Schwarz R, Bongers N M, Hinterleitner C, Ditt H, Nikolaou K, Fritz J, Bösmüller H, Horger M
Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Hoppe-Seyler-Str. 3, 72076 Tuebingen, Germany.
Department of Internal Medicine II, Eberhard-Karls-University, Otfried-Müller-Str. 8, 72076 Tuebingen, Germany.
Eur J Radiol Open. 2018 Jul 29;5:114-120. doi: 10.1016/j.ejro.2018.07.005. eCollection 2018.
To compare the diagnostic performance of frequency-selective non-linear blending and conventional linear blending contrast-enhanced CT for the diagnosis of acute (AC) and gangrenous (GC) cholecystitis.
Following local ethics committee approval for retrospective data analysis, a database search derived 39 patients (26 men, mean age 67.8 ± 14.6 years) with clinical signs of acute cholecystitis, contrast enhanced CT (CECT) evaluation, cholecystectomy, and pathological examination of the resected specimen. The interval between CECT and surgery was 4.7 ± 4.1 days. Pathological gross examination was used to categorize the cases into AC and GC. Subsequently, two radiologists categorized the CECT studies in a blinded and independent fashion into AC and GC, during two different reading sessions using linear blending and frequency-selective non-linear blending CECT.
Histologic analysis diagnosed 31/39 (79.4%) cases of GC and 8/39 (20.6%) cases of AC. Image interpretation of linear blending CECT resulted in classification of 7/39 (17.9%) patients as GC and 32/39 (82.1%) as AC, whereas image interpretation of frequency-selective non-linear blending CECT resulted in classification of 29/39 (74.3%) patients as GC and 10/39 (25.7%) as AC. Sensitivity/specificity/PPV/NPV for detection of GC were 22.6%/100%/100%/25% with linear blending CECT and 80.6%/50%/86.2%/40% with frequency-selective non-linear blending CECT, respectively. Based on the histopathologic diagnosis frequency-selective non-linear blending had a significant improvement (p > 0.0001) in the diagnostic accuracy of gangrenous cholecystitis compared with linear blending.
Frequency-selective non-linear blending post-processing increases the diagnostic accuracy of gangrenous cholecystitis owing to improved visualization of absence of focal enhancement and mural ulcerations.
比较频率选择性非线性融合与传统线性融合对比增强CT对急性胆囊炎（AC）和坏疽性胆囊炎（GC）的诊断效能。
经当地伦理委员会批准进行回顾性数据分析，通过数据库检索获得39例患者（26例男性，平均年龄67.8±14.6岁），这些患者均有急性胆囊炎的临床症状，接受了对比增强CT（CECT）检查、胆囊切除术以及切除标本的病理检查。CECT检查与手术之间的间隔时间为4.7±4.1天。通过病理大体检查将病例分为AC和GC。随后，两名放射科医生在两个不同的阅片环节中，采用线性融合和频率选择性非线性融合CECT，以盲法和独立方式将CECT研究分类为AC和GC。
组织学分析诊断出31/39（79.4%）例为GC，8/39（20.6%）例为AC。线性融合CECT的图像解读将7/39（17.9%）例患者分类为GC，32/39（82.1%）例分类为AC；而频率选择性非线性融合CECT图像解读将29/39（74.3%）例患者分类为GC，10/39（25.7%）例分类为AC。线性融合CECT检测GC的灵敏度/特异度/阳性预测值/阴性预测值分别为22.6%/100%/100%/25%，频率选择性非线性融合CECT分别为80.6%/50%/86.2%/40%。基于组织病理学诊断，与线性融合相比，频率选择性非线性融合在坏疽性胆囊炎的诊断准确性方面有显著提高（p>0.0001）。
频率选择性非线性融合后处理提高了坏疽性胆囊炎的诊断准确性，这归因于对局灶性强化缺失和壁溃疡的可视化改善。
