自适应性统计迭代重建联合低管电压提高肝细胞癌患者肝脏CT三期增强扫描图像质量研究

doi:10.3969/j.issn.1672-5069.2021.05.033

摘要/Abstract

摘要： 目的分析自适应性统计迭代重建(ASIR)联合低管电压用于CT肝脏三期增强扫描诊断原发性肝癌(PLC)对图像质量的影响。方法 2018年5月～2020年5月我院诊治的84例PLC患者,在行腹部CT增强扫描时,38例接受100 kV和ASIR扫描(观察组),另46例接受常规120 kV和滤过反投影(FBP)扫描(对照组)。勾画感兴趣区,记录噪声、信噪比和对比噪声比,参照有关指南对图像质量进行评分,记录CT剂量指数(CTDIvol)和有效剂量(ED)。结果观察组动脉期、门静脉期和延迟期噪声分别为(9.4±1.5)HU、(9.5±2.0)HU和(9.8±1.8)HU,显著低于对照组【分别为(10.3±1.7)HU、(10.5±2.1)HU和(10.7±2.0)HU,P<0.05】,动脉期和延迟期信噪比分别为(9.1±1.6)和(10.6±2.1),显著高于对照组【分别为(8.2±1.8)和(9.7±1.7),P <0.05】,动脉期和延迟期对比信噪比分别为(3.1±0.9)和(4.6±1.5),显著高于对照组【分别为(2.4±1.0)和(3.6±1.4),P <0.05】;观察组动脉期噪声、细小结构、病变显示和伪影评分分别为(1.4±0.6)分、(1.6±0.7)分、(1.2±0.6)分和(1.2±0.5)分,显著低于对照组【分别为(2.0±0.7)分、(2.7±0.9)分、(1.7±0.9)分和(1.6±0.8)分,P <0.05】,延迟期噪声、细小结构、病变显示和伪影评分分别为(1.5±0.7)分、(1.7±0.8)分、(1.6±0.6)分和(1.4±0.6)分,显著低于对照组【分别为(1.9±0.5)分、(2.4±0.8)分、(2.0±0.7)分和(1.9±0.7)分,P<0.05】;观察组CTDIvol 为(6.4±1.7)mGy,显著低于对照组【(7.3±1.8)mGy,P<0.05】,ED为(2.3±0.7)mSv,显著低于对照组【(2.8±0.8)mSv,P <0.05】。结论采用ASIR结合低管电压CT扫描诊断PLC患者能满足图片质量要求,降低了CT辐射剂量,提高了检查的安全性,值得临床探讨使用。

关键词: 原发性肝癌, CT扫描, 自适应性统计迭代重建, 低管电压, 图像质量, 辐射剂量

Abstract: Objective The aim of this study was to investigate the image quality ofadaptive statistical iterative reconstruction (ASIR) under low tube voltage of CT scan in diagnosis of patients with primary liver cancer (PLC) . Methods 84 patients with PLC were encountered in our hospital between May 2018and May 2020, and all patients underwent CT examination, with ASIR under 100 kV scan in 38 patients (observation group) and filtered back projection (FBP) under normal 120kV scan in 46 patients (control group). The subjective indicators, such as noise, artifact, small structure, lesion display score, the Objective indicators, such as noise, signal to noise ratio and contrast signal to noise ratio in arterial phase, portal venous phase and delayed phase, and the CT dose index of volume (CTDIvol) and effective dose (ED) were recorded. Results The noise levels in arterial phase, portal vein phase and delayed phase in the observation group were (9.4±1.5) HU, (9.5±2.0) HU and (9.8±1.8) HU, significantly lower than in the control group, the signal-to-noise ratio in arterial phase and in delayed phase in the observation group were (9.1±1.6) and (10.6±2.1), significantly higher than in the control group, and the contrast signal to noise ratio in arterial phase and in delayed phase in the observation group were (3.1±0.9) and (4.6±1.5), significantly higher than in the control group; the scores of noise, fine structure, lesion display and artifact in arterial phase in the observation group were (1.4±0.6), (1.6±0.7),(1.2±0.6) and (1.2±0.5), significantly lower than in the control group; the score of noise, fine structure, lesion display and artifact in the delay phase in the observation group were (1.5±0.7),(1.7±0.8),(1.6±0.6) and (1.4±0.6), significantly lower than in the control group; the CTDIvol in the observation group was (6.4±1.7) mGy, significantly lower than and the ED was (2.3±0.7) mSv, significantly lower than in the control group. Conclusion The application of ASIR under low tube voltage fulfills the diagnostic requirement with good CT image quality and less radiation inpatients with PLC, which might need further clinical investigations.

Key words: Hepatoma, Adaptive statistical iterative reconstruction, Low tube voltage, Image quality, Radiation dose

彭光明, 葛尚, 井桂银. 自适应性统计迭代重建联合低管电压提高肝细胞癌患者肝脏CT三期增强扫描图像质量研究[J]. 实用肝脏病杂志, 2021, 24(5): 737-740.

Peng Guangming, Ge Shang, Jin Guiyin. Image quality of adaptive statistical iterative reconstruction under low tube voltage of CT scan in diagnosis of patients with primary liver cancer[J]. Journal of Practical Hepatology, 2021, 24(5): 737-740.

