Wei Weian,Yi Ting,Yang Jiqian,et al.Application of virtual unenhanced images generated using multimaterial decomposition technology from dual-energy CT in pediatric CT with liver tumors[J].Journal of Clinical Pediatric Surgery,2025,(01):58-64.[doi:10.3760/cma.j.cn101785-202312053-011]
能谱CT多材料分离技术重建虚拟平扫对儿童肝肿瘤的诊断价值
- Title:
- Application of virtual unenhanced images generated using multimaterial decomposition technology from dual-energy CT in pediatric CT with liver tumors
- 摘要:
- 目的 探讨能谱CT虚拟平扫(virtual unenhance,VUE)技术对儿童肝肿瘤的诊断价值。方法 回顾性分析2021年1月至2022年12月于湖南省儿童医院确诊的96例肝肿瘤患儿能谱CT扫描结果,分别重建真实平扫(true unenhance,TUE)、动脉期虚拟平扫(virtual unenhanced artery,VUEa)和门脉期虚拟平扫(virtual unenhanced portal vein,VUEpv)图像。图像质量客观评价参数包括肝实质、肝肿瘤、右侧竖脊肌3个部位的CT值、信噪比(signal-to-noise ratio,SNR)、肝肿瘤对比噪声比(contrast-to-noise ratio,CNR)以及背景噪声(standard deviation,SD)。采用随机区组方差分析和Friedman秩和检验比较TUE、VUEa和VUEpv图像质量客观参数和主观评分的差异。分析三组图像CT值的相关性与一致性,采用χ2检验比较肝肿瘤和钙化灶的检测能力。结果 VUE与TUE图像的肝实质CT值、肝肿瘤CNR值差异均无统计学意义(P＞0.05)。VUE的图像背景噪声SD值均低于TUE,VUE的肝实质SNR值、肝肿瘤CT值和SNR值、右侧竖脊肌CT值和SNR值均高于TUE,差异均有统计学意义(P＜0.001)。VUEa、VUEpv分别与TUE图像的CT值相关性较高(肝实质:r=0.816、0.797,P均＜0.001;肝肿瘤:r=0.769、0.839,P＜0.001;右侧竖脊肌:r=0.664、0.687,P＜0.001)。除肝肿瘤外,其他组织CT值的临床诊断一致性界限为10 HU时,界外数据点占比均＜5%。VUEpv肝肿瘤的主观评分和检出率均高于VUEa,差异具有统计学意义(P＜0.05),但与TUE的差异无统计学意义(P＞0.05)。而VUEa和VUEpv的钙化灶检出率明显低于TUE,差异有统计学意义(P＜0.001)。三期CT扫描剂量DLP总计为513.94(375.00,652.86)mGy,TUE的DLP占总DLP的30.14%。结论 多材料分离(multi-material decomposition,MMD)技术重建的VUEpv图像质量、病灶检测能力均优于VUEa,可明显降低长期肝肿瘤患儿CT随访的辐射剂量,但仍不能完全替代TUE图像的临床价值。
- Abstract:
- Objective To explore the diagnostic value of virtual unenhanced (VUE) technique using dual-energy CT for pediatric liver tumors. Methods The energy spectrum CT images were retrospectively reviewed for children with liver tumors or liver metastases diagnosed at Hunan Children’s Hospital from January 2021 to 2022.True unenhance (TUE),virtual unenhanced arterial phase (VUEa) and virtual unenhanced portal venous phase (VUEpv) images were separately reconstructed.Objective evaluation parameters of image quality included CT values of liver parenchyma,liver tumors,right vertical spinal muscles,signal-to-noise ratio (SNR),contrast-to-noise ratio (CNR) of liver tumors and background noise (SD).Randomized block variance analysis and Friedman rank sum test were utilized for comparing the differences in image quality and lesion display scores among TUE,VUEa and VUEpv.The correlation of CT values among three groups was analyzed and Bland-Altman plots were generated for illustrating the agreement between VUE and TUE CT value measurements.Chi-square test was utilized for comparing the detection capabilities for liver tumors and calcifications. Results No significant difference existed in CT values of liver parenchyma and CNR of liver tumors between TUE and VUE groups (P>0.05).SD values of background noise in VUE were lower than those in TUE and SNR of liver parenchyma and liver tumor and right erector spinae muscle.And CT values of liver tumors and right erector spinae muscles inVUE were all significantly higher than those in TUE (P<0.001).The correlation of CT values between VUEa,VUEpv and TUE images was relatively high (liver parenchyma:r=0.816,0.797,P<0.001 for both),(liver tumor:r=0.769,0.839,P<0.001 for both),(right paraspinal muscle:r=0.664,0.687,P<0.001 for both).Bland-Altman scatter plot indicated that the proportion of data points outside the limits of agreement was less than 5% when clinical diagnostic threshold was set at 10HU for tissues other than liver tumors.Subjective display scores and detection rates of lesions on VUEpv were both higher than those of VUEa (P<0.05).And there were no differences with TUE (P>0.05).However,detection rate of calcifications for both VUEpv and VUEa were significant lower than TUE (P<0.001).Total DLP of three phase CT scan was 513.94(375.00,652.86) mGy with DLP from TUE phase representing 30.13% of overall DLP. Conclusions For children with liver tumors requiring long-term CT follow-ups,VUEpv image reconstructing using multi-material decomposition (MMD) technique offers better capabilities of image quality and lesion detection as compared to VUEa.It may significantly lower radiation dose in children with liver tumors requiring long-term CT follow-ups.However,it still cannot completely replace clinical value of TUE images.
