能谱CT对血液病输血患者肝脏铁沉积含量的诊断价值

The diagnostic value of dual-energy CT in the liver iron quantification in patients with haematological disorders with blood transfusion

目的探讨能谱CT对血液病患者输血后肝脏铁沉积的诊断价值。方法选取我院血液科住院的无输血史患者41例(对照组)及近6个月内有至少一次输血史患者47例(实验组)行常规入院能谱CT胸部平扫,得到部分肝脏能谱数据,测量75 keV水平时的肝脏平均CT值(CT75 keV)、肝脏能谱曲线斜率(Slope)、肝脏物质分离的铁(水)含量(LIC),并分别评价几个能谱参数的组间差异以及实验组内Slope、LIC与同一时段被检者血清铁蛋白(SF)含量的相关性。结果实验组与对照组间的肝脏CT75 keV、LIC及Slope差异有统计学意义(P<0.05);相关性分析结果显示:实验组LIC、Slope与同一时段SF均呈中等程度正相关,LIC与Slope存在极强负相关。当所选ROI包含尾状叶时,相关系数分别为:0.496、0.431、-0.821;当所选ROI不包含尾状叶时,相关系数分别为0.457、0.457、-0.866,P值均<0.05。结论能谱CT非强化扫描可以定量诊断肝脏铁含量,对输血后肝脏铁沉积定量研究及指导临床进一步去铁治疗具有重要价值。

Objective To explore the application value of dual energy CT in the diagnosis of liver transfusional haemosiderosis.Methods This study evaluated the dual-energy non-contrast chest-CTs in 88 hematological in-patients,including 41 cases without any erythrocyte transfusion(control group)and 47 cases with one erythrocyte transfusion or more within the past 6 months(test group).Parameters of the mean liver CT value at 75 keV(CT75 keV),the slope of the liver energy spectrum curve(Slope),the liver iron(water)content(LIC)were all determined based on DECT image data of liver obtained with a routine chest examinational protocol and calculated with the proposed post-processing prototype.The differences of CT75 keV,Slope and LIC between groups were evaluated,and the correlation between Slope and SF,between LIC and SF at the same time in the test group were evaluated respectively.Results There were significant statistical differences in CT75 keV,LIC and Slope between groups(P<0.05).In the test group,there were good positive correlations between LIC and SF,between Slope and SF at the same time,and there was a strong negative correlation between LIC and Slope,with coefficients of 0.496,0.431 and-0.821 when ROIs contained the caudate lobe,and coefficients of 0.457,0.457 and-0.866 when ROIs did not contain the caudate lobe(P<0.05).Conclusion Non-contrast routine DECT exam could be used in the daily routine diagnosis for complementary quantitative evaluation of liver transfusional haemosiderosis,which has important value in evaluating liver iron deposition after blood transfusion and guiding clinical treatment of iron removal.