School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA.
Department of Physics and Astronomy, The University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA.
Eur Radiol. 2019 Apr;29(4):1665-1673. doi: 10.1007/s00330-018-5703-9. Epub 2018 Sep 25.
The imaging evaluation of cystic fibrosis currently relies on chest radiography or computed tomography. Recently, digital chest tomosynthesis has been proposed as an alternative. We have developed a stationary digital chest tomosynthesis (s-DCT) system based on a carbon nanotube (CNT) linear x-ray source array. This system enables tomographic imaging without movement of the x-ray tube and allows for physiological gating. The goal of this study was to evaluate the feasibility of clinical CF imaging with the s-DCT system.
CF patients undergoing clinically indicated chest radiography were recruited for the study and imaged on the s-DCT system. Three board-certified radiologists reviewed both the CXR and s-DCT images for image quality relevant to CF. CF disease severity was assessed by Brasfield score on CXR and chest tomosynthesis score on s-DCT. Disease severity measures were also evaluated against subject pulmonary function tests.
Fourteen patients underwent s-DCT imaging within 72 h of their chest radiograph imaging. Readers scored the visualization of proximal bronchi, small airways and vascular pattern higher on s-DCT than CXR. Correlation between the averaged Brasfield score and averaged tomosynthesis disease severity score for CF was -0.73, p = 0.0033. The CF disease severity score system for tomosynthesis had high correlation with FEV1 (r = -0.685) and FEF 25-75% (r = -0.719) as well as good correlation with FVC (r = -0.582).
We demonstrate the potential of CNT x-ray-based s-DCT for use in the evaluation of cystic fibrosis disease status in the first clinical study of s-DCT.
• Carbon nanotube-based linear array x-ray tomosynthesis systems have the potential to provide diagnostically relevant information for patients with cystic fibrosis without the need for a moving gantry. • Despite the short angular span in this prototype system, lung features such as the proximal bronchi, small airways and pulmonary vasculature have improved visualization on s-DCT compared with CXR. Further improvements are anticipated with longer linear x-ray array tubes. • Evaluation of disease severity in CF patients is possible with s-DCT, yielding improved visualization of important lung features and high correlation with pulmonary function tests at a relatively low dose.
目前囊性纤维化的影像学评估依赖于胸部 X 射线摄影或计算机断层扫描。最近，数字胸部断层合成已被提议作为替代方法。我们已经开发了一种基于碳纳米管（CNT）线性 X 射线源阵列的固定数字胸部断层合成（s-DCT）系统。该系统能够在不移动 X 射线管的情况下进行断层成像，并允许进行生理门控。本研究的目的是评估 s-DCT 系统用于临床 CF 成像的可行性。
招募接受临床指征胸部 X 射线摄影的 CF 患者进行研究，并在 s-DCT 系统上进行成像。三名经过董事会认证的放射科医生对 CXR 和 s-DCT 图像进行了与 CF 相关的图像质量审查。CF 疾病严重程度通过 CXR 上的 Brasfield 评分和 s-DCT 上的断层合成疾病严重程度评分进行评估。还针对受试者的肺功能测试评估了疾病严重程度的度量。
14 名患者在接受胸部 X 射线摄影后 72 小时内进行了 s-DCT 成像。读者对近端支气管、小气道和血管模式的可视化评分高于 CXR。CF 的平均 Brasfield 评分与平均断层合成疾病严重程度评分之间的相关性为-0.73，p=0.0033。用于断层合成的 CF 疾病严重程度评分系统与 FEV1（r=-0.685）和 FEF 25-75%（r=-0.719）高度相关，与 FVC（r=-0.582）也有很好的相关性。
我们在 s-DCT 的首次临床研究中证明了基于 CNT X 射线的 s-DCT 在评估囊性纤维化疾病状态方面的潜力。
基于碳纳米管的线性阵列 X 射线断层合成系统有可能为囊性纤维化患者提供有诊断意义的信息，而无需移动龙门架。
尽管在这个原型系统中角度跨度较短，但与 CXR 相比，近端支气管、小气道和肺血管等肺部特征在 s-DCT 上的可视化得到了改善。随着线性 X 射线管的长度增加，预计会有进一步的改进。
可以使用 s-DCT 评估 CF 患者的疾病严重程度，可提高重要肺部特征的可视化程度，并与肺功能测试高度相关，同时剂量相对较低。
