Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany.
Invest Radiol. 2010 Jul;45(7):406-12. doi: 10.1097/RLI.0b013e3181dfdabd.
To report our initial experience with dual-energy computed-tomography (CT) cholangiography in potential donors for living-related liver transplantation.
Seventeen potential donors for living-related liver transplantation (6 women and 11 men; average age 37.8 +/- 10.4 years) underwent contrast-enhanced dual-energy CT cholangiography. A dual-energy CT scan of the liver was carried out with acquisition of 2 raw datasets at tube currents of 140 and 80 kV, respectively. A third weighted average dataset were obtained (weighting ratio: 70% 140 kV, 30% 80 kV). Pure iodine images (fourth dataset) and contrast-optimized images (fifth dataset) were reconstructed. Analysis of all datasets comprised determination of bile duct visualization scores (on a scale of 1 to 4: 1, not visualized; 2, faintly seen; 3, identified but the origin or portions of the duct are not visualized; and 4, excellent visualization from origin to branches), maximum bile duct diameters, bile duct attenuation, and liver parenchyma attenuation as well as image noise, signal-to-noise ratio, and contrast-to-noise ratio.
Highest maximum bile duct diameters were detected for optimized-contrast images and the 80 kV dataset, intermediate for pure iodine images and the weighted average dataset and lowest for the 140 kV dataset with significant differences. Highest bile duct attenuation was detected for optimized-contrast images (535.7 +/- 148.3 HU) and the 80 kV dataset (533.7 +/- 145.9 HU) with significant differences compared with pure iodine images (344.9 +/- 106.5 HU) and the weighted average dataset (355.5 +/- 87.6 HU) (P < 0.001). Highest image noise was detected for the 80 kV dataset (39.3 +/- 5.4 HU) with significant differences compared with the optimized-contrast images (31.5 +/- 4.0) (P < 0.001). Highest signal-to-noise ratio and contrast-to-noise ratio were detected for pure iodine images (18.3 +/- 7.1 and 17.6 +/- 7.0) and optimized-contrast images (17.3 +/- 5.8 and 14.8 +/- 5.5) with significant differences compared with the 80 kV dataset (14.0 +/- 5.2 and 11.8 +/- 4.8) and the weighted average dataset (15.1 +/- 4.4 and 12.1 +/- 4.1) (P < 0.001 and P < 0.01).
Dual-energy CT cholangiography in potential donors for living-related liver transplantation is remarkable. Pure iodine images and contrast-optimized images allow precise analysis of the biliary system with increased image quality compared with conventional images. Contrast-optimized images should be used for detection and localization of the bile ducts and pure iodine images for quantitative description of the anatomic dimensions of the biliary segments.
报告我们在活体肝移植供者中应用双能 CT 胆系成像的初步经验。
17 例活体肝移植供者（6 名女性，11 名男性；平均年龄 37.8±10.4 岁）行增强双能 CT 胆系成像。采用 140kV 和 80kV 管电流行肝脏双能 CT 扫描，分别采集 2 组原始数据。获得加权平均数据集（权重比：70%140kV，30%80kV）。重建纯碘图像（第 4 数据集）和对比优化图像（第 5 数据集）。对所有数据集进行分析，确定胆管显示评分（1 至 4 分：1，未显示；2，隐约可见；3，可识别但胆管的起源或部分未显示；4，显示良好，从起源至分支）、最大胆管直径、胆管衰减和肝实质衰减以及图像噪声、信噪比和对比噪声比。
优化对比图像和 80kV 数据集检测到的最大胆管直径最高，纯碘图像和加权平均数据集居中，140kV 数据集最低，差异有统计学意义。优化对比图像（535.7±148.3HU）和 80kV 数据集（533.7±145.9HU）检测到的胆管衰减最高，与纯碘图像（344.9±106.5HU）和加权平均数据集（355.5±87.6HU）比较，差异有统计学意义（P＜0.001）。80kV 数据集的图像噪声最高（39.3±5.4HU），与优化对比图像（31.5±4.0）比较，差异有统计学意义（P＜0.001）。纯碘图像和优化对比图像的信噪比和对比噪声比最高（18.3±7.1 和 17.6±7.0），与 80kV 数据集（14.0±5.2 和 11.8±4.8）和加权平均数据集（15.1±4.4 和 12.1±4.1）比较，差异有统计学意义（P＜0.001 和 P＜0.01）。
活体肝移植供者的双能 CT 胆系成像效果显著。纯碘图像和对比优化图像可以提高胆管系统分析的图像质量，与常规图像相比，可更精确地分析胆管系统。对比优化图像应用于胆管的检测和定位，纯碘图像用于胆管解剖结构的定量描述。
