Application of a Contrast Enhancement Boost Technique in Cranial Four-dimensional Computed Tomography Angiography
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摘要:
目的：本研究旨在探索柔性减影CE-Boost技术在头颅4D-CTA不同期相不同增强程度血管中的增强能力和适用范围。方法：回顾性分析43例接受脑灌注CTP检查的患者4D-CTA数据，依据主观评分标准从4D-CTA中选取一组动脉早期不可诊断图像和两组动脉期可诊断图像共3组CTA原始数据，用副台减影软件生成对应的CE-Boost组图像。测量六组图像大脑中动脉（MCA）M1段、基底动脉（BA）、脑干（BA），以CT值、图像噪声（SD）、信噪比（SNR）、对比噪声比（CNR）对CE-Boost技术前后图像进行客观评价。采用五分制法对图像进行主观评分。结果：全部图像CE-Boost组大脑中动脉、基底动脉的CT值、SD值、SNR、CNR高于原始图像，P均＜0.001。全部图像CE-Boost组主观打分高于原始图像（3.59±1.33 VS. 2.92±0.95，P<0.001）。结论：CE-Boost技术对颅内4D-CTA动脉期可诊断的图像在提高主干客观评价的同时也可以提高颅内分支小血管的显示。对于动脉早期不可诊断图像仅可提高主干的客观评价，对提升颅内分支小血管的显示能力有限。本研究建议CE-Boost技术适用于颅内主观评分大于等于3分的动脉期可诊断图像。
Abstract:PurposeThis study aimed to explore the efficacy and versatility of contrast enhancement boost (CE-Boost) technology for enhancing blood vessels with varying phases and degrees of enhancement on cranial four-dimensional computed tomography angiography (4D-CTA). Materials and Methods: Forty-three patients who underwent cerebral CT perfusion (CTP) were enrolled retrospectively. For each patient, three single-phase images were selected from the 4D-CTA based on subjective scoring criteria: one image was scored as arterial early phase non-diagnostic (insufficient enhancement for clinical diagnosis), and two images were scored as arterial phase diagnostic (sufficient enhancement for clinical diagnosis). Subsequently, the corresponding CE-Boost group images were generated using subtraction software. Measurements were obtained on the normal side in six image groups, including: the middle cerebral artery (MCA) M1 segment, basilar artery (BA), and brainstem (BS). Objective image quality was assessed using the CT value, image noise, signal-to-noise ratio (SNR), and contrast noise ratio (CNR). The subjective image quality was assessed using a five-point Likert scale.
ResultsThe CT attenuation value, noise value, SNR, and CNR of the MCA and BA were significantly higher in the CE-Boost group than in the original images (all P<0.001). The subjective score of the CE-Boost group was higher than that of the original image (3.59±1.33 versus 2.92±0.95, P<0.001).
ConclusionThe CE-Boost technique can improve the objective image quality of arterial phase diagnostic images of intracranial 4D-CTA while improving the visualization of branch vessels. However, arterial early phase non-diagnostic images only improve the objective evaluation of the trunk and have limited ability to improve the visualization of intracranial branch vessels. This study suggests that the CE-Boost technique is suitable for arterial phase diagnostic images with an intracranial subjective score greater than or equal to 3.
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Keywords:
- X-ray computer /
- angiography /
- contrast enhancement
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图 1 主观评分为2分、3分、4分原始图像行CE-Boost处理示例
Figure 1. The subjective score is 2 points, 3 points, and 4 points, and the original image is exemplified by CE-Boost processing
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图 2 左侧颈内动脉闭塞，大脑中动脉延迟显影。主观评分为2分、3分、4分的原始图像行CE-Boost处理示例
Figure 2. Left internal carotid artery occlusion and delayed middle cerebral artery development. The subjective score is 2 points, 3 points, and 4 points, and the original image is exemplified by CE-Boost processing
表 1 不同主观评分原始图像与CE-Boost组客观图像质量评价比较
Table 1 Comparison of the objective image quality evaluation between the raw images with different subjective scores and the CE-Boost group
组别 CT值 SD SNR CNR MCA BA MCA BA MCA BA MCA BA 全部 原始图像 318.32
（136.83）280.82
（139.31）16.00
（10.55）13.02
（9.71）24.21
（11.43）28.20
（18.15）39.11
（24.09）34.00
（24.08）CE-Boost 444.70
（205.50）390.72
（205.00）19.55
（13.90）14.92
（12.61）30.27
（18.81）40.18
（32.28）61.23
（42.48）53.37
（42.42）P值 <0.001 <0.001 <0.001 <0.001 <0.001 <0.001 <0.001 <0.001 增长% 39.70 39.14 22.19 14.59 25.03 42.48 56.56 56.97 不可诊断图像1&2分 原始图像 165.05
（54.35）133.51
（56.40）8.08
（3.37）6.92
（3.75）23.45
（11.23）23.61
（13.78）18.68
（11.80）13.87
（9.85）CE-Boost 214.71
（80.29）173.36
（79.84）8.90
（4.08）7.06
（4.71）28.70
（15.94）32.01
（21.02）25.96
（17.52）19.66
（14.11）P值 <0.001 <0.001 <0.001 1.00 <0.001 <0.001 <0.001 <0.001 增长% 30.09 29.85 10.15 2.02 22.39 35.58 38.97 41.74 可诊断图像
3&4分原始图像 394.95
（94.38）354.48
（105.75）19.96
（10.70）16.08
（10.33）24.58
（11.58）30.49
（19.66）49.33
（22.10）44.07
（22.76）CE-Boost 559.69
（142.38）499.40
（155.83)24.88
（14.02）18.85
（13.48）31.05
（20.13）44.27
（36.06）78.87
（40.27）70.23
（41.82）P值 <0.001 <0.001 <0.001 <0.001 <0.001 <0.001 <0.001 <0.001 增长% 41.71 40.88 24.65 17.23 26.32 45.20 59.88 59.36 注：CE-Boost组与原始图像比较P＜0.05；增长%为与原始图像比较。 
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表 2 原始图像（列）与相对应的CE-Boost组图像（行）主观图像评价结果比较
Table 2 Comparison of subjective image evaluation results between the original images (columns） and the CE-Boost group (rows）.
组别 医师1/例 医师2/例 一致性分析 1 2 3 4 5 1 2 3 4 5 Kappa值 原始评分1分（10例） 10 10 0.890 原始评分2分（33例） 22 11 33 原始评分3分（43例） 10 33 43 原始评分4分（43例） 43 43
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表 3 原始图像与CE-Boost组图像两名主观打分者评分结果
Table 3 Comparison of the scores of two subjective scorers between the original image and the CE-Boost group
全部 原始图像1&2分 原始图像3&4分 原始图像 CE-Boost P值 原始图像 CE-Boost P值 原始图像 CE-Boost P值 平均分 2.92±0.95 3.59±1.33 <0.001 1.77±0.43 1.90±0.54 0.001 3.50±0.50 4.44±0.59 <0.001 注：平均值±标准差，表示两名主观打分者对原始图像和CE-Boost组图像主观评分。
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