CT能谱成像在鉴别颈部不同性质淋巴结病变中的临床价值
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摘要
背景和目的：
颈部淋巴结肿大是常见的临床表现,其病因有以下三种：一,淋巴结炎性改变,包括淋巴结结核和淋巴结炎,二,各种恶性肿瘤的颈部淋巴结转移,主要包括头颈部鳞癌,腺癌的淋巴结转移,上呼吸道,消化道鳞癌的颈部淋巴结转移等。三,淋巴瘤。不同性质的淋巴结病变其治疗方案和预后也不一样,治疗前对颈部淋巴结性质的判定以及肿大淋巴结数目多少的估计,为临床治疗方案的制定,治疗后的随访及预后评估都有非常重要的临床意义。
本研究的目的是探究CT能谱成像在鉴别颈部不同性质淋巴结病变中的作用,将结果与病理进行对照,为临床提供更多的诊断信息。
材料和方法
1研究对象
对2011年4月-2012年2月间郑州大学第一附属医院临床发现颈部淋巴结肿大56名患者进行能谱扫描
2扫描设备及用药
采用美国GE宝石能谱CT (Discovery CT750HD),
CT高压注射器采用美国Medrad公司Stellent双筒高压注射器
非离子型对比剂欧乃派克300mgI/ml
3扫描方法
常规平扫定位：扫描范围自颅底至胸廓入口,所有病例均行CT平扫及双期增强扫描,平扫采用普通螺扫,扫描参数管电压120kVp,管电流为220～650mA,层厚5mm,机架转速0.8s/周,螺距1.375。然后采用能谱成像进行双期增强扫描,扫描参数为：管电压140kVp和80kVp的瞬时(0.5ms)切换,管电流约为600mA,层厚和层间距均为5mm,机架旋转时间为0.6s/周,螺距为1.375,探测器宽度为0.625mmX64。增强扫描对比剂采用非离子型对比剂(欧乃派克,300mgI.ml-1),经前臂肘静脉团注,采用智能追踪(Smart Prep)触发扫描技术,用量按照1.0ml/kg,速率为3-4ml/s,注射开始后分别于25s(动脉期)及60s(静脉期)进行扫描。
4数据处理及图像分析
获得动静脉期QC混能图像及MONO单能量图像和碘基图像。采用能谱分析软件处理能谱图像,在淋巴结炎、淋巴结转移及淋巴瘤碘基图像上分别选取相同大小的感兴趣区测量病变淋巴结的动脉期碘浓度(ICap),静脉期碘浓度(ICvp),动静脉期病变淋巴结碘浓度的差值(ICD),以及动静脉期病变淋巴结与各期颈内动脉碘浓度的比值(即得到病变淋巴结与颈内动脉碘浓度标准化碘浓度比值NIC),进行两两比较,以p<0.05具有统计学意义。
5统计分析
将三种不同性质淋巴结的碘浓度(IC),碘浓度差值(ICD)及均一化碘浓度(NIC)进行统计学分析,采用SPSS17.0统计学软件进行分析,对各定量指标采用单因素方差分析,统计量采用均数士标准差的形式表示,以p<0.05为差异具有统计学意义。
结果
1.在动脉期淋巴瘤颈部病变淋巴结的平均碘浓度(ICAP)最高,为14.54±2.38mg/ml,淋巴结炎次之,为13.34±2.17mg/ml,淋巴结转移的碘浓度最低,7.82+3.74mg/ml,淋巴结炎的平均碘浓度与淋巴瘤的平均碘浓度差异未见统计学意义(P>0.294),淋巴结转移的平均碘浓度(ICAP)与淋巴瘤的平均碘浓度(ICAP)差异具有统计学意义(p<0.000),淋巴结炎平均碘浓度(ICAP)与淋巴结转移的平均碘浓度(ICap)差异具有统计学意义(p<0.000)。
2静脉期淋巴瘤碘浓度(ICVP)略高于淋巴转移瘤及淋巴结炎的碘浓度,分别为20.61±1.89mg/ml,17.02±2.79mg/ml,20.55±4.42mg/ml,但无显著性差异(P>0.05)。
3.淋巴结炎,淋巴瘤,淋巴结转移动静脉期平均碘浓度差值(ICD)分别为8.37±2.52mg/ml,2.49±2.64m∥ml,12.72±6.39mg/ml,差异均有统计学意义(p<0.05)
4颈部淋巴结炎、颈部淋巴瘤及颈部淋巴结转移动脉期均一化的碘浓度比值(NICAp)分别为0.15±0.27,0.14±0.11,0.07±0.34,三者差异具有统计学意义,颈部淋巴结炎、淋巴瘤及颈部淋巴结转移静脉期均一化的碘含量比值(NICVp)分别为0.76±0.89,0.48±0.36,0.42±0.13,三者差异未见统计学意义。
结论
1CT能谱成像可以鉴别不同性质的淋巴结病变。
2CT能谱成像动静脉期强化程度可对病变淋巴结类型具有一定的临床指导意义。
3CT能谱成像简单易行可以广泛应用于临床。
Background and purpose:
Cervical lymph node enlargement is a common clinical manifestations, the etiology is of the following three:first, inflammatory lymph node change, including lymph node tuberculosis and lymphadenitis; second, a variety of malignant cervical lymph node metastasis, including head and neck squamous cell carcinoma, Aden carcinoma of lymph node metastasis, upper respiratory tract, digestive tract squamous cell carcinoma of cervical lymph node metastasis. Third, the lymphoma. Treatment options and prognosis are not the same in the concern of the different nature of the lymphadenopathy. To determine the nature of right cervical lymph nodes before treatment and lymph nodes the number of estimates has a very important clinical significance for clinical treatment program development, follow-up after treatment and prognosis assessment.
The purpose of this study is to explore the role of CT spectroscopy imaging in the different nature of the identification of neck lymph node lesions, the results were compared with pathological and it provides more diagnostic information for clinical.
