ISSN 1004-4140
CN 11-3017/P

低剂量CT灌注联合双能扫描在胰腺神经内分泌肿瘤中的应用

Combining Low-dose Perfusion with Dual-energy CT Scanning for Pancreatic Neuroendocrine Tumors

  • 摘要: 目的:探讨一站式低剂量胰腺CT灌注联合双能扫描在胰腺神经内分泌肿瘤检出中的应用价值。方法:回顾性收集2020年1月至2024年6月于我院行胰腺CT灌注和双能CT联合扫描,且手术或病理证实为胰腺神经内分泌肿瘤患者23例。灌注扫描管电压80 kV,管电流40 mAs,每1.5 s采集1期共28期,时间42.42s;双能扫描管电压100/Sn 150 kV,参考管电流180/90 mAs。记录辐射剂量,对灌注及双能图像质量进行主观评分,采用Kappa检验评价一致性;测量灌注参数血流量(BF)、血容量(BV)、平均通过时间(MTT)、毛细血管渗透性(FE)及时间一密度曲线(TDC),采用t检验比较差异性;以手术或病理结果为金标准,评价诊断准确性。结果:一站式低剂量胰腺CT灌注和双能扫描图像质量均达到诊断标准,两位医师主观评分结果一致性良好(Kappa=0.79),联合扫描全程有效辐射剂量为(6.48±0.84)mSv。病灶异常灌注区与正常胰腺实质灌注参数相比,BF、BV明显增高,差异有统计学意义;病灶区MTT、TDC达峰时间略降低,差异有统计学意义。与手术或病理证实的27枚肿瘤病灶对比,单独灌注CT检查诊断符合率为70.37%(19/27),一站式灌注联合双能延迟检查提高为85.18%(23/27)。结论:一站式胰腺CT灌注联合双能扫描可根据形态学特征和相关参数分析,提高胰腺神经内分泌肿瘤诊断准确率,且有效辐射剂量较低,具有较高的临床应用价值。

     

    Abstract: Objectives: This study explores the clinical value of one-time, low-dose pancreatic CT perfusion combined with dual-energy scanning for detecting pancreatic neuroendocrine tumors. Methods: We retrospectively analyzed data from 23 patients with surgically or pathologically confirmed pancreatic neuroendocrine tumors who underwent pancreatic CT perfusion and delayed dual-energy CT scanning at our hospital between January 2020 to June 2024. The perfusion scan was performed at 80 kV and 40 kmAs, with 28 scans acquired at 1.5 ks intervals over a total duration of 42.42 ks. The dual-energy CT scan used a tube voltage of 100/Sn at 150 kV and a reference tube current of 180/90 kmAs. The radiation dose was recorded, the image quality of perfusion and dual-energy CT scans was subjectively assessed. The interobserver agreement was evaluated using the Kappa coefficient. Differences in blood flow (BF), blood volume (BV), mean transit time (MTT), flow-extraction product (FE), and time-density curve (TDC) characteristics between tumor lesions and normal pancreatic parenchyma were analyzed using the T-test. The diagnostic accuracy was assessed against surgical and pathological findings. Results: The image quality of both low-dose pancreatic perfusion and delayed dual-energy CT images met the diagnostic criteria, with high interobserver agreement (Kappa=0.79). The total effective radiation dose of the combined scan was (6.48±0.84) mSv. Compared to normal pancreatic parenchyma, the BF and BV in the abnormal perfusion areas of the lesions were significantly higher, whereas the MTT and peak TDC in lesion areas were slightly but significantly lower. The diagnostic accuracy of the single perfusion CT was 70.37% (19/27), whereas the combined one-time perfusion and delayed dual-energy CT achieved an accuracy of 85.18% (23/27), as confirmed in the 27 tumor lesions by the surgical and pathological results. Conclusions: One-time pancreatic perfusion CT combined with dual-energy CT scanning improves the diagnostic accuracy of pancreatic neuroendocrine tumors by enhancing morphological and perfusion parameter analysis while maintaining a low effective radiation dose. This approach has significant clinical value.

     

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