第3代双源CT低剂量胰腺CT灌注成像初探
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摘要
目的:探讨第3代双源CT低剂量胰腺灌注成像的参数特点及可靠性。方法:前瞻性收集24例正常胰腺受检者,行上腹部增强CT及CT胰腺灌注检查,按不同低剂量扫描方案,将受检者随机分成两组(A组:管电压70kV,管电流100mA,进行27次连续动态数据采集;B组:管电压80kV,管电流80mA,进行29次连续动态数据采集),每组12例。由两位放射科医师独立测量胰腺头部、体部、尾部的血流量(BF)、血容量(BV)、平均通过时间(MTT)、达峰时间(TTP)和表面通透性(PS),记录、计算辐射剂量并进行统计学分析。结果:两位观察者测得各部位所有灌注参数的一致性良好(ICC均>0.75);A组各参数值的ICC分别为:BF(0.949～0.968)、BV(0.941～0.977)、MTT(0.843～0.873)、PS(0.857～0,944)、TTP(0.859～0.897);B组各参数值的ICC分别为:BF(0.908～0.984)、BV(0.858～0.974)、MTT(0.837～0.955)、PS(0.909～0.964)、TTP(0.783～0.944)。正常胰腺头部、体部和尾部的不同参数之间及A、B两组的胰腺组织血流灌注参数之间差异均无统计学意义(P值均>0.05);各灌注参数的测量值及统计学分析结果:BF:139.36～155.43mL/(100mL·min),F=0.417,P=0.835;BV:16.86～18.90mL/100mL,F=0.308,P=0.906;MTT:7.27～8.41s,F=1.819,P=0.121;PS:66.76～77.32mL/(100mL·min),F=0.430,P=0.826;TTP:7.41～8.51s,F=2.293,P=0.055。两个年龄组(<60岁组、≥60岁组)的胰腺组织灌注参数差异无统计学意义(P>0.05);两个年龄组各灌注参数的测量值及统计学分析结果:BF:(138.39±41.43)vs(143.30±43.69)mL/(100mL·min),P=0.106;BV:(17.52±5.08)vs(18.44±4.59)mL/100mL,P=0.647;MTT:(7.92±0.99)vs(7.76±1.71)s,P=0.784;PS:(67.70±23.16)vs(72.61±17.46)mL/(100mL·min),P=0.569;TTP:(8.08±0.77)vs(7.97±1.42)s,P=0.819。不同性别间胰腺组织灌注参数除MTT[女性为(7.33±1.20)s,男性为(8.69±1.17)s,P=0.013]差异有统计学意义外,其余参数差异均无统计学意义(P>0.05);两组间各灌注参数的测量值及统计学分析结果:BF:(133.01±29.53)vs (145.23±39.32)mL/(100mL·min),P=0.341;BV:(19.01±4.76)vs(17.31±4.83)mL/100mL,P=0.411;PS:(71.40±27.70)vs(69.08±15.72)mL/(100mL·min),P=0.795;TTP:(8.58±1.08)vs(7.70±0.99)s,P=0.053。灌注期有效辐射剂量:A组DLP为616.7mGy·cm,有效辐射剂量为9.25mSv;B组DLP为871.7mGy·cm,有效辐射剂量为13.07mSv。结论:第3代双源CT可实现胰腺低剂量灌注扫描,并能获得稳定、重复性好的灌注参数值。
Objective:To study the characteristics of the normal pancreas measured by low-dose pancreatic CT perfusion on a third-generation dual-source CT,and to evaluate the reliability of CT perfusion parameters.Methods:Twenty-four subjects with normal pancreas underwent upper abdominal CT enhanced scan and low-dose whole pancreas CT perfusion scan.The subjects were randomly divided into two groups according to different scanning schemes(group A:70 kV,100 mA;group B:80 kV,80 mA).In addition,they were grouped according to age and sex.Blood flow(BF),blood volume(BV),mean transit time(MTT),time to peak(TTP)and permeability of surface(PS)in the head,body and tail of pancreas were measured independently by two radiologists.Effective radiation dose was calculated and statistically analyzed.Results:The good consistency was observed in all perfusion parameters between two groups(all ICC>0.75):BF [(139.36±38.53)mL/(100 mL·min)～(155.43±23.27)mL/(100 mL·min),F=0.417,P=0.835],BV[(16.86±3.03)mL/100 mL～(18.90±5.94)mL/100 mL,F=0.308,P=0.906],MTT[(7.27±1.41)s～(8.41±1.03)s,F=1.819,P=0.121],PS[(66.76±17.10)mL/(100 mL·min)～(77.32±23.19)mL/(100 mL·min),F=0.430,P=0.826],TTP[(7.41±1.00)s～(8.51±0.96)s,F=2.293,P=0.055].There was no significant statistical difference for BF、BV、MTT、TTP and PS of the head,body and tail of the normal pancreas,and no significant difference on CT perfusion parameters