Materials and Methods
1Object of study
Spectrum scanning56patients between April2011February2012in Affiliated Hospital of Zhengzhou University of cervical lymph node enlargement
2Scanning equipment and medication
Using GE gem spectroscopy, CT (Discovery CT750HD),
CT high pressure injector made by Medrad in USA
Non-ionic contrast medium iohexol300mgI/ml
3scanning methods
Conventional positioning:the scan range is from the base of the skull to the thoracic inlet. All patients underwent CT scan and dual-phase enhanced scan, first use the spiral sweep, the scanning parameters of120kVp tube voltage, tube current of220-650mA, layer reaches5-mm thick, rack speed of0.8s/week, pitch1.375. Then use the spectroscopy imaging and dual-phase enhanced scan, the scan parameters as follows:the voltage of the tube switch form140kVp to80kVp instantaneous (0.5ms), the tube current is about600mA, thickness and layer spacing are5mm, gantry rotation time of0.6s/week and a pitch of1.375, the detector width is0.625mmX64. Non-ionic contrast agent to enhance the scanning contrast agent (Omnipatient,300mgI.ml-1), use intelligent tracking (Smart Prep) to trigger scanning technology, the amount is in accordance with10ml/kg, rate of3-4ml/s. After the start of the injection, scan in25s (arterial phase) and60s (venous phase)
4Data processing and image analysis
Get single-energy image of arteriovenous of QC hybrid image and MONO, and iodine-based images. Use spectroscopy spectrum analysis the images, select the region of interest measurements of the same size of the lesions of lymph nodes in the three different types of lymph nodes iodine-based image in arterial phase iodine concentration, venous phase iodine concentration, dynamic venous lesions lymph node concentration of iodine difference, and arteriovenous lesions, lymph nodes, and the iodine concentration of carotid artery ratio (ie, standardized iodine concentration ratio of the iodine concentration of lesions of lymph nodes and internal carotid artery), the pairwise comparison, is approached in p<0.05which has statistically significant.
5Statistical Analysis
Three different types of lymph node concentration of iodine, iodine concentration of the difference between the iodine concentration and homogenization were statistically analyzed using SPSS17.0statistical software for analysis of various quantitative indicators. By using single factor analysis of variance statistics and using the mean±standard deviation, expressed as difference of p<0.05was considered statistically significant.
Result
1In the highest average concentration is of iodine (ICAP) in arterial phase lymphoma of cervical lymph node, lymphadenitis is followed by the average and iodine concentration is the lowest, difference of the minimum iodine concentration of lymph node metastasis, lymph node inflammation in average and lymphoma have no statistically significant (P<0.05), the average iodine content of lymph node metastasis and lymphadenitis average iodine content differences were statistically significant (p<0.05)
2Vein of lymphoma slightly higher than the concentration of iodine (ICVP) lymphatic metastases and lymph node inflammation, iodine concentration, but no significant difference (P>0.05).
3Lymphoma, lymphadenitis, lymph nodes switch to move the vein of the average iodine concentration difference (ICD) were statistically significant (p<0.05)
4Cervical lymph node inflammation, neck lymphoma and cervical lymph node metastasis homogenization of the arterial phase iodine concentration ratio (NICAP) was statistically significant, cervical lymphadenitis, lymphoma, and cervical lymph node metastasis of the iodine content of the venous phase homogenization ratio (NICVP) has no statistical significance.
Conclusion
1CT spectroscopy imaging can identify the different natures of the lymphadenopathy.
2CT spectroscopy imaging arteriovenous degree of enhancement of lesions of lymph node type has a certain clinical significance.
3CT spectroscopy imaging is simple and can be widely used in clinical.
颈部淋巴结肿大是常见的临床表现,其病因有以下三种：一,淋巴结炎性改变,包括淋巴结结核和淋巴结炎,二,各种恶性肿瘤的颈部淋巴结转移,主要包括头颈部鳞癌,腺癌的淋巴结转移,上呼吸道,消化道鳞癌的颈部淋巴结转移等。三,淋巴瘤。不同性质的淋巴结病变其治疗方案和预后也不一样,治疗前对颈部淋巴结性质的判定以及肿大淋巴结数目多少的估计,为临床治疗方案的制定,治疗后的随访及预后评估都有非常重要的临床意义。
本研究的目的是探究CT能谱成像在鉴别颈部不同性质淋巴结病变中的作用,将结果与病理进行对照,为临床提供更多的诊断信息。
材料和方法
1研究对象
对2011年4月-2012年2月间郑州大学第一附属医院临床发现颈部淋巴结肿大56名患者进行能谱扫描
2扫描设备及用药
采用美国GE宝石能谱CT (Discovery CT750HD),
CT高压注射器采用美国Medrad公司Stellent双筒高压注射器
非离子型对比剂欧乃派克300mgI/ml
3扫描方法
常规平扫定位：扫描范围自颅底至胸廓入口,所有病例均行CT平扫及双期增强扫描,平扫采用普通螺扫,扫描参数管电压120kVp,管电流为220～650mA,层厚5mm,机架转速0.8s/周,螺距1.375。然后采用能谱成像进行双期增强扫描,扫描参数为：管电压140kVp和80kVp的瞬时(0.5ms)切换,管电流约为600mA,层厚和层间距均为5mm,机架旋转时间为0.6s/周,螺距为1.375,探测器宽度为0.625mmX64。增强扫描对比剂采用非离子型对比剂(欧乃派克,300mgI.ml-1),经前臂肘静脉团注,采用智能追踪(Smart Prep)触发扫描技术,用量按照1.0ml/kg,速率为3-4ml/s,注射开始后分别于25s(动脉期)及60s(静脉期)进行扫描。