参考文献/References:
[1] 王焕民.重视安全与历练, 提高小儿肝胆肿瘤诊治水平[J]. 临床小儿外科杂志, 2023, 22(12):1101-1103.DOI:10.3760/cma.j.cn101785-202310061-001. Wang HM.Further improving the diagnoses and treatments of pediatric hepatobiliary tumors[J]. DOI:10.3760/cma.j.cn101785-202310061-001.
[2] 儿童肝母细胞瘤诊疗规范(2019年版)编写审定专家组.儿童肝母细胞瘤诊疗规范(2019年版)[J]. 临床肝胆病杂志, 2019, 35(11):2431-2434.DOI:10.3969/j.issn.1001-5256.2019.11.008. Compilation and Examination Expert Group for Guidelines for the Diagnosis and Treatment of Hepatoblastoma(2019).Guidelines for the diagnosis and treatment of hepatoblastoma (2019)[J]. J Clin Hepatol, 2019, 35(11):2431-2434.DOI:10.3969/j.issn.1001-5256.2019.11.008.
[3] Lennartz S, Parakh A, Cao JJ, et al.Longitudinal reproducibility of attenuation measurements on virtual unenhanced images:multivendor dual-energy CT evaluation[J]. Eur Radiol, 2021, 31(12):9240-9249.DOI:10.1007/s00330-021-08083-6.
[4] Jamali S, Michoux N, Coche E, et al.Virtual unenhanced phase with spectral dual-energy CT:Is it an alternative to conventional true unenhanced phase for abdominal tissues?[J]. Diagn Interv Imaging, 2019, 100(9):503-511.DOI:10.1016/j.diii.2019.04.007.
[5] Zhou J, Zhou Y, Hu H, et al.Feasibility study of using virtual non-contrast images derived from dual-energy CT to replace true non-contrast images in patients diagnosed with papillary thyroid carcinoma[J]. J Xray Sci Technol, 2021, 29(4):711-720.DOI:10.3233/XST-210884.
[6] 王会霞, 岳松伟, 吕培杰, 等.对比分析两种胸部能谱CT虚拟平扫图像与常规平扫图像[J]. 中国医学影像技术, 2019, 35(9):1409-1413.DOI:10.13929/j.1003-3289.201812006. Wang HX, Yue SW, Lyu PJ, et al.Comparative analysis of two kinds of virtual unenhanced technique of spectral CT and routine plain CT in thorax[J]. Chin J Med Imaging Technol, 2019, 35(9):1409-1413.DOI:10.13929/j.1003-3289.201812006.
[7] 杨亮, 罗德红, 赵燕风, 等.头颈部肿瘤检查中能谱CT虚拟平扫替代常规平扫的可行性研究[J]. 中华放射学杂志, 2015, 49(8):572-576.DOI:10.3760/cma.j.issn.1005-1201.2015.08.003. Yang L, Luo DH, Zhao YF, et al.Feasibility study on application of gemstone spectral CT material suppressed Iodine as virtual non-contrast CT scan in head and neck neoplasms[J]. Chin J Radiol, 2015, 49(8):572-576.DOI:10.3760/cma.j.issn.1005-1201.2015.08.003.
[8] Mendonca PRS, Lamb P, Sahani DV.A flexible method for multi-material decomposition of dual-energy CT images[J]. IEEE Trans Med Imaging, 2014, 33(1):99-116.DOI:10.1109/TMI.2013.2281719.
