV images were significantly lower than those of conventional images (LSD-t=-2.6, -5.3, -7.1, -9.2, -10.4, -11.1, -11.6, -12.1; P<0.05). The intraluminal CT values of 40-60 keV images were significantly higher than those of conventional images (LSD-t=36.7, 18.5, 7.8; P<0.05). With the decrease of energy level, the intraluminal SD value was gradually increased. The SD values of 80-200 keVimages were significantly lower than those of conventional images (LSD-t=-4.4, -5.1, -6.0, -6.6, -6.1, -6.3, -6.3, -6.3; P<0.05). The intraluminal SD value images of 40 keV was significantly higher than those of conventional images (LSD-t=4.5, P<0.05). With the decrease of energy level, the CNR of stent was gradually increased. The stent CNR values of 90-200 keV images were significantly lower than those of conventional images (LSD-t=-2.2, -3.6, -5.4, -6.1, -6.0, -6.1, -6.2; P<0.05). The stent CNR values of 40-70 keV images were significantly higher than those of conventional images (LSD-t=22.7, 16.7, 8.4, 3.4; P<0.05). The diagnostic confidence score of each group showed that the subjective scores in 90-140 keV group were significantly higher than those in conventional image group (χ2=292.1, 302.8, 343.7, 270.8; P<0.05). The subjective score of 120 keV group was the highest. The consistency of subjective scores betweentwo radiologists was high (κ=0.81). For the subjective score of intraluminal artifacts, the subjective scores of 90-200 keV group were significantly higher than those of conventional image group (χ2=207.2, 240.1, 260.5, 281.6, 302.0, 322.4, 322.6; P<0.05). The consistency of subjective scores between two radiologists was high (κ=0.85).

Conclusions

Single-energy images reconstructed based on spectral CT can effectively reduce the intraluminal artifacts of stents after TIPS, and improve the diagnostic confidence and image quality. Images of 120 keV are the optimal single-energy images.

