Amiodarone-induced hepatotoxicity-quantitative measurement of iodine density in the liver using dual-energy computed tomography:Three case reports

BACKGROUND Amiodarone is the drug most commonly used to manage arrhythmias.Long-term amiodarone administration causes hepatotoxicity due to iodine accumulation in the liver.Here,we present three cases of amiodarone-induced hepatotoxicity in patients on long-term oral amiodarone therapy who underwent dual-energy computed tomography(DECT).CASE SUMMARY We report the clinical and iodine density in the liver using DECT in three patients with amiodarone-induced hepatotoxicity.Liver enzymes were increased in these three patients,and abdominal DECT without contrast medium showed highly increased attenuation in the liver.Furthermore,the iodine concentration in the liver was increased.The first patient with amiodarone-induced reversible hepatotoxicity,showed a reversible course of liver function and a decrease in CT values after discontinuation of amiodarone.The second patient on long-term oral amiodarone had increased iodine concentration in the liver and liver damage,the patient eventually developed rapidly progressive pneumonia and died of multiple organ failure.The third patient,showed an increased iodine concentration in the liver and elevated liver enzymes.However,the patient refused radiofrequency ablation for atrial fibrillation and continued oral amiodarone to control atrial fibrillation,and routine liver function tests were required every 3-6 mo in this patient.CONCLUSION DECT is a potentially noninvasive diagnostic tool for quantifying iodine concentration in the liver and monitoring adverse reactions due to amiodarone.

Characterization of ureteral stents by dual-energy computed tomography: Clinical implications

Dual-energy computed-tomography(DECT) has been suggested as the method of choice for imaging urinary calculi due to the modality's high sensitivity for detect-ing stones and its capability of accurately differentiat-ing between uric-acid(UA) and non-UA(predominantly calcium) stones. The clinical significance of the latter feature relates to the differences in management of UA vs non-UA calculi. Like calculi, ureteral stents are assigned color by the dual-energy post-processing algorithm, which may lead to improved or worsened stone visualization based on the resulting stent/stone contrast. Herein we depict the case of a nephrolithiasis patient with bilateral stents, each with different color, clearly displaying the effect of stent color on stone vi-sualization. Further, three-dimensional reconstruction of the DECT images illustrates advantages of this enhancement compared to conventional two-dimensional computed tomography. The resulting stent/stone contrast produces an unanticipated potential advantage of DECT in patients with urolithiasis and stents and may promote improved management decision-making.

COVID-19-related cardiomyopathy:Can dual-energy computed tomography be a diagnostic tool?

BACKGROUND No study on dual energy computed tomography(DECT)has been found in the literature to evaluate possibly fatal cardiac/myocardial problems in corona virus disease 2019(COVID-19)patients.Myocardial perfusion deficits can be found in COVID-19 patients even without any significant coronary artery occlusion,and these deficits can be shown via DECT with a perfect interrater agreement.AIM To assess lung perfusion alterations in COVID-19 patients.To our knowledge,no study using DECT has been performed to evaluate possibly fatal cardiac/myocardial problems in COVID-19 patients.The purpose of this study is to evaluate the role of DECT in the detection of COVID-19-related cardiac diseases.METHODS Two blinded independent examiners evaluated CT images using the 17-segment model according to the American Heart Association’s classification of the segmentation of the left ventricular myocardium.Additionally,intraluminal diseases and abnormalities in the main coronary arteries and branches were investigated.Following segment-by-segment analysis,perfusion deficiencies identified on the iodine map pictures on DECT were identified.RESULTS The study enrolled a total of 87 patients.Forty-two of these individuals were classified as COVID-19 positive,and 45 were classified as controls.Perfusion deficits were identified in 66.6%(n=30)of the cases.All control patients had a normal iodine distribution map.Perfusion deficits were found on DECT iodine map images with subepicardial(n=12,40%),intramyocardial(n=8,26.6%),or transmural(n=10,33.3%)anatomical locations within the left ventricular wall.There was no subendocardial involvement in any of the patients.CONCLUSION Myocardial perfusion deficits can be found in COVID-19 patients even without any significant coronary artery occlusion.These deficits can be shown via DECT with a perfect interrater agreement.Additionally,the presence of perfusion deficit is positively correlated with D-dimer levels.

