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
  • 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，2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（P均 < 0.01）；病灶区MTT、TDC达峰时间略降低，差异有统计学意义（P均 < 0.05）。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 mAs, with 28 scans acquired at 1.5-s intervals over a total duration of 42.42 s. The dual-energy CT scan used a tube voltage of 100/Sn at 150 kV and a reference tube current of 180/90 mAs. 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 (both P < 0.01), whereas the MTT and peak TDC in lesion areas were slightly but significantly lower (both P < 0.05). 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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