| 翟晓静,孙碧霞,易娅闻,钱吉芳,朱大林,张皓,张旭霞.光谱CT肺动脉成像定性诊断肺动脉栓塞及定量评估肺组织灌注[J].中国医学影像技术,2023,39(7):1014~1018 |
| 光谱CT肺动脉成像定性诊断肺动脉栓塞及定量评估肺组织灌注 |
| Spectral CT pulmonary angiography for qualitation on pulmonary embolism and quantitation of pulmonary tissue perfusion |
| 投稿时间：2023-03-19 修订日期：2023-04-22 |
| DOI：10.13929/j.issn.1003-3289.2023.07.014 |
| 中文关键词: 肺栓塞 体层摄影术,X线计算机 |
| 英文关键词:pulmonary embolism tomography, X-ray computed |
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| 中文摘要: |
| 目的 观察光谱CT肺动脉成像(SCTPA)定性诊断肺动脉栓塞(PE)和定量评估肺组织灌注的价值。方法 回顾性分析37例临床诊断PE患者的CTPA资料,观察常规CTPA及SCTPA后处理图像,后者包括40 keV虚拟单能量图(VMI40 keV)、碘密度图(IDI)与有效原子序数(Z-eff)图的融合图及电子密度图(EDI);记录2种图像中肺段动脉、肺亚段及以下动脉内的栓子数量和位置,对比其中相应肺灌注缺损区与对侧相应正常肺实质区常规CT值、碘密度(ID)、Z-eff及电子密度(ED)的差异;针对差异有统计学意义的sCTPA参数绘制受试者工作特征(ROC)曲线,计算曲线下面积(AUC),评估其区分PE肺灌注缺损区与正常肺实质的效能。结果 37例中,仅以常规CTPA检出37个栓子,其中26个位于肺段动脉、11 个位于肺亚段及以下动脉;之后结合SCTPA后处理图像额外检出1个肺段动脉和2个肺亚段以下动脉内栓子。全部40个栓子对应肺灌注缺损区常规CT值高于、ID及Z-eff均低于对侧正常肺实质区(P均<0.01),而ED与正常肺实质区差异无统计学意义(P=0.54)。以常规CT值区分肺灌注缺损区与正常肺实质区的敏感度、特异度分别为42.50%及87.50%,以ID及Z-eff区分的敏感度分别为95.00%、97.50%,特异度均为100%。ID及Z-eff的AUC均为0.99,均高于常规CT值(0.65,Z=5.56、5.53,P均<0.01),而 ID与Z-eff的AUC差异无统计学意义(Z=0.71,P=0.48)。结论 利用SCTPA可提高PE检出率及定量评估肺组织灌注;根据ID及Z-eff可有效区分肺灌注缺损区与正常肺实质。 |
| 英文摘要: |
| Objective To explore the value of spectral CT pulmonary angiography (sCTPA) for qualitation on pulmonary embolism (PE) and quantitation of pulmonary tissue perfusion. Methods Data of SCTPA of 37 patients with clinical diagnosed PE were retrospectively analyzed. Post-processed images of conventional CTPA and sCTPA were observed, the latter including 40 keV virtual monoenergetic images (VMI40 keV), fusion figure of iodine density images (IDI) and effective atomic number (Z-eff) image as well as electron density images (EDI), and the number and location of emboli showed on conventional CTPA and sCTPA images in segmental pulmonary arteries, pulmonary subsegment and lower arteries were recorded. Then conventional CT values, iodine density (ID), Z-eff and electron density (ED) of the corresponding pulmonary perfusion defect area were compared with those of the opposite corresponding normal pulmonary area. Receiver operating characteristic (ROC) curve of sCTPA quantitative parameters being statistically different between defect areas and opposite corresponding normal pulmonary areas were drawn, and areas under the curve (AUC) were calculated to evaluate the efficacy for distinguishing PE lung perfusion defect area from normal pulmonary area. Results Conventional CTPA initially detected 37 emboli in 37 cases, 26 in segmental pulmonary arteries and 11 in subsegmental pulmonary arteries or lower branches. Combined with sCTPA post-processing images, 1 embolus in segment pulmonary artery and 2 emboli in subsegmental pulmonary arteries were furtherly detected. Conventional CT value of 40 emboli corresponding pulmonary perfusion defect area was higher, ID and Z-eff were lower than those of the opposite normal pulmonary area (all P<0.01), while no significant difference of ED was found between perfusion defect area and the opposite normal pulmonary area (P=0.54). The sensitivity and specificity of conventional CT value for distinguishing pulmonary perfusion defect area from normal pulmonary area was 42.50% and 87.50%, respectively, while the sensitivity of ID and Z-off was 95.00% and 97.50%, respectively, both with specificity of 100%. AUC of ID (0.99) and Z-off (0.99) were both higher than that of conventional CT value (0.65, Z=5.56, 5.53, both P<0.01), while no significant difference of AUC was found between ID and Z-eff (Z=0.71, P=0.48). Conclusion Spectral CTPA could improve the detection rate of PE and quantitatively evaluate pulmonary perfusion. ID and Z-eff could effectively distinguish pulmonary perfusion defect and normal pulmonary areas. |
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