ISSN 1004-4140
CN 11-3017/P

能谱CT最佳单能量成像在胃底静脉曲张出血内镜术前的应用价值

邓小林, 谢惠, 屈亚林, 吴绍全, 周帮建, 杨正彬, 冯练, 王敏

邓小林, 谢惠, 屈亚林, 吴绍全, 周帮建, 杨正彬, 冯练, 王敏. 能谱CT最佳单能量成像在胃底静脉曲张出血内镜术前的应用价值[J]. CT理论与应用研究, 2021, 30(5): 603-609. DOI: 10.15953/j.1004-4140.2021.30.05.08
引用本文: 邓小林, 谢惠, 屈亚林, 吴绍全, 周帮建, 杨正彬, 冯练, 王敏. 能谱CT最佳单能量成像在胃底静脉曲张出血内镜术前的应用价值[J]. CT理论与应用研究, 2021, 30(5): 603-609. DOI: 10.15953/j.1004-4140.2021.30.05.08
DENG Xiaolin, XIE Hui, QU Yalin, WU Shaoquan, ZHOU Bangjian, YANG Zhengbin, FENG Lian, WANG Min. The Value of Optimal Monochromatic Spectral CT Imaging in Gastric Variceal Bleeding before Endoscopic Treatment[J]. CT Theory and Applications, 2021, 30(5): 603-609. DOI: 10.15953/j.1004-4140.2021.30.05.08
Citation: DENG Xiaolin, XIE Hui, QU Yalin, WU Shaoquan, ZHOU Bangjian, YANG Zhengbin, FENG Lian, WANG Min. The Value of Optimal Monochromatic Spectral CT Imaging in Gastric Variceal Bleeding before Endoscopic Treatment[J]. CT Theory and Applications, 2021, 30(5): 603-609. DOI: 10.15953/j.1004-4140.2021.30.05.08

能谱CT最佳单能量成像在胃底静脉曲张出血内镜术前的应用价值

基金项目: 

重庆市科卫联合医学科研项目(门静脉能谱CTA用于胃底静脉曲张出血内镜术前筛查和术后评估(2019MSXM055));重庆市大足区科技发展项目(食管胃底静脉曲张破裂出血患者能谱CTPV最佳单能量技术研究(DZKJ,2018ACC1031))。

详细信息
    作者简介:

    邓小林,男,重庆市大足区人民医院放射科副主任医师,主要从事CT能谱成像与CT血管成像研究,E-mail:15823380958@163.com;杨正彬*,男,重庆市大足区人民医院放射科主治医师,主要从事全身血管CT造影技术及诊断研究,E-mail:364327992@qq.com。

  • 中图分类号: R445.3;R573.2

The Value of Optimal Monochromatic Spectral CT Imaging in Gastric Variceal Bleeding before Endoscopic Treatment

  • 摘要: 目的:通过对肝门静脉、胃底静脉曲张及胃肾分流等的显示情况,评价能谱CT最佳单能量成像在胃底静脉曲张出血患者内镜术前的参考应用价值。方法:选取2016年9月至2021年1月期间收治的60例胃底静脉曲张出血患者,进行肝门静脉能谱CTA检查。比较最佳单能量、70keV及混合能量(QC)3组图像肝门静脉CT值、图像噪声(IN)、信噪比(SNR)、对比噪声比(CNR)及图像质量主观评分,将图像质量最佳组用于影像诊断。结果:最佳单能量、70keV、QC组肝门静脉平均CT值分别为273.12±25.48、168.70±20.16、164.92±20.74;IN分别为31.22±4.13、17.72±3.09、24.25±2.98;SNR分别为8.95±1.80、9.92±2.64、6.93±1.37;CNR分别为6.18±1.52、4.82±1.71、3.22±0.99;主观质量评分分别为4.57±0.63、3.10±0.98、2.47±0.93;除70keV、QC组肝门静脉平均CT值组间无统计学差异外,其余均有统计学差异;最佳单能量组图像质量最佳,并能清晰显示胃肾分流、胃底静脉曲张、肝门静脉血栓等征象。结论:肝门静脉能谱CT最佳单能量成像可优化图像质量,在胃底静脉曲张出血患者内镜术前具有较高的应用价值。
    Abstract: Objective: We intend to evaluate the application value of optimal monochromatic spectral CT imaging performed on patients with gastric variceal bleeding before endoscopic treatment by way of observing the manifestation of portal vein, gastric varies gastro renal shunt etc. Methods: A total of 60 patients with gastric variceal bleeding admitted to our hospital from September 2016 to January 2021 were selected for spectral CT portal venography. By comparing the CT value of hepatic portal vein, the image noise (IN), the signal-to-noise ratio (SNR), contrast noise ratio (CNR) and subjective evaluation of the image quality among the 3 sets of images of optimal monochromatic energy group, 70keV group and mixed energy group (QC), we obtained the spectral CT portal venography with the best image quality for the imaging diagnosis. Results: The average CT values of hepatic portal vein of the 3 groups (the optimal monochromatic energy group, 70keV group and QC group) vein were 273.12±25.48, 168.70±20.16 and 164.92±20.74, respectively. the average IN value were 31.22±4.13, 17.72±3.09 and 24.25±2.98, respectively. The SNR were 8.95±1.80, 9.92±2.64 and 6.93±1.37, respectively. The CNR were 6.18±1.52, 4.82±1.71 and 3.22±0.99, respectively. While the subjective evaluation scores of image quality were 4.57±0.63, 3.10±0.98 and 2.47±0.93, respectively. All showed significant statistical difference except the average CT value of hepatic portal vein between the 70keV group and QC group. The CT portal venography with optimal monochromatic energy was the best, and it showed clear manifestation of gastric renal shunt, gastric varices, portal vein thrombosis, etc. Conclusion: The optimal monochromatic spectral CT imaging can optimize the image quality and it shows high application value when treated patients with gastric variceal bleeding before endoscopic surgery.
  • [1] 中华医学会外科学分会脾及门静脉高压外科学组. 肝硬化门静脉高压症食管、胃底静脉曲张破裂出血诊治专家共识(2019版)[J]. 中华消化外科杂志, 2019, 18(12):1087-1093.

