Honda Keiichi, Oda Seitaro, Kondo Daisuke, Kujirai Ryusuke, Higuchi Ko, Osaki Takumi, Sugisaki Akiko, Moriguchi Naoya, Akagi Ryo, Hirai Toshinori, Katahira Kazuhiro
Department of Radiological Technology, Kumamoto University, Kumamoto, Japan.
Department of Diagnostic Radiology, Kumamoto University, Kumamoto, Japan.
J Clin Imaging Sci. 2025 Mar 3;15:11. doi: 10.25259/JCIS_171_2024. eCollection 2025.
This study evaluated the efficacy of dual-layer spectral detector computed tomography (DLCT) for detecting early ischemic changes (EICs) in patients with acute ischemic stroke (AIS), focusing on electron density (ED) and effective atomic number (effective Z) imaging.
This retrospective study included 15 patients (mean age: 76.5 ± 9.8 years) with AIS who underwent non-contrast computed tomography (CT) with DLCT and magnetic resonance imaging (MRI) on the same day. Quantitative analysis was performed to compare conventional CT, ED, and effective Z values between the infarcted and contralateral brain regions. Qualitative assessment was conducted by two radiologists using the modified Alberta Stroke Program Early CT Score methodology. Receiver operating characteristic curve analysis was performed to evaluate diagnostic performance, and kappa statistics were used to assess interobserver agreement.
Significant differences were observed in the conventional CT and ED values ( < 0.01) but not in effective Z values ( = 0.46) between the infarcted and contralateral regions. ED imaging demonstrated superior diagnostic accuracy (area under curve [AUC] = 0.90) compared with conventional 120-kVp CT (AUC = 0.85) and effective Z imaging (AUC = 0.62). Furthermore, interobserver agreement (kappa = 0.71) was better for ED imaging than for conventional 120-kVp CT (kappa = 0.65). Qualitative analysis revealed that ED images showed better agreement with MRI findings and higher interobserver consistency than conventional 120-kVp images.
Compared with conventional CT, DLCT with ED imaging significantly enhanced detection of EICs in AIS.
本研究评估双层光谱探测器计算机断层扫描（DLCT）在检测急性缺血性卒中（AIS）患者早期缺血性改变（EIC）方面的疗效，重点关注电子密度（ED）和有效原子序数（有效Z）成像。
本回顾性研究纳入了15例AIS患者（平均年龄：76.5±9.8岁），这些患者在同一天接受了非增强计算机断层扫描（CT）、DLCT以及磁共振成像（MRI）检查。对梗死脑区和对侧脑区之间的传统CT、ED及有效Z值进行定量分析比较。由两名放射科医生采用改良的阿尔伯塔卒中项目早期CT评分方法进行定性评估。进行受试者操作特征曲线分析以评估诊断性能，并使用kappa统计量评估观察者间的一致性。
梗死区与对侧区之间，传统CT值和ED值存在显著差异（<0.01），而有效Z值无显著差异（=0.46）。与传统的120 kVp CT（曲线下面积[AUC]=0.85）和有效Z成像（AUC=0.62）相比，ED成像显示出更高的诊断准确性（AUC=0.90）。此外，ED成像的观察者间一致性（kappa=0.71）优于传统的120 kVp CT（kappa=0.65）。定性分析显示，ED图像与MRI结果的一致性更好，且观察者间一致性高于传统的120 kVp图像。
与传统CT相比，采用ED成像的DLCT显著提高了AIS患者EIC的检测率。
