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中华普通外科学文献(电子版)

中华普通外科学文献(电子版) ›› 2019, Vol. 13 ›› Issue (06) : 459 -462. doi: 10.3877/cma.j.issn.1674-0793.2019.06.009

所属专题： 专题评论； 文献；

论著

肝脏CT动态增强扫描非刚性对位减影技术的质量评价
燕子1, 蔡华崧1, 胡曼诗1, 王丽琴1, 冯仕庭1, 王猛1,†()   
  1. 1. 510080　广州，中山大学附属第一医院放射科
  • 收稿日期:2019-04-29 出版日期:2019-12-01
  • 通信作者: 王猛
  • 基金资助:
    国家重点研发计划资助项目(2017YFC0113402)

Quality evaluation of non-rigid subtraction technique in CT dynamic enhancement scanning of liver

Zi Yan1, Huasong Cai1, Manshi Hu1, Liqin Wang1, Shiting Feng1, Meng Wang1,†()   

  1. 1. Department of Diagnostic Radiology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China
  • Received:2019-04-29 Published:2019-12-01
  • Corresponding author: Meng Wang
  • About author:
    Corresponding author: Wang Meng, Email:
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引用本文：

燕子, 蔡华崧, 胡曼诗, 王丽琴, 冯仕庭, 王猛. 肝脏CT动态增强扫描非刚性对位减影技术的质量评价[J]. 中华普通外科学文献(电子版), 2019, 13(06): 459-462.

Zi Yan, Huasong Cai, Manshi Hu, Liqin Wang, Shiting Feng, Meng Wang. Quality evaluation of non-rigid subtraction technique in CT dynamic enhancement scanning of liver[J]. Chinese Archives of General Surgery(Electronic Edition), 2019, 13(06): 459-462.

目的

利用血管减影前后的吻合程度，探讨非刚性对位减影技术在肝脏CT动态增强检查中的质量评价。

方法

收集2018年12月至2019年2月于中山大学附属第一医院行肝脏CT动态增强检查的50例患者资料，使用非刚性对位减影技术获得减影图像，对减影前后的图像质量进行评价，定性评价包括图像伪影情况及解剖错配程度，定量评价测量各血管（腹主动脉、肝右动脉、肝左动脉、门静脉主干、门静脉右支、门静脉左支）减影前后在动脉晚期、门静脉晚期的CT值。采用混合线性效应模型及拟合方程评估减影前后各血管的CT值曲线拟合程度。

结果

减影后图像均无明显解剖结构错配导致的伪影，3名测量者一致性较高（ICC=0.844，P<0.001）。减影技术一定程度上会降低各血管的CT值，与强化分期不存在交互作用。无论是在动脉晚期还是门静脉晚期，减影前后各血管CT值走势一致，CT值变化曲线吻合。

结论

非刚性对位减影技术可轻松实现肝脏CT动态增强检查的图像减影，并获得良好的图像质量。

关键词: 体层摄影术，螺旋计算机, 图像增强, 减影技术, 肝
Objective

To evaluate the quality of non-rigid subtraction technique in CT dynamic enhancement scanning of liver.

Methods

The image data of fifty patients undergoing CT dynamic enhancement scanning of liver were retrospectively collected from December 2018 to February 2019 in the First Affiliated Hospital of Sun Yat-sen University. The subtraction images were obtained by non-rigid subtraction technique. The image quality before and after subtraction was evaluated. Qualitative evaluation included image artifacts and anatomical mismatch degree. The CT value of each blood vessel (abdominal aorta, right hepatic artery, left hepatic artery, portal vein trunk, right portal vein branch, and left portal vein branch) before and after the subtraction were measured quantitatively in the arterial and portal vein phases, mixed linear effect model and fitting equation were used to evaluate the fitting degree of CT value curve of each blood vessel before and after subtraction.

Results

There were no obvious artifacts caused by anatomical mismatch of the images after non-rigid subtraction, and the consistency of three surveyors was high (ICC=0.844,P<0.001). Subtraction technique could reduce the CT value of each blood vessel to a certain extent, and there was no interaction with enhancement phase. The CT values of each blood vessel before and after subtraction showed the same trend in both late arteries and the CT value curve was consistent.

Conclusion

Non-rigid subtraction technique can be applied to CT dynamic enhancement scanning of liver to obtain high quality images.

Key words: Tomography, spiral computed, Image enhancement, Subtraction technique, Liver
图1 肝脏各血管CT扫描感兴趣区（ROI）的选择　①为腹主动脉开口于腹腔干层面；②为肝右动脉；③为肝左动脉；④为门静脉主干；⑤为门静脉右支；⑥为门静脉左支
图2 减影前后肝右动脉CT图像　箭头所示为肝右动脉边缘；A为减影前肝右动脉边缘模糊，周围组织干扰明显；B为减影后肝右动脉边缘清晰无干扰
表1 3名测量者对CT减影图像的定性评价[五分法,例(%)]
测量者 1级 2级 3级 4级 5级
1 0(0) 0(0) 2(4.0) 27(54.0) 21(42.0)
2 0(0) 0(0) 1(2.0) 16(32.0) 33(66.0)
3 0(0) 0(0) 0(0) 12(24.0) 38(76.0)
表2 肝脏各供血血管平扫、动脉晚期和门静脉晚期CT值（Hu, ±s）
供血血管 平扫 动脉晚期 门静脉晚期 减影 分期 减影×分期
减影前 减影后 减影前 减影后 F值 P值 F值 P值 F值 P值
腹主动脉 44.82±3.68 261.12±51.19 224.14±50.00 158.56±24.84 122.30±24.18 60.45 <0.001 464.98 <0.001 0.01 0.92
肝右动脉 44.41±5.09 236.63±44.78 208.81±45.95 144.56±25.73 120.75±25.86 32.94 <0.001 360.63 <0.001 0.34 0.56
肝左动脉 44.48±4.39 241.80±44.37 215.44±47.59 146.76±24.72 120.19±25.11 27.54 <0.001 358.12 <0.001 0 0.98
门静脉主干 44.05±2.49 171.36±45.15 141.71±43.89 165.45±28.20 130.12±26.41 55.44 <0.001 2.21 0.14 1.02 0.32
门静脉右支 45.16±2.40 171.36±43.75 141.62±43.79 165.56±28.00 130.39±25.96 57.71 <0.001 2.19 0.14 0.96 0.33
门静脉左支 44.87±2.95 168.16±44.45 138.02±42.80 165.54±27.70 129.77±25.44 56.45 <0.001 0.42 0.52 0.98 0.32
表3 减影前后肝脏各血管CT值线性拟合方程
分期 线性方程 决定系数 P值 斜率 斜率的95%CI
动脉晚期 ? ? ? ? ?
? 减影前 y= -20.9x+281.51 0.36 <0.001 -20.9 -24.1~-17.7
? 减影后 y= -20.2x+248.88 0.34 <0.001 -20.2 -23.4 ~-17.0
门静脉晚期 ? ? ? ? ?
? 减影前 y= -3.3x+146.10 0.04 <0.001 -3.3 -1.5~-5.2
? 减影后 y= -2.2x+118.00 0.02 0.011 -2.2 -0.5~-3.9
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