双能 CT 下的物质密度碘图：与磁共振成像相比，对富血管性肝脏病变的检测和特征分析。
Material density iodine images in dual-energy CT: Detection and characterization of hypervascular liver lesions compared to magnetic resonance imaging.
机构信息
Department of Radiology, Massachusetts General Hospital, 55 Fruit St, Boston MA 02114, USA; Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Ismaningerstr. 22, 81675 Munich, Germany.
Department of Radiology, Massachusetts General Hospital, 55 Fruit St, Boston MA 02114, USA.
出版信息
Eur J Radiol. 2017 Oct;95:300-306. doi: 10.1016/j.ejrad.2017.08.035. Epub 2017 Aug 31.
PURPOSE
To determine the diagnostic potential of Material Density (MD) iodine images in dual-energy CT (DECT) for the detection and characterization of hypervascular liver lesions compared to monenergetic 65keV images, using MRI as the standard.
MATERIALS AND METHODS
The study complied with HIPAA guidelines and was approved by the institutional review board. Fifty-two patients (36 men, 16 women; age range, 29-87 years) with 236 hypervascular liver lesions (benign, n=31; malignant, n=205; mean diameter, 29.4mm; range: 6-90.6mm) were included. All of them underwent both contrast-enhanced single-source DECT and contrast-enhanced abdominal MRI within three months. Late arterial phase CT imaging was performed with dual energies of 140 and 80kVp. Protocol A showed monoenergetic 65keV images, and protocol B presented MD-iodine images. Three radiologists qualitatively evaluated randomized images, and lesion detection, characterization, and reader confidence were recorded. Liver-to-lesion ratio (LLR) and contrast-to-noise ratio (CNR) were assessed on protocol A, protocol B, and MRI. Paired t-tests were used to compare LLR, CNR, and the number of detected lesions.
RESULTS
LLR was significantly increased in protocol B (2.8±2.33) compared to protocol A (0.77±0.55) and MRI (0.61±0.66). CNR was significantly higher in protocol B (0.08±0.04) compared to protocol A (0.01±0.01) and MRI (0.01±0.01). All three observers correctly identified more liver lesions using protocol B vs protocol A: 83.13% vs 63.64%, 84.57% vs 68.09%, and 79.37% vs 65.52%. There was no significant difference between the three observers in classification of a lesion as benign or malignant. However, higher diagnostic confidence was reported more frequently by the experienced radiologist when using protocol B vs protocol A (84.6% vs 75%).
CONCLUSION
MD-iodine images in DECT help to increase the conspicuity and detection of hypervascular liver lesions.
目的
通过与 MRI 作为标准相比，确定双能 CT（DECT）中的物质密度（MD）碘图像在检测和特征化富血管性肝病变中的诊断潜力。
材料和方法
该研究符合 HIPAA 指南，并获得了机构审查委员会的批准。共纳入 52 例（36 例男性，16 例女性；年龄范围，29-87 岁）236 个富血管性肝病变（良性 31 例，恶性 205 例；平均直径 29.4mm；范围：6-90.6mm）。所有患者均在三个月内接受了对比增强单源 DECT 和对比增强腹部 MRI 检查。在 140 和 80kVp 的双能量下进行晚期动脉期 CT 成像。方案 A 显示单能 65keV 图像，方案 B 显示 MD-碘图像。三位放射科医生对随机图像进行定性评估，并记录病变的检测、特征描述和读者的信心。在方案 A、方案 B 和 MRI 上评估肝脏与病变比值（LLR）和对比噪声比（CNR）。使用配对 t 检验比较 LLR、CNR 和检测到的病变数量。
结果
与方案 A（0.77±0.55）和 MRI（0.61±0.66）相比，方案 B 的 LLR 显著增加（2.8±2.33）。与方案 A（0.01±0.01）和 MRI（0.01±0.01）相比，方案 B 的 CNR 显著升高（0.08±0.04）。三位观察者使用方案 B 比方案 A 正确识别出更多的肝脏病变：83.13% vs 63.64%，84.57% vs 68.09%，79.37% vs 65.52%。三位观察者在良性或恶性病变的分类方面没有显著差异。然而，经验丰富的放射科医生在使用方案 B 时报告的诊断信心更高，分别为 84.6%和 75%。
结论
DECT 中的 MD-碘图像有助于提高富血管性肝病变的显影和检测。
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