between group A and group B(P > 0.05):BF [(139.36 ±38.53)mL/(100 mL·min)～(155.43±23.27)mL/(100 mL·min),F=0.417,P=0.835],BV[(16.86±3.03)mL/100 mL～(18.90±5.94)mL/100 mL,F=0.308,P=0.906],MTT[(7.27±1.41)s～(8.41±1.03)s,F=1.819,P=0.121],PS[(66.76±17.10)mL/(100 mL·min)～(77.32±23.19)mL/(100 mL·min),F=0.430,P=0.826],TTP[(7.41±1.00)s～(8.51±0.96)s,F=2.293,P=0.055].There was no statistical difference in all perfusion parameters between different age groups(≥60 years old,< 60 years old)(P>0.05):BF[(138.39±41.43)mL/(100 mL·min)vs(143.30±43.69)mL/(100 mL·min),P=0.106],BV[(17.52±5.08)mL/100 mL vs(18.44±4.59)mL/100 mL,P=0.647],MTT[(7.92±0.99)s vs(7.76±1.71)s,P=0.784],PS[(67.70±23.16)mL/(100 mL·min)vs(72.61±17.46)mL/(100 mL·min),P=0.569],TTP[(8.08±0.77)s vs(7.97±1.42)s,P=0.819].No statistically significant differences in all perfusion parameters were noted between male and female groups(P>0.05):BF[(133.01±29.53)mL/(100 mL·min)vs(145.23±39.32)mL/(100 mL·min),P=0.341),BV[(19.01±4.76)mL/100 mL vs(17.31±4.83)mL/100 mL,P=0.411],PS[(71.40±27.70)mL/(100 mL·min)vs(69.08±15.72)mL/(100 mL·min),P=0.795],TTP[(8.58±1.08)s vs(7.70±0.99)s,P=0.053],except for the MTT between male(8.69±1.17 s)and female(7.33±1.20 s).The effective radiation dose of the whole pancreas CT perfusion of Group A and Group B were9.25 and 13.07 mSv(DLP 616.7 and 871.7 mGy·cm),respectively.Conclusion:Low-dose pCTP is feasible on third-generation dual-source CT,which can obtain stable and reproducible perfusion parameters.
Objective:To study the characteristics of the normal pancreas measured by low-dose pancreatic CT perfusion on a third-generation dual-source CT,and to evaluate the reliability of CT perfusion parameters.Methods:Twenty-four subjects with normal pancreas underwent upper abdominal CT enhanced scan and low-dose whole pancreas CT perfusion scan.The subjects were randomly divided into two groups according to different scanning schemes(group A:70 kV,100 mA;group B:80 kV,80 mA).In addition,they were grouped according to age and sex.Blood flow(BF),blood volume(BV),mean transit time(MTT),time to peak(TTP)and permeability of surface(PS)in the head,body and tail of pancreas were measured independently by two radiologists.Effective radiation dose was calculated and statistically analyzed.Results:The good consistency was observed in all perfusion parameters between two groups(all ICC>0.75):BF [(139.36±38.53)mL/(100 mL·min)～(155.43±23.27)mL/(100 mL·min),F=0.417,P=0.835],BV[(16.86±3.03)mL/100 mL～(18.90±5.94)mL/100 mL,F=0.308,P=0.906],MTT[(7.27±1.41)s～(8.41±1.03)s,F=1.819,P=0.121],PS[(66.76±17.10)mL/(100 mL·min)～(77.32±23.19)mL/(100 mL·min),F=0.430,P=0.826],TTP[(7.41±1.00)s～(8.51±0.96)s,F=2.293,P=0.055].There was no significant statistical difference for BF、BV、MTT、TTP and PS of the head,body and tail of the normal pancreas,and no significant difference on CT perfusion parameters between group A and group B(P > 0.05):BF [(139.36 ±38.53)mL/(100 