【摘要】 目的探讨宝石CT能谱成像碘基图及最佳单能量成像在肺栓塞诊断中的价值。方法对28例肺栓塞患者行宝石CT能谱增强扫描,以70Kev单能量图为标准对照最佳单能量图像CTPA观察肺动脉内有无栓子,并记录栓子发生的部位及数量;定量测定肺组织碘基图中碘含量正常区与异常区的碘含量值并记录碘含量异常区的部位及数量,通过配对t检验分别观察两组结果间的差异;与70Kev CTPA单能量图的诊断一致性采用Kappa检验,同时计算出最佳单能量成像、肺组织碘基图诊断肺栓塞的敏感性、特异性、阳性预测值及阴性预测值。结果 28例患者利用70KevCTPA图像共发现肺栓塞108处,CTPA最佳单能量图共显示128处肺栓塞,肺组织碘基图共检出133处,碘含量异常区均值(0. 12±2. 11) 100μg/cm~3,碘含量正常区均值(18. 56±6. 37) 100μg/cm~3,二者的差异有统计学意义(t=21. 26,P <0. 05)。最佳单能量成像、肺碘基图与70Kev CTPA对肺栓塞的诊断经一致性Kappa检验K值分别为(K=0. 924、K=0. 935,P <0. 001),二者联合对照70Kev CTPA图像诊断肺栓塞具有良好的一致性。肺碘基图联合最佳单能量图诊断肺动脉主干栓塞的敏感性、特异性、阳性预测值及阴性预测值均为100%;诊断肺叶动脉栓塞的敏感性为95. 83%,特异性为100%,阳性预测值为100%,阴性预测值为99. 85%;诊断肺段动脉栓塞的敏感性为86. 76%,特异性为99. 19%,阳性预测值为95. 16%,阴性预测值为97. 62%;诊断肺亚段动脉栓塞的敏感性为80. 77%,特异性为99. 88%,阳性预测值为95. 45%,阴性预测值为99. 42%。结论宝石CT最佳单能量图像可以提高肺段以下动脉栓塞的显示率,能谱肺碘基图反映了肺组织血流灌注情况,能够显示肺栓塞时肺血管功能的改变,二者结合对肺栓塞的早期诊断、病情评估及疗效评价提供重要依据,具有重要的临床应用价值。更多还原

【Abstract】 Objective To investigate the value of gemstone CT spectral imaging with iodine-based images and the optimal monochromatic images in the diagnosis of pulmonary embolism. Methods 28 patients with pulmonary embolism underwent gemstone spectral CT enhanced scanning with 70 Kev single energy as the standard control of optimal monochromatic energy image CTPA. Then,whether the in pulmonary embolus existed or not was observed and the location and number of emboli were recorded.The iodine content of normal and abnormal areas in iodine-based images of lung tissue was quantitatively measured and the number and location in iodine abnormal area were recorded. The differences between the two groups were compared by paired t test. The consistency to the diagnosis by 70 Kev CTPA single energy image was determined by Kappa test. Meanwhile,the best single energy imaging,sensitivity,specificity,positive predictive value and negative predictive value for the diagnosis of pulmonary embolism by iodine-based images of lung tissue were calculated in this work. Results In 28 patients with pulmonary embolism,108 emboli were found by 70 Kev CTPA images. The optimal monochromatic images showed a total of 128 pulmonary emboli,iodine-based images of pulmonary tissue detected 133 emboli. The average of iodine content in abnomal area was(0. 12 ± 2. 11) 100 μg/cm~3,the average of iodine content in normal area was(18. 56 ± 6. 37) 100 μg/cm~3,the difference was statistically significant between the two groups(t = 21. 26,P < 0. 05). K value of the Kappa test for the consistency of pulmonary embolism diagnosis by the optimal monochromatic images,the iodine-based images of pulmonary tissue and 70 Kev CTPA were K = 0. 924,K = 0. 935,and P< 0. 001),respectively. The two combined control of 70 Kev CTPA image had good consistency in the diagnosis of pulmonary embolism. The sensitivity,specificity,positive predictive value of diagnosis of trunk embolization and negative predictive value by iodine-based images of pulmonary tissue combined with the optimal monochromatic images were all 100%; the sensitivity of diagnosis of lobar artery embolism was 95. 83%,the specificity was 100%,the positive predictive value was 100%,the negative predictive value was 99. 85%; the sensitivity of diagnosis for pulmonary embolism 86. 76%,the specificity was 99. 19%,the positive predictive value was 95. 16%,the negative predictive value was 97. 62%; the sensitivity of diagnosis of pulmonary artery embolism sub segment was 80. 77%,the specificity was 99. 88%,the positive predictive value was 95. 45%,the negative predictive value was 99. 42%. Conclusion Gem CT optimal monochromatic energy image can improve the display rate of pulmonary segments following arterial embolism. The iodine-based images of pulmonary tissue can reflect the lung perfusion and show the changes of lung vascular function in case of pulmonary embolism. The combination of the two modalities can provide an important basis for the evaluation of early diagnosis and severity of pulmonary embolism and the curative effect,which has an important value in clinical application.更多还原