Key words: Computed tomographic, Spectrometry, Monochromatic image, Portasystemic shunt, transjugular intrahepatic, Stents, Hypertension, portal
表1 各组客观评价比较结果（±s）
组别 管腔内CT值 管腔内SD值 竖脊肌CT值 竖脊肌SD值 CNR
常规图像组 160±24 16.6±5.2 59±11 10.0±2.8 10.8±3.9
40 keV组 503±94 20.7±5.6 79±18 10.3±2.8 44.1±14.7
50 keV组 333±59 18.2±4.2 69±13 8.2±2.5 35.6±8.8
60 keV组 233±39 14.9±4.0 63±11 7.9±2.2 23.1±6.7
70 keV组 173±28 12.9±3.9 60±9 7.7±2.1 15.8±5.1
80 keV组 135±21 12.6±3.6 57±8 7.6±2.0 11.4±3.8
90 keV组 110±17 12.0±3.1 56±8 7.5±1.9 7.5±2.8
100 keV组 94±16 11.2±2.8 55±7 7.5±1.9 5.5±2.7
120 keV组 73±15 10.6±2.5 54±7 7.4±1.9 2.9±1.9
140 keV组 62±14 11.0±2.4 53±7 7.4±1.9 1.9±1.5
160 keV组 56±14 10.9±2.3 53±7 7.4±1.9 1.9±1.3
180 keV组 51±14 10.8±2.2 52±7 7.3±1.8 1.8±1.3
200 keV组 47±14 10.8±2.2 51±6 7.2±1.8 1.7±1.4
F值 11.783 26.025 4.227 6.715 176.521
P值 <0.001 <0.001 <0.001 <0.001 <0.001
[1]
杨帆, 曾懿. 双能量CT虚拟单能谱成像技术在TIPS术后支架评估中的应用[J]. 中国中西医结合影像学杂志, 2019, 17(3):266-268.
[2]
任海燕, 甄艳华, 郑加贺. 双层光谱探测器CT临床应用与研究进展[J]. 中国医学影像技术, 2020, 36(10):1555-1558.
[3]
Kalisz K, Rassouli N, Dhanantwari A, et al. Noise characteristics of virtual monoenergetic images from a novel detector-based spectral CT scanner[J]. Eur J Radiol, 2018(98):118-125.
[4]
邹颖, 王世伟, 李涛, 等. 单源双探测器能谱CT合成的单能级图像对下腔静脉成像质量的影响[J]. 中国医学科学院学报, 2020, 42(3):359-363.
[5]
Neuhaus V, Abdullayev N, Große Hokamp N, et al. Improvement of image quality in unenhanced dual-layer CT of the head using virtual monoenergetic images compared with polyenergetic single-energy CT[J]. Invest Radiol, 2017, 52(8):470-476.
[6]
杨林林, 侯阳, 马跃, 等. 双层探测器光谱CT冠状动脉支架成像的最适虚拟单能量及对比剂浓度的模体研究[J]. 中华放射学杂志, 2020, 54(6):521-526.
[7]
秦乐, 顾圣佳, 陈炽华, 等. 基于双层探测器光谱CT的冠状动脉支架最佳单能级图像研究[J]. 中华放射学杂志, 2020, 54(6):508-513.
[8]
王世伟, 李金锋, 邹颖, 等. 双层探测器能谱CT单能级成像对门静脉成像质量的影响[J]. 中国临床医学影像杂志, 2020, 31(6):425-428, 433.
[9]
Große Hokamp N, Höink AJ, Doerner J, et al. Assessment of arterially hyper-enhancing liver lesions using virtual monoenergetic images from spectral detector CT: phantom and patient experience[J]. Abdom Radiol, 2018, 43(8):2066-2074.
[10]
Mileto A, Marin D. Dual-energy computed tomography in genitourinary imaging[J]. Radiol Clin North Am, 2017, 55(2):373-391.
[11]
Komlosi P, Grady D, Smith JS, et al. Evaluation of monoenergetic imaging to reduce metallic instrumentation artifacts in computed tomography of the cervical spine[J]. J Neurosurg Spine, 2015, 22(1):34-38.
[12]
骆秋霞, 李远辉, 张建生, 等. 双层探测器光谱CT低keV虚拟单能级图像在小肝癌评估中的应用[J/OL]. 中华肝脏外科手术学电子杂志, 2021, 10(5):489-492.
[13]
陈菁华, 盛二燕, 黄健. IQon光谱CT在冠状动脉CTA成像中的诊断价值初步探讨[J]. 世界最新医学信息文摘, 2021, 21(45): 261-262, 270.
[14]
刘珮君, 王怡宁, 金征宇. 光谱CT在心血管病诊断中的临床应用[J]. 中华放射学杂志, 2020, 54(6):613-616.
[15]
孟庆林, 许欢, 宗林雄, 等. 基于光谱CT的腹部实质器官碘浓度测量的可重复性分析[J]. 中国医学科学院学报, 2021, 43(1):57-62.
[16]
谢馥淳, 侯阳. 双层探测器光谱CT在外周血管成像中的应用进展[J]. 中华放射学杂志, 2021, 55(12): 1341-1344.
[17]
Stolzmann P, Winklhofer S, Schwendener N, et al. Monoenergetic computed tomography reconstructions reduce beam hardening artifacts from dental restorations[J]. Forensic Sci Med Pathol, 2013, 9(3):327-332.
[18]
Laukamp KR, Große Hokamp N, Alabar O, et al. Metal artifacts from sternal wires: evaluation of virtual monoenergetic images from spectral-detector CT for artifact reduction[J]. Clin Imaging, 2020, 60(2):249-256.
[19]
Van Hedent S, Große Hokamp N, Kessner R, et al. Effect of virtual monoenergetic images from spectral detector computed tomography on coronary calcium blooming[J]. J Comput Assist Tomogr, 2018, 42(6):912-918.
[20]
Riederer I, Fingerle AA, Zimmer C, et al. Potential of dual-layer spectral CT for the differentiation between hemorrhage and iodinated contrast medium in the brain after endovascular treatment of ischemic stroke patients[J]. Clin Imaging, 2021(79):158-164.
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