Service d'Imagerie Médicale, AP-HP, Hôpitaux Universitaires Henri Mondor, 94010 Créteil, France.
Service d'Imagerie Médicale, AP-HP, Hôpitaux Universitaires Henri Mondor, 94010 Créteil, France; Faculté de Médecine de Créteil, Université Paris Est Créteil, 94000 Créteil, France; INSERM IMRB, U 955, Equipe 18, Créteil, France.
Eur J Radiol. 2020 Dec;133:109387. doi: 10.1016/j.ejrad.2020.109387. Epub 2020 Nov 2.
To evaluate the reliability of attenuation values of the liver parenchyma and focal liver lesions on virtual unenhanced images from arterial (VUEart) and portal venous phases (VUEport) compared to native unenhanced (NU) attenuation values in patients referred for assessment of malignant liver lesions.
Seventy-three patients with confirmed primary or metastatic liver tumors who underwent a multiphase contrast-enhanced rapid-switching kVp dual-energy CT (rsDECT) were included in this IRB-approved retrospective study. Both qualitative and quantitative analyses - including the lesion-to-liver contrast-to-noise ratio (LL-CNR) - were performed and compared between NU and both VUEart and VUEport images.
The mean liver attenuation values were significantly lower in VUEart images (56.7 ± 6.7 HU) than in NU images (59.6 ± 7.5 HU, p = 0.008), and were comparable between VUEart and VUEport images (57.9 ± 6 UH, p = 0.38) and between VUEport and NU images (p = 0.051). The mean liver lesions attenuation values were comparable between NU, VUEart and VUEport images (p = 0.60). Strong and significant correlations values were found both in liver lesions and tumor-free parenchyma (r = 0.82-0.91, p < 0.01). The mean LL-CNR was significantly higher in VUEart and VUEport images than in NU images (1.7 ± 1 and 1.6 ± 1.1 vs 0.9 ± 0.6; p < 0.001), but was comparable between VUEart and VUEport images (p > 0.9). Lesion conspicuity was significantly higher in VUEport images than in NU images (p < 0.001).
VUEport images derived from 3rd generation rsDECT could confidently replace NU images in patients undergoing assessment for malignant liver lesions. These images provide comparable attenuation values in both liver lesions and liver parenchyma while reducing the radiation dose and scanning time.
评估在评估恶性肝病变患者时，动脉期（VUEart）和门静脉期（VUEport）虚拟不增强（VUE）图像与平扫（NU）衰减值相比，肝实质和局灶性肝病变衰减值的可靠性。
本研究回顾性分析了 73 例经多期对比增强快速切换千伏双能 CT（rsDECT）证实的原发性或转移性肝肿瘤患者。对 NU 和 VUEart 和 VUEport 图像均进行了定性和定量分析，包括病变-肝对比噪声比（LL-CNR）。
VUEart 图像的平均肝衰减值明显低于 NU 图像（56.7±6.7 HU）（p=0.008），VUEart 图像与 VUEport 图像之间（57.9±6 UH）（p=0.38）以及 VUEport 图像与 NU 图像之间（p=0.051）无差异。NU、VUEart 和 VUEport 图像之间的平均肝病变衰减值无差异（p=0.60）。在肝病变和无病变肝实质中均发现了较强且具有显著相关性（r=0.82-0.91，p<0.01）。VUEart 和 VUEport 图像的平均 LL-CNR 明显高于 NU 图像（1.7±1 和 1.6±1.1 比 0.9±0.6；p<0.001），但 VUEart 和 VUEport 图像之间无差异（p>0.9）。VUEport 图像的病变显著性明显高于 NU 图像（p<0.001）。
第三代 rsDECT 衍生的 VUEport 图像可以在评估恶性肝病变患者时替代 NU 图像。这些图像在肝病变和肝实质中提供了可比的衰减值，同时降低了辐射剂量和扫描时间。