    DOI:10.3760/cma. j.issn.1673-9752.2019.12.001.

    [2] 丁惠国, 张世斌, 李磊, 等. 肝硬化食管胃底静脉曲张的内镜诊断治疗——从指南到临床实践[J]. 临床肝胆病杂志, 2017, 33(3):454-457.

    DING H G, ZHANG S B, LI L, et al. Endoscopic diagnosis and treatment of esophageal and gastric varices in patients with liver cirrhosis:From guidelines to clinical practice[J]. Journal of Clinical Hepatology, 2017, 33(3):454-457. (in Chinese).

    [3]

    QIAO W, REN Y, BAI Y, et al. Cyanoacrylate injection versus band ligation in the endoscopic management of acute gastric variceal bleeding:Meta-Analysis of randomized, controlled studies based on the PRISMA statement[J]. Medicine, 2015, 94(41):e1725.

    [4] 赵威, 徐浩, 崔艳峰, 等. 食管胃底静脉栓塞术中组织胶所致异位栓塞分析[J]. 医学影像学杂志, 2020, 30(10):1843-1846.

    ZHAO W, XU H, CUI Y F, et al. Clinical analysis of ectopic embolization induced by tissue adhesive during esophagogastric venous embolization[J]. Journal of Medical Imaging, 2020, 30(10):1843-1846. (in Chinese).

    [5]

    BURKE M P, O'DONNELL C, BABER Y. Death from pulmonary embolism of cyanoacrylate glue following gastric varix endoscopic injection[J]. Forensic Science, Medicine, and Pathology, 2017, 13(1):82-85.

    [6] 游荣娇, 吴伟烽, 陈松发, 等. 组织胶注射治疗胃底静脉曲张致脑栓塞一例[J]. 中国现代神经疾病杂志, 2020, 20(3):248-251.

    YOU R J, WU W F, CHEN S F, et al. Cerebral embolism caused by tissue adhesive injection for varices of gastric fundus:one case report[J]. Chinese Journak of Contemporary Neurology and Neurosurggery, 2020, 20(3):248-251. (in Chinese).

    [7] 梅雪灿, 马维娟, 孔德润. 胃底静脉曲张组织胶治疗并发脑动脉空气栓塞一例[J]. 中华消化内镜杂志, 2020, 37(1):61-62.
    [8] 柳维娜, 董健, 王仁贵. 宽体探测器能谱CT最佳单能量成像在肝门静脉与肝静脉成像中的应用价值研究[J]. 中国医学装备, 2020, 17(4):83-86.

    DOI:10.3969/J.ISSN.1672-8270.2020.04.020. LIU W N, DONG J, WANG R G. Study on the application of optimally single energy imaging of energy spectrum CT with wide detector in imaging of hepatic portal vein and hepatic vein[J]. China Medical Equipment, 2020, 17(4):83-86. DOI:10.3969/J.ISSN.1672-8270.2020.04.020. (in Chinese).

    [9]

    HAN D, CHEN X, LEI Y, et al. Iodine load reduction in dual-energy spectral CT portal venography with low energy images combined with adaptive statistical iterative reconstruction[J]. The British Journal of Radiology, 2019, 92(1100):20180414.

    [10]

    QI X, LI Z, HUANG J, et al. Virtual portal pressure gradient from anatomic CT angiography[J]. Gut, 2015, 64(6):1004-1005.

