1 Department of Radiology, All India Institute of Medical Science, New Delhi 110029, India.
2 Department of Urology, All India Institute of Medical Science, New Delhi, India.
AJR Am J Roentgenol. 2018 Jul;211(1):W22-W32. doi: 10.2214/AJR.17.18786. Epub 2018 May 24.
The primary objective of this study was to compare triple-bolus dual-energy CT (DECT) against standard triple-phase MDCT in terms of appropriateness of patient treatment.
One hundred twenty-four patients with suspected renal masses seen at ultrasound were randomized into triple-bolus DECT and triple-phase MDCT groups. Patients in the triple-bolus DECT group underwent synchronous corticomedullary nephrographic delayed-phase triple-bolus DECT. In the triple-phase MDCT group, single-energy triple-phase scans were acquired after an unenhanced scan. The primary outcome was appropriateness of treatment received at 1 year. The predefined noninferiority limit was 10%. Histopathologic analysis or follow-up confirmed the benign or malignant nature of the masses. Diagnostic accuracy to differentiate benign from malignant masses was calculated. Size-specific dose estimates were compared.
After excluding six patients, 118 patients were analyzed (62 triple-bolus DECT; 56 triple-phase MDCT). Treatment appropriateness was not significantly different (p = 0.9397) between the two groups (61/62 [98.39%; 95% CI, 95.26-101.52%] for triple-bolus DECT vs 55/56 [98.21%; 95% CI, 94.74-101.68%] for triple-phase MDCT). The absolute difference was 0.18% (95% CI, -4.48% to 4.84%). Both techniques had similar diagnostic accuracy (sensitivity, 98.25% vs 96.67%; specificity, 98.17% vs 97.97%). The mean (± SD) size-specific dose estimate was significantly lower for triple-bolus DECT than for triple-phase MDCT (19.02 ± 4.07 vs 57.04 ± 15.17 mGy; p < 0.0001).
Single-acquisition triple-bolus DECT is noninferior to triple-phase MDCT, with similar diagnostic accuracy but delivering significantly less radiation.
本研究的主要目的是比较三脉冲双能 CT（DECT）与标准三期多层 CT（MDCT）在患者治疗的适宜性方面的差异。
124 例超声检查疑诊为肾肿块的患者被随机分为三脉冲 DECT 组和三期 MDCT 组。三脉冲 DECT 组患者行同步皮质-髓质肾造影延迟期三脉冲 DECT。三期 MDCT 组行单能三期扫描，增强前先行平扫。主要结局为 1 年时的治疗适宜性。预设的非劣效性界值为 10%。组织病理学分析或随访结果证实了肿块的良恶性。计算了鉴别良恶性肿块的诊断准确性。比较了大小特异性剂量估计值。
排除 6 例患者后，对 118 例患者进行了分析（三脉冲 DECT 组 62 例，三期 MDCT 组 56 例）。两组间的治疗适宜性无显著差异（p = 0.9397）（三脉冲 DECT 组 61/62 [98.39%；95%CI，95.26%-101.52%]，三期 MDCT 组 55/56 [98.21%；95%CI，94.74%-101.68%]）。绝对差值为 0.18%（95%CI，-4.48%-4.84%）。两种技术的诊断准确性相似（敏感性，98.25%比 96.67%；特异性，98.17%比 97.97%）。三脉冲 DECT 的平均（±标准差）大小特异性剂量估计值明显低于三期 MDCT（19.02±4.07 比 57.04±15.17 mGy；p<0.0001）。
单次采集三脉冲 DECT 与三期 MDCT 相比无明显劣势，诊断准确性相似，但辐射剂量明显降低。