Head dual energy-computed tomography angiography versus neuro-digital subtraction angiography

Dual-energy X-ray absorptiometry provides two modes of head computed tomography （CT） angiography scanning： neuro-digital subtraction angiography and dual-energy CT angiography （DE-CTA）. Previous studies have compared image quality, radiation exposure, and bone removal between neuro-digital subtraction angiography and DE-CTA. However, the number of cases was relatively small. The present study examined 300 suspected cases of cerebrovascular disease and observed the methods and duration of post-processing, examination time, and data volume. Results demonstrated similar image quality between the two methods, but lower radiation doses and shorter examination time in DE-CTA. DE-CTA allowed for faster and more stable scanning performance and post-processing methods, facilitating accurate and direct diagnosis of cerebrovascular disease.

Dual energy computed tomography for detection of metastatic lymph nodes in patients with hepatocellular carcinoma

BACKGROUND Regional lymph node metastasis in patients with hepatocellular carcinoma(HCC)is not uncommon, and is often under-or misdiagnosed. Regional lymph node metastasis is associated with a negative prognosis in patients with HCC, and surgical resection of lymph node metastasis is considered feasible and efficacious in improving the survival and prognosis. It is critical to characterize lymph node preoperatively. There is currently no consensus regarding the optimal method for the assessment of regional lymph nodes in patients with HCC.AIM To evaluate the diagnostic value of single source dual energy computed tomography(CT) in regional lymph node assessment for HCC patients.METHODS Forty-three patients with pathologically confirmed HCC who underwent partial hepatectomy with lymphadenectomy were retrospectively enrolled. All patients underwent dual-energy CT preoperatively. Regional lymph nodes(n = 156) were divided into either a metastatic(group P, n = 52) or a non-metastasis group(group N, n = 104), and further, according to pathology, divided into an active hepatitis(group P1, n = 34; group N1, n = 73) and a non-active hepatitis group(group P2, n = 18; group N2, n = 31). The maximal short axis diameter(MSAD),iodine concentration(IC), normalized IC(NIC), and the slope of the spectralcurve(λ_(HU)) of each group in the arterial phase(AP), portal phase(PP), and delayed phase(DP) were analyzed.RESULTS Analysis of the MSAD, IC, NIC, and λ_(HU) showed statistical differences between groups P and N(P < 0.05) during all three phases. To distinguish benign from metastatic lymph nodes, the diagnostic efficacy of IC, NIC, and λ_(HU) in the PP was the best among the three phases(AP, PP, and DP), with a sensitivity up to 81.9%,83.9%, and 81.8%, and a specificity up to 82.4%, 84.1% and 84.1%, respectively.The diagnostic value of combined analyses of MSAD with IC, NIC, or λ_(HU) in the PP was superior to the dual energy CT parameters alone, with a sensitivity up to84.5%, 86.9%, and 86.2%, and a specificity up to 83.0%, 93.6% and 89.8%,respectively. Between groups P1 and P2 and groups N1 and N2, only IC, NIC,and λ_(HU) between groups N1 and N2 in the PP had a statistically significant difference(P < 0.05).CONCLUSION Dual-energy CT contributes beneficially to regional lymph node assessment in HCC patients. Combination of MSAD with IC, NIC, or λ_(HU) values in the PP is superior to using any single parameter alone. Active hepatitis does not deteriorate the capabilities for characterization of metastatic lymph nodes.

Correlation analysis of dual-energy CT iodine maps with quantitative pulmonary perfusion MRI