    [11] 刘伟, 刘盛楠. 门静脉造影+多层螺旋CT用于肝硬化食管胃底静脉曲张破裂出血患者围术期的意义[J]. 肝脏, 2020, 25(11):1185-1187.

    DOI:10.14000/j.cnki.issn.1008-1704.2020.11.016. LIU W, LIU S N. Application value of perioperative multi-slice spiral CT portal venography in cirrhotic patients with esophagogastric variceal bleeding[J]. Chinese Hepatology, 2020, 25(11):1185-1187. DOI:10.14000/j.cnki.issn.1008-1704.2020.11.016. (in Chinese).

    [12] 王伟新, 张秋奂, 郭鹏德, 等. 能谱CT单能量结合ASiR技术对腹部静脉成像质量的优化研究[J]. CT理论与应用研究, 2019, 28(1):61-72.

    DOI:10.15953/j.1004-4140.2019.28.01.07. WANG W X, ZHANG Q H, GUO P D, et al. The evaluation of imaging quality of abdominal vein by combining spectral CT optimal monotromatic imging and ASiR technique[J]. CT Theory and Applications, 2019, 28(1):61-72. DOI:10.15953/j.1004-4140.2019.28.01.07. (in Chinese).

    [13]

    WANG W, HUANG J, WANG A, et al. Dual-energy spectral computed tomography with adaptive statistical iterative reconstruction for improving image quality of portal venography[J]. Journal of Computer Assisted Tomography, 2018, 42(6):954-958.

    [14]

    MA C L, CHEN X X, LEI Y X, et al. Clinical value of dual-energy spectral imaging with adaptive statistical iterative reconstruction for reducing contrast medium dose in CT portal venography:In comparison with standard 120-kVp imaging protocol[J]. The British Journal of Radiology, 2016, 89(1062):20151022.

    [15] 邓小林, 谢惠, 屈亚林, 等. 能谱CT最佳单能量技术优化头颈部CTA图像质量的研究[J]. CT理论与应用研究, 2018, 27(6):719-726.

    DOI:10.15953/j.1004-4140.2018.27.06.05. DENG X L, XIE H, QU Y L, et al. Spectral CT with optimal monochromatic energy to improve CTA image quality of head and neck[J]. CT Theory and Applications, 2018, 27(6):719-726. DOI:10.15953/j.1004-4140.2018.27.06.05. (in Chinese).

    [16]

    ZHAO L, WINKLHOFER S, JIANG R, et al. Dual energy CT (DECT) monochromatic imaging:Added value of adaptive statistical iterative reconstructions (ASIR) in portal venography[J]. PloS One, 2016, 11(6):e0156830.

    [17] 宋明全, 孙学国, 李倩, 等. CT门静脉成像指导内镜治疗胃底静脉曲张疗效[J]. 世界华人消化杂志, 2021, 29(1):41-47.

    DOI:10.11569/wcjd.v29.i1.41. SONG M Q, SUN X G, LI Q, et al. CT portography guided endoscopic injection of cyanoacrylate into gastric varices[J]. World Chinese Journal of Digestology, 2021, 29(1):41-47. DOI:10. 11569/wcjd.v29.i1.41. (in Chinese).

    [18] 李会贤, 孔德润. 胃肾及脾肾分流道对胃底曲张静脉内镜治疗的影响[J]. 世界华人消化杂志, 2017, 25(20):1805-1810.

    DOI:10.11569/wcjd.v25.i20.1805. LI H X, KONG D R. Effect of gastrorenal shunt and splenorenal shunt on endoscopic treatment of gastric varices[J]. World Chinese Journal of Digestology, 2017, 25(20):1805-1810. DOI:10.11569/wcjd.v25.i20.1805. (in Chinese).

  • 期刊类型引用(3)

    1. 张婷婷,钟朝辉,张奥博,程晓悦,王振常. 股前外侧穿支皮瓣术前CT血管成像扫描及重建方案研究. CT理论与应用研究. 2024(06): 661-668 . 本站查看
    2. 项澄,李翠红. 内镜下组织胶三明治夹心法联合钛夹在食管胃底静脉曲张中的应用效果. 中国当代医药. 2024(28): 31-34 . 百度学术
    3. 成娜,雷炜,吴晓华. 对比分析常规增强CT扫描以及能谱CT单能量成像对门静脉血管成像图像质量的影响. 世界复合医学. 2023(12): 83-86 . 百度学术

    其他类型引用(1)

计量
  • 文章访问数:  177
  • HTML全文浏览量:  9
  • PDF下载量:  21
  • 被引次数: 4
出版历程
  • 收稿日期:  2021-03-27
  • 网络出版日期:  2021-09-22

目录

    /

    返回文章
    返回
    x 关闭 永久关闭