mL·min)～(155.43±23.27)mL/(100 mL·min),F=0.417,P=0.835],BV[(16.86±3.03)mL/100 mL～(18.90±5.94)mL/100 mL,F=0.308,P=0.906],MTT[(7.27±1.41)s～(8.41±1.03)s,F=1.819,P=0.121],PS[(66.76±17.10)mL/(100 mL·min)～(77.32±23.19)mL/(100 mL·min),F=0.430,P=0.826],TTP[(7.41±1.00)s～(8.51±0.96)s,F=2.293,P=0.055].There was no statistical difference in all perfusion parameters between different age groups(≥60 years old,< 60 years old)(P>0.05):BF[(138.39±41.43)mL/(100 mL·min)vs(143.30±43.69)mL/(100 mL·min),P=0.106],BV[(17.52±5.08)mL/100 mL vs(18.44±4.59)mL/100 mL,P=0.647],MTT[(7.92±0.99)s vs(7.76±1.71)s,P=0.784],PS[(67.70±23.16)mL/(100 mL·min)vs(72.61±17.46)mL/(100 mL·min),P=0.569],TTP[(8.08±0.77)s vs(7.97±1.42)s,P=0.819].No statistically significant differences in all perfusion parameters were noted between male and female groups(P>0.05):BF[(133.01±29.53)mL/(100 mL·min)vs(145.23±39.32)mL/(100 mL·min),P=0.341),BV[(19.01±4.76)mL/100 mL vs(17.31±4.83)mL/100 mL,P=0.411],PS[(71.40±27.70)mL/(100 mL·min)vs(69.08±15.72)mL/(100 mL·min),P=0.795],TTP[(8.58±1.08)s vs(7.70±0.99)s,P=0.053],except for the MTT between male(8.69±1.17 s)and female(7.33±1.20 s).The effective radiation dose of the whole pancreas CT perfusion of Group A and Group B were9.25 and 13.07 mSv(DLP 616.7 and 871.7 mGy·cm),respectively.Conclusion:Low-dose pCTP is feasible on third-generation dual-source CT,which can obtain stable and reproducible perfusion parameters.
引文
[1]Zhu L,Wu WM,Xue HD,et al.Sporadic insulinomas on volume perfusion CT:dynamic enhancement patterns and timing of optimal tumour-parenchyma contrast[J].Eur Radiol,2017,27(8):1-8.
[2]Kim DW,Kim HJ,Kim KW,et al.Prognostic value of CT findings to predict survival outcomes in patients with pancreatic neuroendocrine neoplasms:a single institutional study of 161patients[J].Eur Radiol,2016,26(5):1320-1329.
[3]Yadav AK,Sharma R,Kandasamy D,et al.Perfusion CT:can it predict the development of pancreatic necrosis in early stage of severe acute pancreatitis?[J].Abdom Imaging,2015,40(3):488-499.
[4]Wang X,Henzler T,Gawlitza J,et al.Image quality of mean temporal arterial and mean temporal portal venous phase images calculated from low dose dynamic volume perfusion CT datasets in patients with hepatocellular carcinoma and pancreatic cancers[J].Eur J Radiol,2016,85(11):2104-2110.
[5]Miles KA,Hayball M,Dixon AK,et al.Colour perfusion imaging:a new application of computed tomography[J].Lancet,1991,337(8742):643-645.
[6]Miles KA,Hayball MP,Dixon AK.Measurement of human pancreatic perfusion using dynamic computed tomography with perfusion imaging[J].Br J Radiol,1995,68(809):471-475.
[7]Li HO,Sun C,Xu ZD,et al.Low-dose whole organ CT perfusion of the pancreas:preliminary study[J].Abdom Imaging,2014,39(1):40-47.
[8]Pieńkowska J,Gwodziewicz K,Skrobisz-Balandowska K,et al.Perfusion-CT-can we predict acute pancreatitis outcome within the first 24hours from the onset of symptoms?[J].Plos One,2016,11(1):e0146965.