AIM:To correlate dual-energy computed tomography(DECT) pulmonary angiography derived iodine maps with parameter maps of quantitative pulmonary perfusion magnetic resonance imaging(MRI).METHODS:Eighteen patients with pulmonary perfusion defects detected on DECT derived iodine maps were included in this prospective study and additionally underwent time-resolved contrast-enhanced pulmonary MRI [dynamic contrast enhanced(DCE)-MRI].DCE-MRI data were quantitatively analyzed using a pixel-by-pixel deconvolution analysis calculating regional pulmonary blood flow(PBF),pulmonary blood volume(PBV) and mean transit time(MTT) in visually normal lung parenchyma and perfusion defects.Perfusion parameterswere correlated to mean attenuation values of normal lung and perfusion defects on DECT iodine maps.Two readers rated the concordance of perfusion defects in a visual analysis using a 5-point Likert-scale(1 = no correlation,5 = excellent correlation).RESULTS:In visually normal pulmonary tissue mean DECT and MRI values were:22.6 ± 8.3 Hounsfield units(HU);PBF:58.8 ± 36.0 mL/100 mL per minute;PBV:16.6 ± 8.5 mL;MTT:17.1 ± 10.3 s.In areas with restricted perfusion mean DECT and MRI values were:4.0 ± 3.9 HU;PBF:10.3 ± 5.5 mL/100 mL per minute,PBV:5 ± 4 mL,MTT:21.6 ± 14.0 s.The differences between visually normal parenchyma and areas of restricted perfusion were statistically significant for PBF,PBV and DECT(P < 0.0001).No linear correlation was found between MRI perfusion parameters and attenuation values of DECT iodine maps(PBF:r = 0.35,P = 0.15;PBV:r = 0.34,P = 0.16;MTT:r = 0.41,P = 0.08).Visual analysis revealed a moderate correlation between perfusion defects on DECT iodine maps and the parameter maps of DCE-MRI(mean score 3.6,k 0.45).CONCLUSION:There is a moderate visual but not statistically significant correlation between DECT iodine maps and perfusion parameter maps of DCE-MRI.

Determinants of Detection of Stones and Calcifications in the Hepatobiliary System on Virtual Nonenhanced Dual-energy CT

Objective To retrospectively determine the features of stones and calcifications in hepatobiliary system on virtual nonenhanced (VNE) dual-energy computed tomography (CT), and to evaluate the possibility of VNE images in diagnosis for those lesions. Methods A total of 128 gall stones and calcifications of the liver found in 110 patients were examined with triple phase abdominal CT scan from July 2007 to December 2011, in which true nonenhanced (TNE) phase and arterial phase were performed with single-energy CT (120 kVp) and portal venous phase was performed with dual-energy CT (100 kVp and 140 kVp). VNE images were generated from the portal venous phase dual-energy CT data sets by using commercially VNC software. The mean CT values for the stone, liver, bile and paraspinal muscle, mean lesion density and size in area dimension, contrast-to-noise ratio (CNR) of lesion to the liver or bile, and image noise were assessed and compared between VNE and TNE images. The effective dose and size-specific dose estimate (SSDE) were also calculated. Results The mean CT values of the lesions measured on VNE images declined significantly compared with those measured on TNE images (164.51±102.13vs. 290.72±197.80 HU,P<0.001), so did the lesion-to-liver CNR (10.80±11.82vs.18.81±17.06,P<0.001) and the lesion-to-bile CNR (17.24±14.41 vs. 21.32±17.31,P<0.001). There was no significant difference in size of lesions area between VNE and TNE images (0.69±0.88vs.0.72±0.85 cm2,P=0.062). Compared to the 128 lesions found in TNE images, VNE images showed the same density in 30 (23.4%) lesions, lighter density in 88 (68.8%) lesions, while failed to show 10 (7.8%) lesions, and showed the same size in 61 (47.7%) lesions and smaller size in 57 (44.5%)&nbsp;lesions. The CT cutoff values of lesion and size were 229.21 HU and 0.15 cm2, respectively. The total effective dose for triple phase scan protocol with TNE images was 19.51±7.03 mSv, and the SSDE was 39.84±11.10 mGy. The effective dose for dual phase scan protocol with VNE images instead of TNE images was 13.29±4.89 mSv, and the SSDE was 27.83±9.99 mGy. Compared with TNE images, the effective dose and SSDE of VNE images were down by 32.05%±3.69 % and 30.63%±2.34 %, respectively. Conclusions Although the CT values and CNR of the lesions decreased in VNE images, the lesions of which attenuation greater than 229.21 HU and size larger than 0.15 cm2could be detected with good reliability and obvious dose reduction. There was good consistency in the size of stones and calcifications in hepatobiliary system between VNE images and TNE images, which ensured the possibility of the clinical application of VNE images.