[9] Tang A, Bashir MR, Corwin MT, et al.Evidence supporting LI-RADS major features for CT-and MR imaging-based diagnosis of hepatocellular carcinoma:a systematic review[J]. Radiology, 2018, 286(1):29-48.DOI:10.1148/radiol.2017170554.
[10] Javadi S, Elsherif S, Bhosale P, et al.Quantitative attenuation accuracy of virtual non-enhanced imaging compared to that of true non-enhanced imaging on dual-source dual-energy CT[J]. Abdom Radiol (NY), 2020, 45(4):1100-1109.DOI:10.1007/s00261-020-02415-8.
[11] Lacroix M, Mulé S, Herin E, et al.Virtual unenhanced imaging of the liver derived from 160-mm rapid-switching dual-energy CT (rsDECT):comparison of the accuracy of attenuation values and solid liver lesion conspicuity with native unenhanced images[J]. Eur J Radiol, 2020, 133:109387.DOI:10.1016/j.ejrad.2020.109387.
[12] Xiao JM, Hippe DS, Zecevic M, et al.Virtual unenhanced dual-energy CT images obtained with a multimaterial decomposition algorithm:diagnostic value for renal mass and urinary stone evaluation[J]. Radiology, 2021, 298(3):611-619.DOI:10.1148/radiol.2021192448.
[13] Kaza RK, Raff EA, Davenport MS, et al.Variability of CT attenuation measurements in virtual unenhanced images generated using multimaterial decomposition from fast kilovoltage-switching dual-energy CT[J]. Acad Radiol, 2017, 24(3):365-372.DOI:10.1016/j.acra.2016.09.002.
[14] Borhani AA, Kulzer M, Iranpour N, et al.Comparison of true unenhanced and virtual unenhanced (VUE) attenuation values in abdominopelvic single-source rapid kilovoltage-switching spectral CT[J]. Abdom Radiol (NY), 2017, 42(3):710-717.DOI:10.1007/s00261-016-0991-5.
[15] ?aml?da? ?.Compatibility of true and virtual unenhanced attenuation in rapid kV-switching dual energy CT[J]. Diagn Interv Radiol, 2020, 26(2):95-100.DOI:10.5152/dir.2019.19345.
[16] Cao JJ, Lennartz S, Pisuchpen N, et al.Renal lesion characterization by dual-layer dual-energy CT:comparison of virtual and true unenhanced images[J]. AJR Am J Roentgenol, 2022, 219(4):614-623.DOI:10.2214/AJR.21.27272.
[17] Laukamp KR, Kessner R, Halliburton S, et al.Virtual noncontrast images from portal venous phase spectral-detector CT acquisitions for adrenal lesion characterization[J]. J Comput Assist Tomogr, 2021, 45(1):24-28.DOI:10.1097/RCT.0000000000000982.
[18] 杨琰昭, 严福华, 韩群, 等.双层光谱探测器CT腹部虚拟平扫代替常规平扫的可行性研究[J]. 中华放射学杂志, 2019, 53(1):33-39.DOI:10.3760/cma.j.issn.1005-1201.2019.01.008. Yang YZ, Yan FH, Han Q, et al.Feasibility study on dual-layer spectral detector CT-derived virtual non-contrast images substitute for true non-contrast images[J]. Chin J Radiol, 2019, 53(1):33-39.DOI:10.3760/cma.j.issn.1005-1201.2019.01.008.
[19] Liang HW, Du SL, Yan GW, et al.Dual-energy CT of the pancreas:comparison between virtual non-contrast images and true non-contrast images in the detection of pancreatic lesion[J]. Abdom Radiol (NY), 2023, 48(8):2596-2603.DOI:10.1007/s00261-023-03914-0.
[20] Ma G, Han D, Dang S, et al.Replacing true unenhanced imaging in renal carcinoma with virtual unenhanced images in dual-energy spectral CT:a feasibility study[J]. Clin Radiol, 2021, 76(1):81.e21-81.e27.DOI:10.1016/j.crad.2020.08.026.
[21] Meyer M, Nelson RC, Vernuccio F, et al.Virtual unenhanced images at dual-energy CT:influence on renal lesion characterization[J]. Radiology, 2019, 291(2):381-390.DOI:10.1148/radiol.2019181100.
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备注/Memo
收稿日期:2023-12-22。
基金项目:湖南省卫生健康委科研计划项目(D202309016291);湖南省卫生健康委科研计划项目(C202309018652)
通讯作者:金科,Email:jinke001@sina.com