动态对比增强 CT 淋巴管成像定量评估胸导管淋巴液流量。
Dynamic Contrast-enhanced CT Lymphangiography to Quantify Thoracic Duct Lymphatic Flow.
机构信息
From the Departments of Radiological Sciences (S.M., A.R.P., Y.Z., I.A.) and Statistics (Z.Y.), University of California Irvine, Medical Sciences I, B-140, Irvine, CA 92697; Department of Radiological Sciences, University of California San Diego, San Diego, Calif (J.R.); and Department of Radiology, University of Pennsylvania, Philadelphia, Pa (M.I.).
出版信息
Radiology. 2023 Dec;309(3):e230959. doi: 10.1148/radiol.230959.
Background CT lymphangiography has been used to image the lymphatic anatomy and assess lymphatic abnormalities. There is, however, a need to develop a method for quantification of lymphatic flow rate in the thoracic duct (TD). Purpose To develop and validate a TD lymphatic flow measurement technique using dynamic contrast-enhanced CT lymphangiography. Materials and Methods Lymphatic flow rate was measured with two techniques: a first-pass analysis technique based on a single compartment model and a thresholding technique distinguishing between opacified and nonopacified voxels within the TD. The measurements were validated in a swine animal model between November 2021 and September 2022. CT images were acquired at 100 kV and 200 mA using a fast-pitched helical scan mode covering the entire TD following contrast material injection into the bilateral inguinal lymph nodes. Two helical CT scans, acquired at the base and peak contrast enhancement of the TD, were used to measure lymphatic flow rate. A US flow probe surgically placed around the TD provided the reference standard measurement. CT lymphatic flow measurements were compared with the reference US flow probe measurements using regression and Bland-Altman analysis. Repeatability was determined using repeated flow measurements within approximately 10 minutes of each other. Results Eleven swine (10 male; mean weight, 43.6 kg ± 2.6 [SD]) were evaluated with 71 dynamic CT acquisitions. The lymphatic flow rates measured using the first-pass analysis and thresholding techniques were highly correlated with the reference US flow probe measurements ( = 0.99 and 0.91, respectively) and showed good agreement with the reference standard, with Bland-Altman analysis showing small mean differences of 0.04 and 0.05 mL/min, respectively. The first-pass analysis and thresholding techniques also showed good agreement for repeated flow measurements ( = 0.94 and 0.90, respectively), with small mean differences of 0.09 and 0.03 mL/min, respectively. Conclusion The first-pass analysis and thresholding techniques could be used to accurately and noninvasively quantify TD lymphatic flow using dynamic contrast-enhanced CT lymphangiography. © RSNA, 2023 See also the editorial by Choyke in this issue.
背景 CT 淋巴管成像已用于成像淋巴解剖结构和评估淋巴异常。然而，需要开发一种方法来量化胸导管 (TD) 中的淋巴流量。目的 使用动态对比增强 CT 淋巴管成像开发和验证 TD 淋巴流量测量技术。材料与方法 淋巴流量率使用两种技术进行测量：一种是基于单室模型的首过分析技术，另一种是在 TD 内区分造影和非造影体素的阈值技术。该测量方法于 2021 年 11 月至 2022 年 9 月在猪动物模型中进行了验证。CT 图像使用快速螺旋扫描模式在对比剂注入双侧腹股沟淋巴结后在 100 kV 和 200 mA 下获取，覆盖整个 TD。使用 TD 对比增强的基础和峰值分别获取两次螺旋 CT 扫描，以测量淋巴流量率。在 TD 周围进行的手术 US 流量探头提供参考标准测量。使用回归和 Bland-Altman 分析将 CT 淋巴流量测量与参考 US 流量探头测量进行比较。通过在彼此大约 10 分钟内重复进行流量测量来确定可重复性。结果 11 头猪（10 头雄性；平均体重 43.6 ± 2.6 [SD] kg）进行了 71 次动态 CT 采集。使用首过分析和阈值技术测量的淋巴流量率与参考 US 流量探头测量高度相关（分别为 0.99 和 0.91），与参考标准具有良好的一致性，Bland-Altman 分析显示平均差异分别为 0.04 和 0.05 mL/min。首过分析和阈值技术对于重复流量测量也具有良好的一致性（分别为 0.94 和 0.90），平均差异分别为 0.09 和 0.03 mL/min。结论 使用动态对比增强 CT 淋巴管成像，首过分析和阈值技术可用于准确、无创地量化 TD 淋巴流量。RSNA，2023 年 参见本期 Choyke 社论。
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