Diagnostic accuracy of cardiac computed tomography angiography for myocardial infarction

AIM:To investigate diagnostic accuracy of high,low and mixed voltage dual energy computed tomography(DECT) for detection of prior myocardial infarction(MI).METHODS:Twenty-four consecutive patients(88% male,mean age 65 ± 11 years old) with clinically documented prior MI(】 6 mo) were prospectively recruited to undergo late phase DECT for characterization of their MI.Computed tomography(CT) examinations were performed using a dual source CT system(64-slice Definition or 128-slice Definition FLASH,Siemens Healthcare) with initial first pass and 10 min late phase image acquisitions.Using the 17-segment model,regional systolic function was analyzed using first pass CT as normal or abnormal(hypokinetic,akinetic,dyskinetic).Regions with abnormal systolic function were identified as infarct segments.Late phase DE scans were reconstructed into:140 kVp,100 kVp,mixed(120 kVp) images and iodine-only datasets.Using the same 17-segment model,each dataset was evaluated for possible(grade 2) or definite(grade 3) late phase myocardial enhancement abnormalities.Logistic regression for correlated data was used to compare reconstructions in terms of the accuracy for detecting infarct segments using late myocardial hyperenhancement scores.RESULTS:All patients reported prior history of documented myocardial infarction,with most occurring more than 5 years prior(n = 18;75% of cohort).Fiftyfive of 408(13%) segments demonstrated abnormal wall motion and were classified as infarct.The remaining 353 segments were classified as non-infarcted segments.A total of 1692 segments were analyzed for late phase enhancement abnormalities,with 91(5.5%) segments not interpretable due to artifact.Combined grades 2 and 3 compared to grade 3 only enhancement abnormalities demonstrated significantly higher sensitivity and similar specificity for detection of infarct segments for all reconstructions evaluated.Evaluation of different voltage acquisitions demonstrated the highest diagnostic performance for the 100 kVp reconstruction which had higher diagnostic accuracy(87%;95%CI:80%-90%),sensitivity(86%-93%;95%CI:54%-78%) and specificity(90%;95%CI:86%-93%) compared to the other reconstructions.For sensitivity,there were significant differences noted between 100 kVp vs 140 kVp(P【0.0005),100 kVp vs mixed(P【0.0001),and 100 kVp vs iodine only(P【0.005) using combined grade 2 and grade 3 perfusion abnormalities.For specificity,there were significant differences noted between 100 kVp vs 140 kVp(P【0.005),and 100 kVp vs mixed(P【0.01) using combined grades 2 and 3 perfusion abnormalities.CONCLUSION:Low voltage acquisition CT,100 kVp in this study,demonstrates superior diagnostic performance when compared to higher and mixed voltage acquisitions for detection of prior MI.

Future of cardiac computed tomography

Coronary computed tomography angiography(CCTA)has become an integral tool in the noninvasive diagnostic workup of patients with suspected coronary artery disease in both elective and emergency settings. Today, it represents a mature technique providing accurate, non-invasive morphological assessment of the coronary arteries and atherosclerotic plaque burden. Iterative reconstruction algorithms, low kV imaging, and single-heart beat acquisitions hold promise to further reduce dose requirements and improve the safety and robustness of the technique in several circumstances including imaging of heavily calcified vessels, patients with morbid obesity or irregular heart rates, and assessment in the emergency setting. However, it has become clear over recent years that cardiac radiologists need to take further steps towards the development and integration of functional imaging with morphological CCTA assessment to truly provide a comprehensive evaluation of the heart. Computed tomography myocardial perfusion imaging, including both dynamic and static dual-energy approaches, has demonstrated the ability to directly assess and quantify myocardial ischemia with simultaneous CCTA acquisition with a reasonable contrast medium volume and radiation dose delivered to the patient. In order to promote CCTA in the clinical and research environments, radiologists should prepare to embrace the change from morphological to functional imaging, furnishing all the necessary resources and information to referring clinicians.

Application of an Advanced Image-Based Virtual Monoenergetic Reconstruction of Dual Source Dual-Energy CT Data at Low keV Increases Image Quality for Esophageal Cancer Patients Imaging

Purpose: To explore the significance of dual-source computed tomography (DECT) virtual monoenergetic reconstructions technology in improving the imaging quality of esophageal cancer patients. Materials and methods: 68 patients with clinically suspected esophageal cancer (all confirmed by pathology) were collected. Routine plain scan was performed with SIEMENS Force dual-energy CT and then dual-phase scans were performed. The venous phase images were respectively subjected to traditional virtual monoenergetic reconstructions (Mono_E) and new generation virtual monoenergetic reconstructions (Mono+). Mono_E 55 keV and Mono+ 55 keV virtual single-energy images were obtained respectively. The signal-to-noise ratio (SNR) of normal esophageal tissue and esophageal cancer lesions, noise and contrast noise ratio (CNR tumor) of normal esophageal tissue and esophageal cancer lesions were compared among 100 kV images, Mono_E images and Mono+ images. At the same time, two imaging physicians read the films and scored the images of each group by using a 5-point scoring method. Results: Mono+ 55 keV images, SNR, SNRtumor, noise and CNRtumor were statistically different from those of 100 kV images and Mono_E images (P < 0.05). And Mono+ 55 keV images also had the highest subjective score, with statistical significance (P 55 keV images had the best quality. Conclusion: The new generation of virtual monoenergetic reconstructions post-processing (Mono+) could reduce image noise and improve the contrast between esophageal cancer lesions and normal esophageal tissues, which was of great significance to improve the imaging quality of esophageal cancer patients and improve the early detection rate of esophageal cancer.

