数字化双能量减影胸部摄片的临床应用价值

Clinical application of dual-energy subtraction chest radiography

目的 :评价双能量减影胸部摄片的临床应用价值 ,探讨影响图像质量的因素。方法 :选择双能减影检查病人 15 0例 ,其中男 78例 ,女 72例 ,年龄 4～ 88岁 ,平均 4 7岁。使用美国GERevolutionXQ/d全数字摄影系统 ,自动曝光条件下采集数字平片、软组织像及骨组织像。由三名医师对图像进行综合分析 ,统计分析采用卡方检验。结果 :15 0例胸片中有阳性征象者 86例 ,其中钙化 2 9例 ,肺内结节性病变 4 5例 ,肋骨骨折 3例 ,骨病 4例 ,胸部其它病变 5例。胸部钙化检出情况 :数字平片检出 5例 ,骨组织像检出 2 9例 ,其中两者共同检出 5例。两者对胸部钙化的检出率有显著差异 (P <0 .0 1)。对肺内结节的检出情况 :数字平片检出 35例 ,软组织像检出 4 5例 ,两者共同检出 35例 ,两者对肺内结节的检出率经统计学处理无显著差异 (P >0 .0 5 )。左下肺心室搏动伪影、双下肺呼吸运动伪影是软组织像上常见的伪影表现 ,曝光时身体移动是双能减影失败的常见原因。结论 :双能减影可增加诊断的信息量 ,增加胸部钙化的检出率 ,有助于肺内结节性病变细节的观察 ;有利于对肺野边缘、骨性胸廓及大气管影像解剖结构和病变的观察 ;心室搏动、曝光时呼吸及身体移动是影响双能减影成像质量的主要因素。

Objective: To evaluate dual-energy subtraction chest radiography (DE) in the diagnosis of chest lesions and analyse the factors affected quality of imaging.Methods: 150 patients (78 men and 72 women, 4-88 years old, 47 years average) were taken DE using GE Revolution XQ/d All-digital Radiography System.Tissue and bone-selective images were obtained.Three radiologists evaluated the images and χ2 tests were performed for statistical analysis.Results: 80 of 150 patients had chest lesions (29 calcifications,45 pulmonary nodules,3 fractures of rib,4 osteonosus,5 other chest lesions).Chest calcification was detected in 5 conventional chest digital images,29 bone-selective images,5 both images.There was significant difference in detection of Chest calcification between conventional chest digital images and bone-selective images (p<0.05).Chest nodules was detected in 35 conventional chest digital images,45 tissue-selective images,35 both images.There was not statistically significant difference in detection of Chest nodules between conventional chest digital images and tissue-selective images (p>0.05).The common artifacts were in left lower lung due to heart beat and in both lower lung due to respiratory movements.The common reason dual-energy subtraction chest radiography failed was body movements in exposing.Conclusion: DE increased detectable rate of chest characterization, improved the detection of pulmonary nodules and lesions in margin of lung field,skeletal thorax and main air passage.Heart beat, respiration and body movements in exposing were main factors in affecting quality of imaging.