4数据处理及图像分析
获得动静脉期QC混能图像及MONO单能量图像和碘基图像。采用能谱分析软件处理能谱图像,在淋巴结炎、淋巴结转移及淋巴瘤碘基图像上分别选取相同大小的感兴趣区测量病变淋巴结的动脉期碘浓度(ICap),静脉期碘浓度(ICvp),动静脉期病变淋巴结碘浓度的差值(ICD),以及动静脉期病变淋巴结与各期颈内动脉碘浓度的比值(即得到病变淋巴结与颈内动脉碘浓度标准化碘浓度比值NIC),进行两两比较,以p<0.05具有统计学意义。
5统计分析
将三种不同性质淋巴结的碘浓度(IC),碘浓度差值(ICD)及均一化碘浓度(NIC)进行统计学分析,采用SPSS17.0统计学软件进行分析,对各定量指标采用单因素方差分析,统计量采用均数士标准差的形式表示,以p<0.05为差异具有统计学意义。
结果
1.在动脉期淋巴瘤颈部病变淋巴结的平均碘浓度(ICAP)最高,为14.54±2.38mg/ml,淋巴结炎次之,为13.34±2.17mg/ml,淋巴结转移的碘浓度最低,7.82+3.74mg/ml,淋巴结炎的平均碘浓度与淋巴瘤的平均碘浓度差异未见统计学意义(P>0.294),淋巴结转移的平均碘浓度(ICAP)与淋巴瘤的平均碘浓度(ICAP)差异具有统计学意义(p<0.000),淋巴结炎平均碘浓度(ICAP)与淋巴结转移的平均碘浓度(ICap)差异具有统计学意义(p<0.000)。
2静脉期淋巴瘤碘浓度(ICVP)略高于淋巴转移瘤及淋巴结炎的碘浓度,分别为20.61±1.89mg/ml,17.02±2.79mg/ml,20.55±4.42mg/ml,但无显著性差异(P>0.05)。
3.淋巴结炎,淋巴瘤,淋巴结转移动静脉期平均碘浓度差值(ICD)分别为8.37±2.52mg/ml,2.49±2.64m∥ml,12.72±6.39mg/ml,差异均有统计学意义(p<0.05)
4颈部淋巴结炎、颈部淋巴瘤及颈部淋巴结转移动脉期均一化的碘浓度比值(NICAp)分别为0.15±0.27,0.14±0.11,0.07±0.34,三者差异具有统计学意义,颈部淋巴结炎、淋巴瘤及颈部淋巴结转移静脉期均一化的碘含量比值(NICVp)分别为0.76±0.89,0.48±0.36,0.42±0.13,三者差异未见统计学意义。
结论
1CT能谱成像可以鉴别不同性质的淋巴结病变。
2CT能谱成像动静脉期强化程度可对病变淋巴结类型具有一定的临床指导意义。
3CT能谱成像简单易行可以广泛应用于临床。
Background and purpose:
Cervical lymph node enlargement is a common clinical manifestations, the etiology is of the following three:first, inflammatory lymph node change, including lymph node tuberculosis and lymphadenitis; second, a variety of malignant cervical lymph node metastasis, including head and neck squamous cell carcinoma, Aden carcinoma of lymph node metastasis, upper respiratory tract, digestive tract squamous cell carcinoma of cervical lymph node metastasis. Third, the lymphoma. Treatment options and prognosis are not the same in the concern of the different nature of the lymphadenopathy. To determine the nature of right cervical lymph nodes before treatment and lymph nodes the number of estimates has a very important clinical significance for clinical treatment program development, follow-up after treatment and prognosis assessment.
The purpose of this study is to explore the role of CT spectroscopy imaging in the different nature of the identification of neck lymph node lesions, the results were compared with pathological and it provides more diagnostic information for clinical.
Materials and Methods
1Object of study
Spectrum scanning56patients between April2011February2012in Affiliated Hospital of Zhengzhou University of cervical lymph node enlargement
2Scanning equipment and medication
Using GE gem spectroscopy, CT (Discovery CT750HD),
CT high pressure injector made by Medrad in USA
Non-ionic contrast medium iohexol300mgI/ml
3scanning methods
Conventional positioning:the scan range is from the base of the skull to the thoracic inlet. All patients underwent CT scan and dual-phase enhanced scan, first use the spiral sweep, the scanning parameters of120kVp tube voltage, tube current of220-650mA, layer reaches5-mm thick, rack speed of0.8s/week, pitch1.375. Then use the spectroscopy imaging and dual-phase enhanced scan, the scan parameters as follows:the voltage of the tube switch form140kVp to80kVp instantaneous (0.5ms), the tube current is about600mA, thickness and layer spacing are5mm, gantry rotation time of0.6s/week and a pitch of1.375, the detector width is0.625mmX64. Non-ionic contrast agent to enhance the scanning contrast agent (Omnipatient,300mgI.ml-1), use intelligent tracking (Smart Prep) to trigger scanning technology, the amount is in accordance with10ml/kg, rate of3-4ml/s. After the start of the injection, scan in25s (arterial phase) and60s (venous phase)
4Data processing and image analysis
Get single-energy image of arteriovenous of QC hybrid image and MONO, and iodine-based images. Use spectroscopy spectrum analysis the images, select the region of interest measurements of the same size of the lesions of lymph nodes in the three different types of lymph nodes iodine-based image in arterial phase iodine concentration, venous phase iodine concentration, dynamic venous lesions lymph node concentration of iodine difference, and arteriovenous lesions, lymph nodes, and the iodine concentration of carotid artery ratio (ie, standardized iodine concentration ratio of the iodine concentration of lesions of lymph nodes and internal carotid artery), the pairwise comparison, is approached in p<0.05which has statistically significant.
5Statistical Analysis
Three different types of lymph node concentration of iodine, iodine concentration of the difference between the iodine concentration and homogenization were statistically analyzed using SPSS17.0statistical software for analysis of various quantitative indicators. By using single factor analysis of variance statistics and using the mean±standard deviation, expressed as difference of p<0.05was considered statistically significant.
