双源CT双能量成像在体分析胆囊结石成分研究
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摘要
目的探讨双源CT(DSCT)双能量成像分析体内胆囊结石成分的应用价值。方法对200例胆囊结石患者于胆囊切除术前行DSCT双能量扫描,分析80kV、140kV图像对胆囊阴性结石的检出率。以显微红外光谱分析结果为判断结石成分的金标准,比较不同成分结石间80kV图像CT值、140kV图像CT值、CT值差值及CT值比值的差异;以ROC曲线评价不同指标鉴别胆固醇与非胆固醇成分胆囊结石的效能。结果 80kV图像、140kV图像及联合应用80kV和140kV图像对胆囊阴性结石的检出率分别为88.89%(80/90)、76.67%(69/90)和100%(90/90)。胆固醇成分结石的80kV图像CT值、140kV图像CT值、CT值差值、CT值比值均低于胆红素钙及罕见成分结石(P均<0.05),胆红素钙与罕见成分结石间差异均无统计学意义(P均>0.05)。以80kV图像CT值62HU和CT值差值-2HU为临界值,诊断胆固醇与非胆固醇成分胆囊结石的敏感度和特异度均为100%。结论 DSCT双能量成像可准确鉴别胆固醇结石与非胆固醇成分胆囊结石。
Objective To explore the clinical value of dual-source CT(DSCT)dual-energy imaging for in vivo diagnosis of gallstone composition.Methods Totally 200 patients with gallstone undergoing cholecystectomy were collected.DSCT dual energy examination was performed preoperatively to analyze the detection rate of 80 kV and 140 kV images for gallbladder negative stones.Taken the results of micro-infrared spectroscopy as golden standards,the 80 kV images CT value,140 kV images CT value,CT value difference and CT value ratio among different stone composition were compared.The diagnostic efficacy of each indicator in differentiating cholesterol from non-cholesterol gallstone was calculated using ROC curves.Results The detection rate of 80 kV images,140 kV images and the combined application of both for gallbladder negative stones was 88.89%(80/90),76.67%(69/90)and 100%(90/90),respectively.The 80 kV images CT value,140 kV images CT value,CT value difference and CT value ratio of cholesterol composition were all lower than those of bilirubin calcium and rare composition(all P<0.05),while the difference between bilirubin calcium and rare composition was not statistically significant(all P>0.05).Taken 62 HU and-2HU as the threshold of 80 kV images CT value and CT value difference,the sensitivity and specificity in diagnosis of cholesterol and non-cholesterol composition stones were both 100%.Conclusion DSCT dual-energy imaging can be used in accurate identification of gallbladder cholesterol gallstones and non-cholesterol gallstones.
Objective To explore the clinical value of dual-source CT(DSCT)dual-energy imaging for in vivo diagnosis of gallstone composition.Methods Totally 200 patients with gallstone undergoing cholecystectomy were collected.DSCT dual energy examination was performed preoperatively to analyze the detection rate of 80 kV and 140 kV images for gallbladder negative stones.Taken the results of micro-infrared spectroscopy as golden standards,the 80 kV images CT value,140 kV images CT value,CT value difference and CT value ratio among different stone composition were compared.The diagnostic efficacy of each indicator in differentiating cholesterol from non-cholesterol gallstone was calculated using ROC curves.Results The detection rate of 80 kV images,140 kV images and the combined application of both for gallbladder negative stones was 88.89%(80/90),76.67%(69/90)and 100%(90/90),respectively.The 80 kV images CT value,140 kV images CT value,CT value difference and CT value ratio of cholesterol composition were all lower than those of bilirubin calcium and rare composition(all P<0.05),while the difference between bilirubin calcium and rare composition was not statistically significant(all P>0.05).Taken 62 HU and-2HU as the threshold of 80 kV images CT value and CT value difference,the sensitivity and specificity in diagnosis of cholesterol and non-cholesterol composition stones were both 100%.Conclusion DSCT dual-energy imaging can be used in accurate identification of gallbladder cholesterol gallstones and non-cholesterol gallstones.
引文
[1]Qiao T,Ma RH,Luo XB,et al.The systematic classification of gallbladder stones.PLoS One,2013,8(10):e74887.
[2]Wang HH,Portincasa P,Mendezsanchez N,et al.Effect of ezetimibe on the prevention and dissolution of cholesterol gallstones.Gastroenterology,2008,134(7):2101-2110.
[3]Tuncer I,Harman M,Mercan R,et al.The effects of ursodeoxycholic acid alone and ursodeoxycholic acid plus low-dose acetylsalicylic acid on radiolucent gallstones.Turk JGastroenterol,2003,14(2):91-96.