Validation of quantitative computed tomography-derived areal bone mineral density with dual energy X-ray absorptiometry in an elderly Chinese population

Background The performance of computed tomography X-ray absorptiometry （CTXA） against the dual energy X-ray absorptiometry （DXA） as standard has not been studied in Chinese population. The aim of this study was to evaluate the precision of this measurement and validate the value of quantitative computed tomography （QCT） by comparing CTXA results with DXA results in an elderly Chinese population. Methods One hundred and three females of 46 to 76 years old and 49 males of 52 to 76 years old were recruited from the Prospective Urban Rural Epidemiology study. All subjects underwent hip scans by both QCT and DXA on the same day. For precision determination, 30 subjects had duplicate DXA hip scans. The hip QCT data of a subset of 27 subjects were separately analyzed by two observers and reanalyzed by one observer at a different time. The inter- and intra-observer variations of CTXA measurement were assessed, and the difference and correlation between CTXA and DXA results were analyzed. Results The inter- and intra-observer variations of CTXA were 0.070 and 0.024 g/cm^2 in the femoral neck （FN）, and 0.030 and 0.012 g/cm2 in the total hip （TH）, which were comparable to the DXA inter-scan variations （0.013 g/cm2 for FN and 0.014 g/cm2 for TH）. The results of CTXA bone mineral density （BMD） were highly correlated with those of DXA （R2 = 0.810 for FN and R2 = 0.878 for TH）. The BMD values of CTXA in FN and TH were lower than those of DXA by 21.0% and 17.8% （P〈0.05）, respectively. However, after appropriate transformation, the difference was eliminated and a comparable T score could be obtained. Conclusions CTXA shows good agreement with DXA for the measurement of BMD in the proximal femur, which makes QCT suitable for the quantification of bone mineral content in the hip and helpful for the diagnosis of osteoporosis.

Fused monochromatic imaging acquired by single source dual energy CT in hepatocellular carcinoma during arterial phase: an initial experience

Objective： To explore whether single and fused monochromatic images can improve liver tumor detection and delineation by single source dual energy CT （ssDECT） in patients with hepatocellular carcinoma （HCC） during arterial phase. Methods： Fifty-seven patients with HCC who underwent ssDECT scanning at Beijing Cancer Hospital were enrolled retrospectively. Twenty-one sets of monochromatic images from 40 to 140 keV were reconstructed at 5 keV intervals in arterial phase. The optimal contrast-noise ratio （CNR） monochromatic images of the liver tumor and the lowest-noise monochromatic images were selected for image fusion. We evaluated the image quality of the optimal-CNR monochromatic images, the lowest-noise monochromatic images and the fused monochromatic images, respectively. The evaluation indicators included the spatial resolution of the anatomical structure, the noise level, the contrast and CNR of the tumor. Results： In arterial phase, the anatomical structure of the liver can be displayed most clearly in the 65-keV monochromatic images, with the lowest image noise. The optimal-CNR monochromatic images of HCC tumor were 50-keV monochromatic images in which the internal structural features of the liver tumors were displayed most clearly and meticulously. For tumor detection, the fused monochromatic images and the 50-keV monochromatic images had similar performances, and were more sensitive than 65-keV monochromatic images. Conclusions： We achieved good arterial phase images by fusing the optimal-CNR monochromatic images of the HCC tumor and the lowest-noise monochromatic images. The fused images displayed liver tumors and anatomical structures more clearly, which is potentially helpful for identifying more and smaller HCC tumors.