Result
1In the highest average concentration is of iodine (ICAP) in arterial phase lymphoma of cervical lymph node, lymphadenitis is followed by the average and iodine concentration is the lowest, difference of the minimum iodine concentration of lymph node metastasis, lymph node inflammation in average and lymphoma have no statistically significant (P<0.05), the average iodine content of lymph node metastasis and lymphadenitis average iodine content differences were statistically significant (p<0.05)
2Vein of lymphoma slightly higher than the concentration of iodine (ICVP) lymphatic metastases and lymph node inflammation, iodine concentration, but no significant difference (P>0.05).
3Lymphoma, lymphadenitis, lymph nodes switch to move the vein of the average iodine concentration difference (ICD) were statistically significant (p<0.05)
4Cervical lymph node inflammation, neck lymphoma and cervical lymph node metastasis homogenization of the arterial phase iodine concentration ratio (NICAP) was statistically significant, cervical lymphadenitis, lymphoma, and cervical lymph node metastasis of the iodine content of the venous phase homogenization ratio (NICVP) has no statistical significance.
Conclusion
1CT spectroscopy imaging can identify the different natures of the lymphadenopathy.
2CT spectroscopy imaging arteriovenous degree of enhancement of lesions of lymph node type has a certain clinical significance.
3CT spectroscopy imaging is simple and can be widely used in clinical.
引文
[1]Gor DM, Langer JE, Loevner LA, et al. Imaging of cervical lymph nodes in head and neck cancer:the basics[J]. Radiol Clin N Am,2006,44(1):101-110.
[2]Johnson TR,Rrauss B,Sedlmair M, etal.Material differentiation by dual energy CT:initial experience[J].Eur Radiol,2007,17(6):1510-1517.
[3]林晓珠,沈云,陈克敏.CT能谱成像的基本原理与临床应研究进展[J].中华放射学杂志,2011,45：798-800
[4]李剑颖.CT能量成像技术进展与临床应用[J].JCT,2010,11(4)：10-11.
[5]任庆国,滑炎卿,李剑颖.CT能谱成像的基本原理及临床应用[J].国际医学放射学杂志2011,34(6)：559-563.
[6]林晓珠,李卫霞,朱延波,等.宝石能谱CT在肿瘤诊断中的初步应用.诊断学理论实践,2010,9：155-160.
[7]Deng K,Sun C,Liu C,et al. Initial experience with xisualizing hand and foot tendons by dual-energy computed tomography[J].Clin Imaging 2009,33(5):384-389.
[8]Sun C,Miao F,Wang XM,et al.An initial qualitative study of dual-energy CT in the knee ligaments[J].Surg Radiol Anat,[J].Clin Imaging.2008,30(5):443-447.
[9]杨智云,孟俊非,徐巧兰,等。颈部淋巴结病变CT灌注成像[J].临床放射学杂志2007,26(9)：865-868
[10]粱颖,罗德红,吴宇,等.颈部恶性淋巴结的多层螺旋CT灌注研究.中华放射学杂志,2004,38：1193
[11]石俊英.CT灌注成像在颈部淋巴结良恶性鉴别中的作用。 中国医科大学,2009.
[12]杨洁,杨亚英,韩丹,等.双源CT灌注成像在颈部淋巴结病变中的临床应用研究林晓珠.昆明医学院学报,2008,29.
[13]生晶,田建明,毕永明,等.CT灌注成像对颈部淋巴结病变的鉴别诊断和疗效评价.中国医学影像技术2005,21(6)
[14]邓凯,张成琪,李伟,等.宝石能谱CT的特点及临床应用价值[J].中国医药导报,2011,8(25)：16-17.
[15]Ehara M,Kawai M,Surmely JF,et al.Diagnostic accuracy of coronary in-stent restenosis using 64-slice computed tomography:comparison with invasive coronary angiography[J].J Am Coll Cardiol,2007,49(9):951-959.
[16]Tanami YJinzaki M,Yamada M,et al.Improvement of in-stent lumen measurement accuracy with new High-Definition CT in a phantom mod-el:comparison with conventional 64-detector row CT[J].Int J Cardiovasclmaging,2011 Jan 8.[Epub ahead of print]
[17]McCollough CH,Primak AN,Saba O,et al.Dose performance of a 64-channel dual-source CT scanner[J]. Radiology,2007,243(3):775-784.
[18]Schoepf UJ,Zwerner PL,Savino G,et al. Coronary CT angiography[J]. Radiology,2007, 244(1):48-63.
[19]Johnson TR, Krauss B, Sedlmair M, et al. Material differentiation by dual energy CT:initial experience [J].Eur Radiol,2007,17(6):1510-1517.
[20]林晓珠,陈克敏,吴志远,等.CT能谱成像在鉴别胰腺寡囊型浆液性囊腺瘤与粘液性囊性肿瘤中的价值.中华放射学杂志,2011,45：713-717.
[21]刘金刚,刘亚,李丽新,等.CT能谱成像在诊断肿瘤淋巴结转移和肿瘤性质中的作用.中华放射学杂志,2011,45：731-735.
[22]Lin XZ, Miao F, Li JY, et al. High-definition CT gemstone spectral imaging of the brain: initial results of selecting optimal monochromatic image for beam-hardening artifacts and image noise reduction. J Comput Assist Tomogr.2011.35:294-297.
[23]Shikhallevi PM, Fritz SG. Photon counting spectral CT versus conventional CT:comparative evaluation for breast imaging application. Phys Med Biol,2011.56:1905-1930.
[24]Anderson NG, Butler AP, Scott NJA, et al. Spectroscopic (multi-energy) CT distinguishes iodine and barium contrast material in MICE. Eur Radiol.2010.20:2126-2134.
[25]吴华伟,程杰军,李剑颖,等.CT能谱成像定量碘基物质图对肺栓塞的诊断价值中华放射学杂志,2011,45：727-730
[26]Santamaria-Pang A, Dutta S, Makrogiannis S, et al. Automated liver lesion characterization using fast kVp switching dual energy computed tomography imaging [EB/OL].San Diego, CA:SPIE,2010 [2011-05-31].DOI:10.1117/12.844059.