[9]芦军涛,李剑,李娜,等.正常胰腺双源CT灌注成像定量分析及应用研究[J].实用放射学杂志,2015,30(5):755-758.
[10]赵常红,郝粉娥,刘挨师,等.胰腺癌定量双能CT碘图与CT灌注参数相关性研究[J].放射学实践,2018,33(6):587-592.
[11]张喜荣,黄小华,董国礼,等.基于原发性肝癌血流再分布的胰腺灌注变化的CT研究[J].放射学实践,2014,29(12):1443-1447.
[12]Kambadakone AR,Sharma A,Catalano OA,et al.Protocol modifications for CT perfusion(CTp)examinations of abdomen-pelvic tumors:impact on radiation dose and data processing time[J].Eur Radiol,2011,21(6):1293-1300.
[13]Nakaura T,Kidoh M,Nakamura S,et al.Low-dose abdominal CT protocols with a tube voltage setting of 100kVp or 80kVp:performance of radiation dose reduction and influence on visual contrast[J].Clin Radiol,2014,69(8):804-811.
[14]Tang K,Wang L,Li R,et al.Effect of low tube voltage on image quality,radiation dose,and low-contrast detectability at abdominal multidetector CT:phantom study[J].J Biomed Biotechnol,2012,2012:130-169.
[15]Watanabe S,Katada Y,Gohkyu M,et al.Liver perfusion CT during hepatic arteriography for the hepatocellular carcinoma:dose reduction and quantitative evaluation for normal-and ultralowdose protocol[J].Eur J Radiol,2012,81(12):3993-3997.
[16]Niesten JM,VD Schaaf IC,Riordan AJ,et al.Radiation dose reduction in cerebral CT perfusion imaging using iterative reconstruction[J].Eur Radiol,2014,24(2):484-493.
[17]Prezzi D,Goh V,Virdi S.Adaptive statistical iterative reconstruction improves image quality without affecting perfusion CTquantitation in primary colorectal cancer[J].Eur J Radiol Open,2017,4(1):69-74.
[18]Hayes SA,Pietanza MC,O'Driscoll D,et al.Comparison of CTvolumetric measurement with RECIST response in patients with lung cancer[J].Eur J Radiol,2016,85(3):524-533.
[19]Sauter AW,Merkle A,Schulze M,et al.Intraobserver and interobserver agreement of volume perfusion CT(VPCT)measurements in patients with lung lesions[J].Eur J Radiol,2012,81(10):2853-2859.
[20]Gawlitza J,Haubenreisser H,Meyer M,et al.Comparison of organ-specific-radiation dose levels between 70kVp perfusion CTand standard tri-phasic liver CT in patients with hepatocellular carcinoma using a Monte-Carlo-Simulation-based analysis platform[J].Eur J Radiol Open,2016,7(3):95-99.
[21]Xu J,Liang Z,Hao S,et al.Pancreatic adenocarcinoma:dynamic64-slice helical CT with perfusion imaging[J].Abdom Imaging,2009,34(6):759-766.
[22]d'Assignies G,Couvelard A,Bahrami S,et al.Pancreatic endocrine tumors:tumor blood flow assessed with perfusion CT reflects angiogenesis and correlates with prognostic factors[J].Radiology,2009,250(2):407-416.
[23]邓锡佳,刘爱连,刘静红,等.正常胰腺宽体探测器单源双能CT灌注成像初探[J].临床放射学杂志,2017,36(7):988-992.
[2]Kim DW,Kim HJ,Kim KW,et al.Prognostic value of CT findings to predict survival outcomes in patients with pancreatic neuroendocrine neoplasms:a single institutional study of 161patients[J].Eur Radiol,2016,26(5):1320-1329.
[3]Yadav AK,Sharma R,Kandasamy D,et al.Perfusion CT:can it predict the development of pancreatic necrosis in early stage of severe acute pancreatitis?[J].Abdom Imaging,2015,40(3):488-499.
[4]Wang X,Henzler T,Gawlitza J,et al.Image quality of mean temporal arterial and mean temporal portal venous phase images calculated from low dose dynamic volume perfusion CT datasets in patients with hepatocellular carcinoma and pancreatic cancers[J].Eur J Radiol,2016,85(11):2104-2110.