[4]Brink JA,Kammer B,Mueller PR,et al.Prediction of gallstone composition:Synthesis of CT and radiographic features in vitro.Radiology,1994,190(1):69-75.
[5]周代全,巫北海.胆囊结石化学成分与体外CT扫描表现的相关性研究.第三军医大学学报,1995,17(6):470-473.
[6]程仲元,白乐,冯友珍,等.双能CT在体诊断泌尿系统尿酸盐和草酸盐结石的Meta分析.中国医学影像技术,2016,32(9):1427-1431.
[7]Bauer RW,Schulz JR,Zedler B,et al.Compound analysis of gallstones using dual energy computed tomography-results in a phantom model.Eur J Radiol,2010,75(1):e74-e80.
[8]Matlaga BR,Kawamoto S,Fishman E.Dual source computed tomography:A novel technique to determine stone composition.Urology,2008,72(5):1164-1168.
[9]曹金铎,高飞,肖路延,等.胆囊多发结石间化学成分差异性的探讨.中华实验外科杂志,1995,12(3):177-178.
[10]李静,李美超,莫卫民.显微红外光谱技术的发展及应用.理化检验(化学分册),2009,45(10):1245-1248.
[11]Liu Z,Zuo T.Comparing core,rim and peripheral composition of intraductal gallstones by infrared spectroscopy.Acta Centiarum Naturalum Universitis Pekinesis,1998,34(4):416-423.
[12]Anderson SW,Lucey BC,Varghese JC,et al.Accuracy of MDCT in the diagnosis of choledocholithiasis.AJR Am JRoentgenol,2006,187(1):174-180.
[13]Wang W,Chen C,Xinjie HU,et al.Diagnose value of single energy imaging and spectral curve in isodense cholesterol stone in gallbladder.J Clin Radiol,2014,33(2):217-220.
[14]Voit H,Krauss B,Heinrich MC,et al.Dual-source CT:In vitro characterization of gallstones using dual energy analysis.Rofo,2009,181(4):367-373.
[15]Johnson TR,Krauss B,Sedlmair M,et al.Material differentiation by dual energy CT:Initial experience.Eur Radiol,2007,17(6):1510-1517.
[2]Wang HH,Portincasa P,Mendezsanchez N,et al.Effect of ezetimibe on the prevention and dissolution of cholesterol gallstones.Gastroenterology,2008,134(7):2101-2110.
[3]Tuncer I,Harman M,Mercan R,et al.The effects of ursodeoxycholic acid alone and ursodeoxycholic acid plus low-dose acetylsalicylic acid on radiolucent gallstones.Turk JGastroenterol,2003,14(2):91-96.
[4]Brink JA,Kammer B,Mueller PR,et al.Prediction of gallstone composition:Synthesis of CT and radiographic features in vitro.Radiology,1994,190(1):69-75.
[5]周代全,巫北海.胆囊结石化学成分与体外CT扫描表现的相关性研究.第三军医大学学报,1995,17(6):470-473.
[6]程仲元,白乐,冯友珍,等.双能CT在体诊断泌尿系统尿酸盐和草酸盐结石的Meta分析.中国医学影像技术,2016,32(9):1427-1431.
[7]Bauer RW,Schulz JR,Zedler B,et al.Compound analysis of gallstones using dual energy computed tomography-results in a phantom model.Eur J Radiol,2010,75(1):e74-e80.
[8]Matlaga BR,Kawamoto S,Fishman E.Dual source computed tomography:A novel technique to determine stone composition.Urology,2008,72(5):1164-1168.
[9]曹金铎,高飞,肖路延,等.胆囊多发结石间化学成分差异性的探讨.中华实验外科杂志,1995,12(3):177-178.
[10]李静,李美超,莫卫民.显微红外光谱技术的发展及应用.理化检验(化学分册),2009,45(10):1245-1248.
[11]Liu Z,Zuo T.Comparing core,rim and peripheral composition of intraductal gallstones by infrared spectroscopy.Acta Centiarum Naturalum Universitis Pekinesis,1998,34(4):416-423.
[12]Anderson SW,Lucey BC,Varghese JC,et al.Accuracy of MDCT in the diagnosis of choledocholithiasis.AJR Am JRoentgenol,2006,187(1):174-180.
[13]Wang W,Chen C,Xinjie HU,et al.Diagnose value of single energy imaging and spectral curve in isodense cholesterol stone in gallbladder.J Clin Radiol,2014,33(2):217-220.
[14]Voit H,Krauss B,Heinrich MC,et al.Dual-source CT:In vitro characterization of gallstones using dual energy analysis.Rofo,2009,181(4):367-373.
[15]Johnson TR,Krauss B,Sedlmair M,et al.Material differentiation by dual energy CT:Initial experience.Eur Radiol,2007,17(6):1510-1517.