[27]Li M, Zheng X, Li J, et al. Dual-energy computed tomography imaging of thyroid nodule specimens:comparison with pathologic finding[J]. Invest Radiol,2011, DOI: 10.1097/RLI.0b013e318229fef3.
[28]Joshi M, Langan DA, Sahanni DS, et al. Effective atomic number accuracy for kidney stone characterization using spectral CT [EB/OL].San Diego, CA:SPIE,2010 [2011-05-31]. DOI:10.1117/12.844372.
[29]张晓鹏.探索的精神与乐趣—CT能谱成像临床应用研究中的思考.中华放射学杂志,2011,45：709-712.
[30]Qu M, Ramirez-Giraldo JC, Leng S, et al. Dual-energy dual-source CT with additional spectral filtration can improve the differentiation of non-uric acid renal stones:an ex vivo phantom study [J]. A JR.2011,196:1279-1287.
[31]李铭,郑向鹏,李剑颖,等.甲状腺结节的能谱CT研究.中华放射学杂志,2011,45：780-781
[32]叶晓华,周诚,吴国庚,等.CT能谱单能量成像对不同肝脏肿瘤检出影响的初步探讨.中华放射学杂志,2011,45：718-722
[33]吕培杰.CT能谱成像在小肝癌中的应用价值.放射学实践,2011,26.321-324.
[34]刘金刚,刘亚,李丽新,等.CT能谱成像在诊断肿瘤淋巴结转移和肿瘤性质中的作用.中华放射学杂志,2011,45：731-735
[35]刘金刚,赵兴圣,周茂义,等.CT能谱成像鉴别不同肿瘤的淋巴结转移性肿大的初步研究[J].中华放射学杂志：能谱征文论文集,2011：93-97.
[36]庞丽芳,张欢,宋立涛,等.宝石CT能谱呈现在胃癌诊断中的初步应用.外科理论与实践[J].外科理论与实践,2011：244-247.
[1]Gor DM, Langer JE, Loevner LA, et al. Imaging of cervical lymph nodes in head and neck cancer:the basics[J]. Radiol Clin N Am,2006,44(1):101-110.
[2]谭红娜,顾雅佳,颈部淋巴结转移瘤的影像学评价[J],国外医学临床医学分册,2007,11,(15)
[3]Sumi M, Van Cauteren M, Nakamura T, et al. MR microimaging obenign and malignent nodes in the neck[J]. AJR,2006,186(3):749-757.
[4]Abdel Razek AA, Soliman NY, Elkhamary S, et al. Role of diffusion weighted MR imaging in cervical lymphadenopathy[J]. Eur Radiol,2006,16(7):1468-1477.
[5]袁爱梅,尹建华,顾太富,等.MRI扩散加权成像及表观扩散系数在鉴别良恶性淋巴结病变中的应用.[J].南昌大学学报(医学版),2011,51(11)：39-41.
[6]刘妍,夏黎明,梁赵玉,等.DWI及动态增强MRI在淋巴结病变鉴别诊断中的价值[J].湖南中医药大学学报,2009,29(6)：64-66
[7]张赞,梁碧玲,高立等.颈部淋巴结的MR扩散加权成像[J].临床放射学杂志,2007,26(3)：244-247.
[8]AbdelRazekAA, SolimanNY. ElkhamaryS, eta.Role of diffusion-weighted MR imaging in cervical lymphadenopathy [J].Eur J Radial,2011,77 (2):281-286.
[9]Vandecaveye V, De Keyzer F, VanderPoorten V, etal. Head and neck squamous cell carcinoma:value of diffusion-Weighted MR imaging for nodal staging[J].Radiology, 2009,251(I):134-146.
[10]胡莹莹等.18F-FDG PET/CT在寻找颈淋巴结转移瘤原发灶中的应用价值梁颖,癌症杂志[J].2009,28,(3)：312-317.
[11]Syed R, Bomanji JB, Nagabhushan N,et al. Impact of combined 18F-FDG PET/CT in head and neck tumours [J].
[12]罗德红,吴宇,等.颈部恶性淋巴结的多层螺旋CT灌注研究[J].中华放射学杂志,2004,38：1193
[13]梁颖,罗德红,吴宇,等.颈部恶性淋巴结的多层螺旋CT灌注研究[J].中华放射学杂志,2004,38：1193
[14]杨智云,孟俊非,徐巧兰,等。颈部淋巴结病变CT灌注成像[J].临床放射学杂志.2007,26(9)：865-868.
[15]石俊英,等CT灌注成像在颈部淋巴结良恶性鉴别中的作用.中国医科大学,2009.
[16]杨洁,杨亚英,韩丹,等.双源CT灌注成像在颈部淋巴结病变中的临床应用研究林晓珠.昆明医学院学报,2008,29.
[17]林晓珠,李卫侠,朱延波,等.能谱CT在肿瘤诊断中的初步应用[J].诊断学理论与实践,2010,9：155-160.
[18]顾海峰,郑玲,李林.双源CT双能量成像及其初步应用初探[J].医疗卫生装 备,2009,30(6)：63-65
[19]赵丽琴,贺文,李剑颖,等.能谱CT对门静脉成像质量影响的研究[J].CT理论与应用研究,2011,20(3)：383-390.
[20]容蓉,邱建英,王霄英,等.正常回肠壁双能成像[J].放射学实践.2012,3(27)：254-258.
[21]吕培杰,等.CT能谱成像在小肝癌检测中的应用价值[J].放射学实践.2011,3(26)：321-324.
[22]程路德,刘斌,吴兴旺,等.能谱CT单能成像对乏血供肝癌的诊断价值[J].安徽医科大学学报.2012,47(1)：60-62。
[23]叶晓华,周城,吴国庚,等.CT能谱单能量成像对不同肝脏肿瘤检出影像的初步探讨[J].中华放射学杂志：能谱征文论文集,2011：718-722.