参考文献

[1]Weiss N , Thabut D . CT scan is still a valuable tool to assess hepatic encephalopathy pathophysiology in both acute and chronic liver diseases. Crit Care Med, 2018, 46(7):e728-e934.
[2]Schaub S K ,Apisarnthanarax S,RG Price, et al. Functional liver imaging and dosimetry to predict hepatotoxicity risk in cirrhotic patients with primary liver cancer.Int J Radiat Oncol Biol Phys,2018,102(4):1339-1348.
[3]冯仲苏, 吴昊, 铁剑,等.有无均整器模式下早期左侧乳腺癌患者放疗后辐射致癌风险比较. 中华放射医学与防护杂志, 2018, 38(3):210-214.
[4]Frederik G ,Clemens K,Thomas L, et al. FAPI-PET/CT: Biodistribution and preliminary dosimetry estimate of two DOTA-containing FAP-targeting agents in patients with various cancers.J Nucl Med,2019,60(3):386-392.
[5]Noda Y , Goshima S , Nagata S , et al. Right adrenal vein: comparison between adaptive statistical iterative reconstruction and model-based iterative reconstruction. Clin Radiol,2018,73(6):594-598.
[6]Son J H , Kim S H , Yoon J H , et al. Comparison of model-based iterative reconstruction, adaptive statistical iterative reconstruction, and filtered back projection for detecting hepatic metastases on submillisievert low-dose computed tomography.J Comput Assist Tomogr, 2017, 41(4):644-650.
[7]Volders D , Bols A , Haspeslagh M , et al. Model-based iterative reconstruction and adaptive statistical iterative reconstruction techniques in abdominal CT: comparison of image quality in the detection of colorectal liver metastases. Radiology, 2013,269(2):468-473.
[8]Katiyar S K , Pal H C , Prasad R . Dietary proanthocyanidins prevent ultraviolet radiation-induced non-melanoma skin cancer through enhanced repair of damaged DNA-dependent activation of immune sensitivity.Semin Cancer Biol, 2017,10(46):138-145.
[9]Suntharos P,Setser R M ,Bradley-Skelton S,et al. Real-time three dimensional CT and MRI to guide interventions for congenital heart disease and acquired pulmonary vein stenosis.Int J Cardiovasc Imaging, 2017,33(10):1619-1626.
[10] Goodenberger M H ,Wagner-Bartak N A, Gupta S,et al. Computed tomography image quality evaluation of a new iterative reconstruction algorithm in the abdomen (adaptive statistical iterative reconstruction–V) a comparison with model-based iterative reconstruction, adaptive statistical iterative reconstructio.J Comput Assist Tomogr,2018:42(2):184-190.
[11] 石莹莹,王元喜.应用肝脏影像报告与数据管理系统诊断肝细胞癌的价值研究.实用肝脏病杂志,2020,23(1):98-101.
[12] 刘婧娟,潘卫东,薛华丹,等.第3代双源CT低管电压70 kV联合高级模拟迭代重建在结肠CT成像中的应用.中国医学科学院学报,2017,39(1):95-100.
[13] Scholtz J E , Kaup M , Husers K , et al. Advanced modeled iterative reconstruction in low-tube-voltage contrast-enhanced neck CT: evaluation of objective and subjective image quality.Am J Neuroradiol, 2016, 37(1):143-151.
[14] Shi Z ,Yu L , Cao D, et al. Airborne ultraviolet imaging system for oil slick surveillance: oil–seawater contrast, imaging concept, signal-to-noise ratio, optical design, and optomechanical model.Appl Opt, 2015,54(25):7648-7655.
[15] Buls N ,Gompel G V, Cauteren T V,et al. Contrast agent and radiation dose reduction in abdominal CT by a combination of low tube voltage and advanced image reconstruction algorithms.Eur Radiol, 2015,25(4):1023-1031.
[16] Wichmann J L, Hardie AD,Schoepf U J, et al. Single- and dual-energy CT of the abdomen: comparison of radiation dose and image quality of 2nd and 3rd generation dual-source CT. Eur Radiol,2017,27(2):642-650.
[17] Yang S P,Chang H L ,Lee J, et al. Low-tube voltage computed tomography during hepatic arterial phase: the effect of body habitus on image quality.J Comput Assist Tomogr, 2017, 41(3):401-406.
[18] 张永县,牛延涛,刘丹丹, 等.管电压联合器官剂量调制技术对胸部CT辐射剂量和图像质量影响的模体研究.中华放射医学与防护杂志,2019,39(7):529-533.
[19] 王小鹏,侯平,吕培杰,等.全模型实时迭代重建对肝硬化患者腹部增强低剂量扫描的应用价值.中华医学杂志,2019,99(27):2124-2129.
[20] Shimoyama S , Nishii T , Watanabe Y , et al. Advantages of 70-kV CT angiography for the visualization of the adamkiewicz artery: comparison with 120-kV imaging.Am J Neuroradiol, 2017, 38(12):2399-2405.
[21] Gill M K , Vijayananthan A , Kumar G , et al. Use of 100 kV versus 120 kV in computed tomography pulmonary angiography in the detection of pulmonary embolism: effect on radiation dose and image quality. Quant Imaging Med Surg, 2015,5(4):524-533.