双源CT双能量碘图对急性坏死性胰腺炎影像的诊断价值

目的初步探讨双源CT双能量碘图技术对急性坏死性胰腺炎影像诊断的价值。方法回顾性分析67例确诊急性坏死性胰腺炎患者的双源CT双能量门静脉期增强图像,测量、计算并评估80kV、140kV、加权融合120kV和碘图图像中的胰腺实质-坏死灶CT差值、胰腺实质-坏死灶对比噪声比、胰腺坏死灶面积以及图像主观诊断评分。结果 80kV、140kV、加权融合120kV和碘图图像中胰腺实质-坏死灶CT差值分别为(67.40±20.82)HU、(42.87±14.99)HU、(48.69±15.82)HU、(33.01±10.26)HU;胰腺实质-坏死灶对比噪声比分别为8.36±3.58、5.85±2.65、7.68±3.51、10.60±4.34;胰腺坏死灶面积分别为(3.78±2.68)cm2、(3.28±2.59)cm2、(3.37±2.46)cm2、(2.42±1.98)cm2;图像主观诊断评分分别为3.88±0.33、3.31±0.80、3.58±0.66、2.81±0.76。碘图的胰腺实质-坏死灶CT差值、胰腺实质-坏死灶对比噪声比、胰腺坏死灶面积以及图像主观诊断评分与80kV、140kV和加权融合120kV图像之间差异均有统计学意义(P<0.05)。其中碘图的胰腺实质-坏死灶CT差值、胰腺坏死灶面积和图像主观诊断评分均低于其他3组图像,碘图的胰腺实质-坏死灶对比噪声比高于其他3组。结论双源CT双能量碘图技术不能提高影像诊断医生对胰腺坏死灶检出的主观判断力,但能更为敏感的显示胰腺实质中坏死灶周边的低灌注区域。

The Value of Dual-source Dual-energy CT with Iodine Overlay in the Diagnosis of Acute Necrotizing Pancreatitis

Objective To investigate the clinical value of dual-source computed tomography dual-energy Iodine overlay technique in the imaging diagnosis of acute necrotizing pancreatitis.Methods The imaging data were retrospectively analyzed in 67 cases of acute necrotizing pancreatitis underwent contrast-enhanced dual-source dual-energy CT in portal venous phase.The CT imaging parameters,including the difference of CT value between pancreatic parenchyma and necrotic lesion,contrast-to-noise ratio of pancreatic parenchyma-to-necrosis,area of pancreatic necrosis and score of subjective diagnosis,were measured and assessed on CT images of 80 kV,140 kV,weighted-average 120 kV as well as Iodine overlay.Results The differences of CT value between pancreatic parenchyma and necrosis in the images of 80 kV,140 kV,weighted-average 120 kV and Iodine overlay were(67.40±20.82) HU,(42.87±14.99) HU,(48.69±15.82) HU,(33.01±10.26) HU,respectively;contrast-to-noise ratios of pancreatic parenchyma-to-necrosis of each group were 8.36±3.58,5.85±2.65,7.68±3.51,10.60±4.34;area of pancreatic necrosis of each group was(3.78±2.68) cm2,(3.28±2.59) cm2,(3.37±2.46) cm2,(2.42±1.98) cm2;the score of subjective diagnosis of each group was 3.88±0.33,3.31±0.80,3.58±0.66,2.81±0.76,respectively.The four indexes in the images of Iodine overlay were significantly different from those of another three groups(P<0.05).Contrast-to-noise ratio of pancreatic parenchyma-to-necrosis in the images of Iodine overlay was significantly higher than that of another three groups,while the difference of CT value,area of pancreatic necrosis and score of subjective diagnosis were lower.Conclusion Dual-source CT dual-energy Iodine overlay is not helpful to improve subjective judgment in the diagnosis of pancreatic necrosis,but contributes to the display of hypoperfusion area around the necrosis.