[24]张静,林晓珠,徐学勤,等.CT能谱成像在胰岛素瘤诊断中的初步研究[J].放射学实践.2011,3(27)：250-253.
[25]王明亮,林晓珠,缪飞,等.CT能谱成像对物质内碘含量测定的价值：体模研究[J].中国医学计算机成像杂志[7]
[26]卜玉莲,张欢,潘自来,等.能谱CT在梗死心肌中的临床应用[J].诊断学理论与实践,2011,10(6)：517-521
[27]吴华伟,程杰军,李剑颖,等.CT能谱成像定量碘基物质图对肺栓塞的诊断价值.中华放射学杂志[J],2011,45：727-730
[28]王明亮,缪飞,林晓珠,等.CT能谱成像评价胰腺癌抗血管生成治疗效果的价值[J].放射学实践,2011,27(3)：246-249.
[29]董海鹏,林晓珠,缪飞,等.颅脑CT能谱成像的最佳单能量选择研究[J].诊断学理论与实践,2011,10
[30]孙晓亮,李美爱,刘吉华,等.探讨宝石CT能谱成像技术减除脊柱金属植入物伪影的最佳单能量[J].中国医学影像技术,2011,27(9)：1918-1921
[31]赵兴圣,张红伟,李丽新,等.能谱成像技术减除I125粒子植入术后体内伪影[J].2011,27(11)：2344-2348
[32]李晓莉,冯卫华,董诚,等.CT能谱成像技术减除金属伪影植入物伪影的定量试验研究[J].中华放射学杂志：能谱征文论文集,2011：736-739.
[33]吕培杰.CT能谱成像在小肝癌中的应用价值.放射学实践[J],2011,26：321-324
[34]林晓珠,陈克敏,吴志远,等.CT能谱成像在鉴别胰腺寡囊型浆液性囊腺瘤与黏液性囊性肿瘤中的价值[J].中华放射学杂志：能谱征文论文集,2011：713-716.
[35]于晓坤,孙浩然,张立仁,等.能谱CT结肠成像探讨结肠小息肉的体模研究[J].中国临床医学影像学杂志.2012,23(1)：13-16
[36]辛小燕,朱斌,陈君坤,等.CT能谱成像在胸腔渗出液与漏出液定性鉴别中的作用[J].中华放射学杂志：能谱征文论文集,2011：723-726.
[37]刘婧,王鹤,王霄英,等.双能CT成像鉴别肾上腺良恶性病变的初步研究[J].放射学实践,2011,27(3)：
[38]李铭,郑向鹏,李剑颖,等.甲状腺结节的能谱CT研究[J].中华放射学杂志,2011,45：780-781
[39]李小虎,余永强,王万勤,等.体外区分泌尿系结石成分：对比观察CT能谱扫描与常 规扫描[J].2011,27(11)：2331-2334
[40]张晓鹏.探索的精神与乐趣—CT能谱成像临床应用研究中的思考.中华放射学杂志[J],2011,45：709-712.
[41]迟永垄,孙应实,张晓鹏.利用能谱CT单能CT值区别霍奇金淋巴瘤与非霍奇金淋巴瘤的初步研究[J].中华放射学杂志：能谱征文论文集,2011：116-119.
[42]刘金刚,赵兴圣,周茂义,等.CT能谱成像鉴别不同肿瘤的淋巴结转移性肿大的初步研究[J].中华放射学杂志：能谱征文论文集,2011：93-97.
[43]庞丽芳,张欢,宋立涛,等.宝石CT能谱呈现在胃癌诊断中的初步应用[J].外科理论与实践,2011：244-247.
[2]Johnson TR,Rrauss B,Sedlmair M, etal.Material differentiation by dual energy CT:initial experience[J].Eur Radiol,2007,17(6):1510-1517.
[3]林晓珠,沈云,陈克敏.CT能谱成像的基本原理与临床应研究进展[J].中华放射学杂志,2011,45：798-800
[4]李剑颖.CT能量成像技术进展与临床应用[J].JCT,2010,11(4)：10-11.
[5]任庆国,滑炎卿,李剑颖.CT能谱成像的基本原理及临床应用[J].国际医学放射学杂志2011,34(6)：559-563.
[6]林晓珠,李卫霞,朱延波,等.宝石能谱CT在肿瘤诊断中的初步应用.诊断学理论实践,2010,9：155-160.
[7]Deng K,Sun C,Liu C,et al. Initial experience with xisualizing hand and foot tendons by dual-energy computed tomography[J].Clin Imaging 2009,33(5):384-389.
[8]Sun C,Miao F,Wang XM,et al.An initial qualitative study of dual-energy CT in the knee ligaments[J].Surg Radiol Anat,[J].Clin Imaging.2008,30(5):443-447.
[9]杨智云,孟俊非,徐巧兰,等。颈部淋巴结病变CT灌注成像[J].临床放射学杂志2007,26(9)：865-868
[10]粱颖,罗德红,吴宇,等.颈部恶性淋巴结的多层螺旋CT灌注研究.中华放射学杂志,2004,38：1193
[11]石俊英.CT灌注成像在颈部淋巴结良恶性鉴别中的作用。 中国医科大学,2009.
[12]杨洁,杨亚英,韩丹,等.双源CT灌注成像在颈部淋巴结病变中的临床应用研究林晓珠.昆明医学院学报,2008,29.
[13]生晶,田建明,毕永明,等.CT灌注成像对颈部淋巴结病变的鉴别诊断和疗效评价.中国医学影像技术2005,21(6)
[14]邓凯,张成琪,李伟,等.宝石能谱CT的特点及临床应用价值[J].中国医药导报,2011,8(25)：16-17.
[15]Ehara M,Kawai M,Surmely JF,et al.Diagnostic accuracy of coronary in-stent restenosis using 64-slice computed tomography:comparison with invasive coronary angiography[J].J Am Coll Cardiol,2007,49(9):951-959.