Dual-energy computed tomography angiography for evaluating the renal vascular variants

Background Recognizing renal vascular variants preoperatively is important in order to avoid vascular complications during surgery. This study aimed to investigate the renal vascular variants with dual-energy computed tomography （DECT） angiography to provide valuable information for surgery. Methods A total of 378 patients underwent DECT. The number, size, course and relationships of the renal vessels were retrospectively observed from the scans. Anomalies of renal arteries and veins were recorded and classified. Multiplanar reformations （MPR）, maximum intensity projections （MIP）, and volume renderings （VR） were used for analysis. Results In 378 patients （756 kidneys）, renal artery variations were discovered and recorded in 123 kidneys （16.3%, 123/756） of 106 patients （28.0%, 106/378）. Type IB （early branches of the only one main renal artery） and IC （accessory renal artery with only one main renal artery） were found most frequently with an incidence of 11.4% （43/378） and 14.5% （55/378）. The incidence of renal artery variations in the left kidney was not statistically different than in the right kidney （12.4% vs. 11.1%）. The incidence of renal vein variations was detected in 104 patients （27.5%, 104/378）. The incidence of venous variants in the right kidney was higher than in the left kidney （20.1% vs. 7.4%）, but left renal vein variations were more complex. Variants of the left renal vein were detected in 28 patients including type 1 （circumaortic left renal vein） in eight cases, type 2 （retroaortic left renal vein） in seven cases, type 3 （abnormal reflux） in six cases, type 4 （late venous confluence of left renal vein） in five cases, and type 5 （rare type） in two cases. The frequency of left renal vein variation associated with the left renal accessory artery was significantly higher than with early branches of the left renal artery （P=0.037）. Conclusions The renal vascular variants are rather common and complex. DECT angiography can demonstrate the precise anatomy of the renal vessels, which is a benefit for renal transplantation or other renal operations

双能CT水-羟基磷灰石分离技术对胸腰椎骨折诊断的影响:不同年资放射科医生间的比较

目的探讨双能CT(DECT)水-羟基磷灰石(HAP)分离技术能否提高椎体新鲜压缩性骨折的检出率,并研究其诊断效能与放射科医生经验水平的相关性。方法回顾性分析50例创伤后接受胸腰椎DECT和MRI检查的患者资料,DECT获得常规混合能量CT平扫图和水-HAP重建图像。四名放射科医生独立盲法阅片,该四名医生分别具有1年、5年、8年和12年工作经验,首先根据CT平扫判断是否存在椎体骨折及骨折的新旧,再结合DECT水-HAP图来判断有无骨折及骨折的新旧。以MR T2脂肪抑制图像为金标准,进行DECT诊断效能的敏感度、特异度、准确度、阳性预测值、阴性预测值分析以及CT平扫与结合水-HAP图结果配对分析。结果MRI共发现54节新鲜骨折,38节陈旧性骨折。与常规CT平扫相比,结合水-HAP图像提高了所有医生的诊断效能。四名医生结合水-HAP图像后,准确度分别由常规CT的0.76、0.75、0.82、0.84提升至0.87、0.89、0.92、0.93;敏感度和特异度分别由0.83、0.83、0.89、0.87,0.66、0.63、0.71、0.79提升至0.93、0.94、0.98、0.94,0.79、0.82、0.84、0.92;阳性预测值和阴性预测值分别由0.78、0.76、0.81、0.85,0.74、0.73、0.82、0.81提升至0.86、0.88、0.90、0.94,0.88、0.91、0.97、0.92;被评为“不确定”椎体的数量分别由23、21、19、12节下降到7、5、5、1节。与常规CT平扫相比,DECT水-HAP分离技术提高了所有医生诊断新鲜椎体骨折的准确度,配对分析差异具有统计学意义(P<0.05)。水-HAP分离技术使患者也受益,四名医生结合水-HAP图像后,需要进一步MRI检查的患者数量分别由14、13、14、11人下降到4、3、3、1人。结论DECT水-HAP分离技术可提高不同经验水平放射科医生基于CT诊断椎体新鲜压缩性骨折的能力。

