能谱CT最佳对比信噪比技术诊断肝硬化并发食管胃底静脉曲张价值分析

The value of energy spectrum CT optimal CNR technique in the diagnosis of esophageal and gastric variceal bleeding in liver cirrhosis

目的研究能谱CT最佳对比信噪比(CNR)技术诊断肝硬化并发食管胃底静脉曲张出血(EGVB)的价值。方法2018年6月至2020年12月许昌市中心医院收治的肝硬化门静脉高压症患者63例,接受腹部3期增强扫描(动脉期、门静脉期、延迟期)。门静脉期启动能谱扫描模式,获取门静脉最佳CNR单能量图像(最佳CNR组)和70 keV单能量图像(70 keV组),记录两组门静脉CT值、肝实质CT值、门静脉主干(MPV)CNR及图像质量评分。采用Kappa一致性检验评估门静脉最佳CNR单能量图像诊断患者食管胃底静脉曲张分级与胃镜检查结果的一致性。结果最佳CNR组门静脉CT值、肝实质CT值、MPV CNR和图像质量评分分别为(298.6±32.6)HU、(165.5±22.6)HU、(6.6±1.3)和(4.5±0.8)分,高于70 keV组的(144.8±28.4)HU、(107.9±16.3)HU、(4.7±1.5)和(4.1±0.7)分,差异均有统计学意义(t=28.235、16.407、7.596和2.987,均P<0.05)。门静脉最佳CNR单能量图像诊断患者食管胃底静脉曲张分级与胃镜检查一致性检验的Kappa值为0.8(P<0.05)。结论能谱CT最佳CNR技术可提供最佳单能量水平图像,优化门静脉图像质量,有助于EGVB风险的预测。

Objective To study on the value of energy spectrum CT best contrast signal-to-noise ratio(CNR)technique in the diagnosis of esophageal variceal bleeding(EGVB)in liver cirrhosis.Methods Sixty-three patients with cirrhosis and portal hypertension admitted between June 2018 and December 2020 were enrolled in this study.All patients received 3 phases of abdominal enhanced scan(arterial phase,portal vein phase and delayed phase).Energy spectrum scanning mode was started in the portal phase to obtain the best single-energy portal CNR images(the best CNR group)and 70 keV single-energy portal vein images(the 70 keV group),and the portal vein CT values,hepatic parenchyma CT values,portal vein main(MPV)CNR and image quality scores were recorded in these two groups.Kappa consistency test was used to evaluate the consistency between the grade of esophageal and gastric fundus varices diagnosed by the best CNR single energy portal vein image and gastroscopy.Results The CT value of portal vein,CT value of liver parenchyma,MPV CNR and image quality score in the best CNR group were(298.6±32.6)Hu,(165.5±22.6)Hu,(6.6±1.3)and(4.5±0.8)points,respectively,which were significantly higher than those of(144.8±28.4)Hu,(107.9±16.3)Hu,(4.7±1.5)and(4.1±0.7)points in the 70 keV Group,respectively(t=2.987,t=28.235,t=16.407,t=7.596,P<0.05).The Kappa value of the grade of esophageal and gastric varices diagnosed by the best CNR single energy portal vein image and the consistency test of gastroscopy was 0.8(P<0.05).Conclusion The best CNR technology of energy spectrum CT can provide the best single energy level image,optimize the image quality of portal vein,and contribute to the prediction of EGVB risk.