[16]Tanami YJinzaki M,Yamada M,et al.Improvement of in-stent lumen measurement accuracy with new High-Definition CT in a phantom mod-el:comparison with conventional 64-detector row CT[J].Int J Cardiovasclmaging,2011 Jan 8.[Epub ahead of print]
[17]McCollough CH,Primak AN,Saba O,et al.Dose performance of a 64-channel dual-source CT scanner[J]. Radiology,2007,243(3):775-784.
[18]Schoepf UJ,Zwerner PL,Savino G,et al. Coronary CT angiography[J]. Radiology,2007, 244(1):48-63.
[19]Johnson TR, Krauss B, Sedlmair M, et al. Material differentiation by dual energy CT:initial experience [J].Eur Radiol,2007,17(6):1510-1517.
[20]林晓珠,陈克敏,吴志远,等.CT能谱成像在鉴别胰腺寡囊型浆液性囊腺瘤与粘液性囊性肿瘤中的价值.中华放射学杂志,2011,45：713-717.
[21]刘金刚,刘亚,李丽新,等.CT能谱成像在诊断肿瘤淋巴结转移和肿瘤性质中的作用.中华放射学杂志,2011,45：731-735.
[22]Lin XZ, Miao F, Li JY, et al. High-definition CT gemstone spectral imaging of the brain: initial results of selecting optimal monochromatic image for beam-hardening artifacts and image noise reduction. J Comput Assist Tomogr.2011.35:294-297.
[23]Shikhallevi PM, Fritz SG. Photon counting spectral CT versus conventional CT:comparative evaluation for breast imaging application. Phys Med Biol,2011.56:1905-1930.
[24]Anderson NG, Butler AP, Scott NJA, et al. Spectroscopic (multi-energy) CT distinguishes iodine and barium contrast material in MICE. Eur Radiol.2010.20:2126-2134.
[25]吴华伟,程杰军,李剑颖,等.CT能谱成像定量碘基物质图对肺栓塞的诊断价值中华放射学杂志,2011,45：727-730
[26]Santamaria-Pang A, Dutta S, Makrogiannis S, et al. Automated liver lesion characterization using fast kVp switching dual energy computed tomography imaging [EB/OL].San Diego, CA:SPIE,2010 [2011-05-31].DOI:10.1117/12.844059.
[27]Li M, Zheng X, Li J, et al. Dual-energy computed tomography imaging of thyroid nodule specimens:comparison with pathologic finding[J]. Invest Radiol,2011, DOI: 10.1097/RLI.0b013e318229fef3.
[28]Joshi M, Langan DA, Sahanni DS, et al. Effective atomic number accuracy for kidney stone characterization using spectral CT [EB/OL].San Diego, CA:SPIE,2010 [2011-05-31]. DOI:10.1117/12.844372.
[29]张晓鹏.探索的精神与乐趣—CT能谱成像临床应用研究中的思考.中华放射学杂志,2011,45：709-712.
[30]Qu M, Ramirez-Giraldo JC, Leng S, et al. Dual-energy dual-source CT with additional spectral filtration can improve the differentiation of non-uric acid renal stones:an ex vivo phantom study [J]. A JR.2011,196:1279-1287.
[31]李铭,郑向鹏,李剑颖,等.甲状腺结节的能谱CT研究.中华放射学杂志,2011,45：780-781
[32]叶晓华,周诚,吴国庚,等.CT能谱单能量成像对不同肝脏肿瘤检出影响的初步探讨.中华放射学杂志,2011,45：718-722
[33]吕培杰.CT能谱成像在小肝癌中的应用价值.放射学实践,2011,26.321-324.
[34]刘金刚,刘亚,李丽新,等.CT能谱成像在诊断肿瘤淋巴结转移和肿瘤性质中的作用.中华放射学杂志,2011,45：731-735
[35]刘金刚,赵兴圣,周茂义,等.CT能谱成像鉴别不同肿瘤的淋巴结转移性肿大的初步研究[J].中华放射学杂志：能谱征文论文集,2011：93-97.
[36]庞丽芳,张欢,宋立涛,等.宝石CT能谱呈现在胃癌诊断中的初步应用.外科理论与实践[J].外科理论与实践,2011：244-247.
[1]Gor DM, Langer JE, Loevner LA, et al. Imaging of cervical lymph nodes in head and neck cancer:the basics[J]. Radiol Clin N Am,2006,44(1):101-110.
[2]谭红娜,顾雅佳,颈部淋巴结转移瘤的影像学评价[J],国外医学临床医学分册,2007,11,(15)
[3]Sumi M, Van Cauteren M, Nakamura T, et al. MR microimaging obenign and malignent nodes in the neck[J]. AJR,2006,186(3):749-757.
[4]Abdel Razek AA, Soliman NY, Elkhamary S, et al. Role of diffusion weighted MR imaging in cervical lymphadenopathy[J]. Eur Radiol,2006,16(7):1468-1477.
[5]袁爱梅,尹建华,顾太富,等.MRI扩散加权成像及表观扩散系数在鉴别良恶性淋巴结病变中的应用.[J].南昌大学学报(医学版),2011,51(11)：39-41.
[6]刘妍,夏黎明,梁赵玉,等.DWI及动态增强MRI在淋巴结病变鉴别诊断中的价值[J].湖南中医药大学学报,2009,29(6)：64-66
[7]张赞,梁碧玲,高立等.颈部淋巴结的MR扩散加权成像[J].临床放射学杂志,2007,26(3)：244-247.
[8]AbdelRazekAA, SolimanNY. ElkhamaryS, eta.Role of diffusion-weighted MR imaging in cervical lymphadenopathy [J].Eur J Radial,2011,77 (2):281-286.
[9]Vandecaveye V, De Keyzer F, VanderPoorten V, etal. Head and neck squamous cell carcinoma:value of diffusion-Weighted MR imaging for nodal staging[J].Radiology, 2009,251(I):134-146.