双能CT联合血清IL-1β检测在痛风诊断中的应用价值

目的研究双能CT(DECT)成像、血清白细胞介素(IL)-1β在痛风诊断中的应用价值。方法抽取2015年6月—2016年6月天津市第一中心医院风湿免疫科门诊及住院的有关节肿痛并明确诊断为痛风患者(痛风组)76例,另抽取40例非痛风患者做为对照组,其中类风湿关节炎33例,骨关节炎7例。DECT检测所有入选患者的受累关节,获取患者存在绿色结晶沉积的数目及堆积部位;采用酶联免疫吸附法(ELISA)检测2组患者血清IL-1β水平。评价DECT和IL-1β诊断通风的临床价值,绘制IL-1β的受试者工作特征(ROC)曲线并计算曲线下面积(AUC),确定最佳诊断界值。结果 DECT共发现尿酸盐沉积病灶349处,主要位于第1跖趾关节(245处),对照组5例患者出现假阳性,3例为甲周伪影,2例为足垫伪影。DECT诊断痛风性关节炎的敏感度和特异度分别为100%和87.5%,血清IL-1β的敏感度和特异度为65.7%和90.0%,两者联合检测敏感度及特异度是100%和95.0%。IL-1β的AUC为0.929(0.882～0.977),最佳诊断界值为5 ng/L。结论 DECT联合血清IL-1β检测有助于早期诊断痛风,明确尿酸盐沉积部位,具有较高的临床应用价值。

基于MAP-EM算法的双能CT直接迭代基材料分解方法

为了提高双能CT基材料分解的精度,降低基材料图像的噪声,提出了基于MAP-EM算法的直接迭代基材料分解方法.结合MAP-EM算法,推导出基材料分解直接迭代求解公式,基于双能投影数据集直接重建基材料分解图像,并对该方法的性能进行了评价和分析.仿真结果表明,所提方法可显著降低分解误差和基材料图像噪声,提高对比噪声比.与基于FBP算法的图像域基材料分解方法相比,该方法可使基材料图像中各材料区域的噪声水平下降57.42%~63.64%,分解误差水平降低31.72%~62.14%,对比噪声比提高1.37%~223.17%.

4D-DECT对甲状旁腺腺瘤的诊断价值

目的:探讨甲状旁腺腺瘤(PA)的4D-DECT影像特征及物质成分信息,评价其定位及定性诊断价值。资料和方法:回顾性分析经手术及病理证实的53例PA患者的临床资料及4D-DECT影像资料,逐一观察并记录CT征象,分别对病变与邻近组织的CT衰减值(HU)、碘浓度、Rho、Z值及DEI进行测定及比较分析。结果:53例患者中,52例(98.11%)为单发病灶,1例(1.89%)为多发病灶,共计病灶54枚,其中32枚(59.26%)位于气管-食管旁沟,10枚(18.52%)为异位腺瘤,22枚(40.74%)可见“短线征”,14枚(25.93%)可见“极血管征”;动脉期(90 kV)图像PA与甲状腺CT值无明显差异,平扫、动脉期(混合0.5、150 kV)及静脉期(90 kV、混合0.5、150 kV)图像中PA、甲状腺及淋巴结CT值均有差异。动脉期及静脉期淋巴结的碘浓度、Z值及DEI明显低于PA及甲状腺,静脉期PA的碘浓度、Z值及DEI明显低于甲状腺;动脉期及静脉期甲状腺Rho明显高于PA,动脉期PA的Rho明显高于淋巴结。结论:4D-DECT可较好地显示PA的影像学特征,还可以提供病变的碘浓度等多种物质成分信息,有助于提高PA的诊断准确性。

多模态MRI联合双源CT成像对甲状腺TI-RADS 4类结节鉴别诊断的临床价值

目的:探讨多模态磁共振成像(MRI)联合双源计算机断层扫描(DECT)对鉴别甲状腺成像报告与数据系统(TI-RADS)4类结节良恶性的临床价值。方法:对多普勒彩色超声诊断为TI-RADS 4类的110例(118个结节)甲状腺结节患者,行MRI和DECT检查。以术后病理结果为金标准,对比MRI和DECT两种影像学方法鉴别4类结节恶性的差异。并绘制受试者工作特征(ROC)曲线,计算曲线下面积,比较MRI、DECT与两种影像学方法联合的诊断效能。结果:118个TI-RADS 4类甲状腺结节中,良性结节21个,恶性结节97个。MRI对甲状腺TI-RADS 4类结节恶性检出率优于DECT(P<0.01)。MRI联合DECT诊断TI-RADS 4类结节的灵敏度、特异度、阳性似然比、阴性似然比为84.4%、78.6%、3.94、0.20,曲线下面积为(0.815±0.050),大于MRI(0.724±0.056)和DECT(0.645±0.056)(Z=2.316,P<0.05;Z=3.781,P<0.01)。结论:相对于DECT,多模态MRI技术对甲状腺TI-RADS 4类恶性结节的检出率更高。MRI联合DECT对鉴别诊断甲状腺TI-RADS 4类结节有一定的临床价值,值得推广。