[5]Miles KA,Hayball M,Dixon AK,et al.Colour perfusion imaging:a new application of computed tomography[J].Lancet,1991,337(8742):643-645.
[6]Miles KA,Hayball MP,Dixon AK.Measurement of human pancreatic perfusion using dynamic computed tomography with perfusion imaging[J].Br J Radiol,1995,68(809):471-475.
[7]Li HO,Sun C,Xu ZD,et al.Low-dose whole organ CT perfusion of the pancreas:preliminary study[J].Abdom Imaging,2014,39(1):40-47.
[8]Pieńkowska J,Gwodziewicz K,Skrobisz-Balandowska K,et al.Perfusion-CT-can we predict acute pancreatitis outcome within the first 24hours from the onset of symptoms?[J].Plos One,2016,11(1):e0146965.
[9]芦军涛,李剑,李娜,等.正常胰腺双源CT灌注成像定量分析及应用研究[J].实用放射学杂志,2015,30(5):755-758.
[10]赵常红,郝粉娥,刘挨师,等.胰腺癌定量双能CT碘图与CT灌注参数相关性研究[J].放射学实践,2018,33(6):587-592.
[11]张喜荣,黄小华,董国礼,等.基于原发性肝癌血流再分布的胰腺灌注变化的CT研究[J].放射学实践,2014,29(12):1443-1447.
[12]Kambadakone AR,Sharma A,Catalano OA,et al.Protocol modifications for CT perfusion(CTp)examinations of abdomen-pelvic tumors:impact on radiation dose and data processing time[J].Eur Radiol,2011,21(6):1293-1300.
[13]Nakaura T,Kidoh M,Nakamura S,et al.Low-dose abdominal CT protocols with a tube voltage setting of 100kVp or 80kVp:performance of radiation dose reduction and influence on visual contrast[J].Clin Radiol,2014,69(8):804-811.
[14]Tang K,Wang L,Li R,et al.Effect of low tube voltage on image quality,radiation dose,and low-contrast detectability at abdominal multidetector CT:phantom study[J].J Biomed Biotechnol,2012,2012:130-169.
[15]Watanabe S,Katada Y,Gohkyu M,et al.Liver perfusion CT during hepatic arteriography for the hepatocellular carcinoma:dose reduction and quantitative evaluation for normal-and ultralowdose protocol[J].Eur J Radiol,2012,81(12):3993-3997.
[16]Niesten JM,VD Schaaf IC,Riordan AJ,et al.Radiation dose reduction in cerebral CT perfusion imaging using iterative reconstruction[J].Eur Radiol,2014,24(2):484-493.
[17]Prezzi D,Goh V,Virdi S.Adaptive statistical iterative reconstruction improves image quality without affecting perfusion CTquantitation in primary colorectal cancer[J].Eur J Radiol Open,2017,4(1):69-74.
[18]Hayes SA,Pietanza MC,O'Driscoll D,et al.Comparison of CTvolumetric measurement with RECIST response in patients with lung cancer[J].Eur J Radiol,2016,85(3):524-533.
[19]Sauter AW,Merkle A,Schulze M,et al.Intraobserver and interobserver agreement of volume perfusion CT(VPCT)measurements in patients with lung lesions[J].Eur J Radiol,2012,81(10):2853-2859.
[20]Gawlitza J,Haubenreisser H,Meyer M,et al.Comparison of organ-specific-radiation dose levels between 70kVp perfusion CTand standard tri-phasic liver CT in patients with hepatocellular carcinoma using a Monte-Carlo-Simulation-based analysis platform[J].Eur J Radiol Open,2016,7(3):95-99.
[21]Xu J,Liang Z,Hao S,et al.Pancreatic adenocarcinoma:dynamic64-slice helical CT with perfusion imaging[J].Abdom Imaging,2009,34(6):759-766.
[22]d'Assignies G,Couvelard A,Bahrami S,et al.Pancreatic endocrine tumors:tumor blood flow assessed with perfusion CT reflects angiogenesis and correlates with prognostic factors[J].Radiology,2009,250(2):407-416.
[23]邓锡佳,刘爱连,刘静红,等.正常胰腺宽体探测器单源双能CT灌注成像初探[J].临床放射学杂志,2017,36(7):988-992.