[10]胡莹莹等.18F-FDG PET/CT在寻找颈淋巴结转移瘤原发灶中的应用价值梁颖,癌症杂志[J].2009,28,(3)：312-317.
[11]Syed R, Bomanji JB, Nagabhushan N,et al. Impact of combined 18F-FDG PET/CT in head and neck tumours [J].
[12]罗德红,吴宇,等.颈部恶性淋巴结的多层螺旋CT灌注研究[J].中华放射学杂志,2004,38：1193
[13]梁颖,罗德红,吴宇,等.颈部恶性淋巴结的多层螺旋CT灌注研究[J].中华放射学杂志,2004,38：1193
[14]杨智云,孟俊非,徐巧兰,等。颈部淋巴结病变CT灌注成像[J].临床放射学杂志.2007,26(9)：865-868.
[15]石俊英,等CT灌注成像在颈部淋巴结良恶性鉴别中的作用.中国医科大学,2009.
[16]杨洁,杨亚英,韩丹,等.双源CT灌注成像在颈部淋巴结病变中的临床应用研究林晓珠.昆明医学院学报,2008,29.
[17]林晓珠,李卫侠,朱延波,等.能谱CT在肿瘤诊断中的初步应用[J].诊断学理论与实践,2010,9：155-160.
[18]顾海峰,郑玲,李林.双源CT双能量成像及其初步应用初探[J].医疗卫生装 备,2009,30(6)：63-65
[19]赵丽琴,贺文,李剑颖,等.能谱CT对门静脉成像质量影响的研究[J].CT理论与应用研究,2011,20(3)：383-390.
[20]容蓉,邱建英,王霄英,等.正常回肠壁双能成像[J].放射学实践.2012,3(27)：254-258.
[21]吕培杰,等.CT能谱成像在小肝癌检测中的应用价值[J].放射学实践.2011,3(26)：321-324.
[22]程路德,刘斌,吴兴旺,等.能谱CT单能成像对乏血供肝癌的诊断价值[J].安徽医科大学学报.2012,47(1)：60-62。
[23]叶晓华,周城,吴国庚,等.CT能谱单能量成像对不同肝脏肿瘤检出影像的初步探讨[J].中华放射学杂志：能谱征文论文集,2011：718-722.
[24]张静,林晓珠,徐学勤,等.CT能谱成像在胰岛素瘤诊断中的初步研究[J].放射学实践.2011,3(27)：250-253.
[25]王明亮,林晓珠,缪飞,等.CT能谱成像对物质内碘含量测定的价值：体模研究[J].中国医学计算机成像杂志[7]
[26]卜玉莲,张欢,潘自来,等.能谱CT在梗死心肌中的临床应用[J].诊断学理论与实践,2011,10(6)：517-521
[27]吴华伟,程杰军,李剑颖,等.CT能谱成像定量碘基物质图对肺栓塞的诊断价值.中华放射学杂志[J],2011,45：727-730
[28]王明亮,缪飞,林晓珠,等.CT能谱成像评价胰腺癌抗血管生成治疗效果的价值[J].放射学实践,2011,27(3)：246-249.
[29]董海鹏,林晓珠,缪飞,等.颅脑CT能谱成像的最佳单能量选择研究[J].诊断学理论与实践,2011,10
[30]孙晓亮,李美爱,刘吉华,等.探讨宝石CT能谱成像技术减除脊柱金属植入物伪影的最佳单能量[J].中国医学影像技术,2011,27(9)：1918-1921
[31]赵兴圣,张红伟,李丽新,等.能谱成像技术减除I125粒子植入术后体内伪影[J].2011,27(11)：2344-2348
[32]李晓莉,冯卫华,董诚,等.CT能谱成像技术减除金属伪影植入物伪影的定量试验研究[J].中华放射学杂志：能谱征文论文集,2011：736-739.
[33]吕培杰.CT能谱成像在小肝癌中的应用价值.放射学实践[J],2011,26：321-324
[34]林晓珠,陈克敏,吴志远,等.CT能谱成像在鉴别胰腺寡囊型浆液性囊腺瘤与黏液性囊性肿瘤中的价值[J].中华放射学杂志：能谱征文论文集,2011：713-716.
[35]于晓坤,孙浩然,张立仁,等.能谱CT结肠成像探讨结肠小息肉的体模研究[J].中国临床医学影像学杂志.2012,23(1)：13-16
[36]辛小燕,朱斌,陈君坤,等.CT能谱成像在胸腔渗出液与漏出液定性鉴别中的作用[J].中华放射学杂志：能谱征文论文集,2011：723-726.
[37]刘婧,王鹤,王霄英,等.双能CT成像鉴别肾上腺良恶性病变的初步研究[J].放射学实践,2011,27(3)：
[38]李铭,郑向鹏,李剑颖,等.甲状腺结节的能谱CT研究[J].中华放射学杂志,2011,45：780-781
[39]李小虎,余永强,王万勤,等.体外区分泌尿系结石成分：对比观察CT能谱扫描与常 规扫描[J].2011,27(11)：2331-2334
[40]张晓鹏.探索的精神与乐趣—CT能谱成像临床应用研究中的思考.中华放射学杂志[J],2011,45：709-712.
[41]迟永垄,孙应实,张晓鹏.利用能谱CT单能CT值区别霍奇金淋巴瘤与非霍奇金淋巴瘤的初步研究[J].中华放射学杂志：能谱征文论文集,2011：116-119.
[42]刘金刚,赵兴圣,周茂义,等.CT能谱成像鉴别不同肿瘤的淋巴结转移性肿大的初步研究[J].中华放射学杂志：能谱征文论文集,2011：93-97.
[43]庞丽芳,张欢,宋立涛,等.宝石CT能谱呈现在胃癌诊断中的初步应用[J].外科理论与实践,2011：244-247.