基于SDN-GMM网络的低剂量双能CT投影数据去噪方法

低剂量双能计算机断层扫描成像(DECT)技术可以在提供人体内部结构及组织成分信息的同时减少X射线辐射剂量.然而,剂量的降低会导致DECT重建图像中出现大量的噪声及伪影,从而影响对疾病的精确诊断.为实现在低剂量条件下重建出高质量的DECT图像,提出了一种采用混合高斯模型的正弦图去噪网络来进行伪影及噪声消除.该网络由两部分构成:一部分通过残差学习以有监督的方式对校准后低剂量与正常剂量下DECT投影数据的映射关系进行拟合;另一部分采用混合高斯模型以无监督学习的方式提取DECT投影数据中噪声的分布模型.采用这种监督与无监督学习结合的方式,不仅可以利用卷积运算的特征提取能力来拟合输入与标签之间任意复杂的映射关系,还可以在无标签约束的情况下,利用输入投影数据的自身分布规律来提高网络模型去噪性能及其泛化能力.实验使用了XCAT生成的10名不同人体DECT投影数据对网络模型进行训练及测试.实验结果表明,与正常剂量下获得的重建图像相比,该方法所获得的去噪后图像均方根误差值低于6×10-3,峰值信噪比以及结构相似性指数分别超过36.7 dB和0.992.相比于目前先进的低剂量CT噪声去除方法,该方法得到的DECT重建图像中组织结构更加清晰,并且可保留更多的细节信息,可为后续医疗诊断提供精准参考.

双能CT肌-水分离技术对健康人腰椎旁肌的定量研究

目的:应用双能CT肌-水分离技术定量评估健康人腰椎旁肌的肌和水含量随年龄的变化规律。方法:回顾性分析125例健康人L1/2-L4/5椎间隙水平竖脊肌、L2/3-L5/S1椎间隙水平多裂肌及腰大肌的肌和水含量。比较青年组(20~39岁)、中年组(40~59岁)及老年组(60~89岁)在各椎间隙水平椎旁肌的肌和水含量差异。结果:多裂肌的肌含量:老年组于L3/4水平低于中年组(t=3.090,P=0.006),L4/5水平低于青年组(t=2.800,P=0.015),老年组于L5/S1水平分别低于青年组(t=3.191,P=0.004,)、中年组(t=3.239,P=0.004)。竖脊肌、腰大肌的肌含量不同年龄组各椎间隙水平差异无统计学意义(P>0.05)。多裂肌水含量:老年组于L2/3、L3/4水平分别高于青年组(t=-6.270,P=0.000;t=-6.021,P=0.000)、中年组(t=-5.701,P=0.000;t=-5.466,P=0.000),各年龄组间于L4/5水平随年龄组增大而增加(青-中年组:t=-3.291,P=0.003,青-老年组:t=-8.355,P=0.000;中-老年组:t=-5.108,P=0.000),各年龄组间于L5/S1水平随年龄组增大而增加(青-中年组:t=-3.146,P=0.005;青-老年组:t=-8.525,P=0.000;中-老年组:t=-5.428,P=0.000)。竖脊肌水含量:于L1/2、L2/3、L3/4水平老年组分别高于青年组(t=-5.727,P=0.000;t=-6.357,P=0.000;t=-6.230,P=0.000)、中年组(t=-3.917,P=0.000;t=-4.336,P=0.000;t=-4.181,P=0.000),各年龄组间于L4/5水平随年龄增大而增加(青-中年组:t=-3.514,P=0.001;青-老年组:t=-8.310,P=0.000;中-老年组:t=-4.835,P=0.000)。腰大肌水含量:老年组于L2/3-L5/S1水平分别高于青年组(t=-5.246,P=0.000;t=-4.785,P=0.000;t=-4.133,P=0.000;t=-4.277,P=0.000)、中年组(t=-4.786,P=0.000;t=-3.143,P=0.005;t=-3.897,P=0.000;t=-3.264,P=0.003)。结论:双能CT肌-水分离技术有助于定量评估健康人腰椎旁肌随年龄增长时肌含量减少、水含量增加的变化规律。