Evaluation of the Optimizing Value of Dual-Energy Computed Tomography Mixed Images Combined with a 3 mL/s Contrast Agent Injection Rate in Reducing Contrast Agent Artifacts in the Axillary Vein Area during Chest and Abdomen Contrast-Enhanced Imaging
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摘要:
目的：通过比较双能量CT（DECT）与单能量CT（SECT）搭配不同对比剂团注速度在胸腹增强检查中动脉期腋静脉对比剂硬化伪影的大小，评估其临床应用价值。方法：回顾性收集2024年1月至2024年11月同一受检者在我院先后分别接受双能量扫描（实验组）和单能量扫描（对照组）的胸腹增强CT检查77例，对比两组图像动脉期腋静脉硬化伪影、动脉强化程度、图像信噪比（SNR）及对比噪声比（CNR）、硬化伪影主观评价、图像质量主观评价方面的差异。硬化伪影和图像质量主观评分由两位放射科医师独立完成。结果：实验组腋静脉硬化伪影主观和客观评分均显著低于对照组。实验组动脉CT值高于对照组。实验组图像在不受硬化伪影影响的区域骨骼、肌肉、脂肪组织的SNR和CNR均不低于对照组，但辐射剂量远低于对照组。硬化伪影主观评分方面实验组优于对照组。腋静脉硬化伪影区域外图像质量主观评分实验组不低于对照组。两位观察者评分一致性较高。结论：双能量CT混合图像结合3 mL/s对比剂团注速度在胸腹部增强检查中，能够显著的降低对比剂硬化伪影干扰，提高图像质量，降低辐射剂量，具有更好的临床应用价值。
Abstract:Objective: To evaluate the clinical application value of dual-energy computed tomography (DECT) combined with a 3 mL/s contrast agent injection rate in comparison with single-energy CT (SECT) using a 2.5 mL/s injection rate by comparing the sizes of contrast agent artifacts in the axillary vein during the arterial phase of chest and abdomen enhanced CT examinations. Methods: A retrospective study was conducted on 77 cases of chest and abdomen enhanced CT scans that were performed from January to November 2024 at our hospital. These scans were performed on the same subjects using both dual-energy (experimental group) and single-energy (control group) CT techniques. The differences between the two groups were compared in terms of axillary vein contrast agent artifact size, arterial phase enhancement, signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), subjective evaluations of artifact severity, and overall image quality. The subjective evaluations of artifact severity and image quality were independently assessed by two radiologists. Results: The subjective and objective scores for axillary vein contrast agent artifacts in the experimental group were significantly lower than those in the control group. The arterial CT values in the experimental group were higher than those in the control group. The SNR and CNR in non-artifact-affected regions, such as bone, muscle, and adipose tissue, in the experimental group were not lower than those in the control group, whereas the radiation dose was significantly lower in the experimental group. The subjective scores for artifact severity were better in the experimental group, and the subjective image quality scores in the experimental group were superior to those in the control group. The interobserver agreement between the two radiologists was high. Conclusion: Dual-energy CT combined with a 3.0 mL/s contrast agent injection rate significantly reduces contrast agent artifacts in the axillary vein, improves image quality, and lowers the radiation dose, compared with single-energy CT with a 2.5 mL/s injection rate, demonstrating a better clinical application value in chest and abdomen enhanced CT examinations.
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Keywords:
- DECT /
- SECT /
- beam-hardening artifact /
- chest and abdominal contrast-enhanced CT /
- image quality /
- arterial phase
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图 1 图a,男，48岁；图b，男，53岁；对照组（A）和实验组（C）同层面腋静脉对比剂硬化伪影图像
Figure 1. Control (A) and experimental group (C) images for a 48-year-old male patient(a) and 53-year-old male patient (b) with axillary vein contrast artifacts
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图 2 图a,女，64岁；图b，男，43岁；对照组（B）和实验组（D）同层面腋静脉对比剂硬化伪影图像
Figure 2. Control (B) and experimental group (D) images are shown for a 64-year-old female patient (a) and 43-year-old male patient (b) with axillary vein contrast artifacts
表 1 成像参数
Table 1 CT acquisition parameters
项目 A（n=30） B（n=47） C（n=30） D（n=47） 双源设备 第二代：Flash 第三代：FORCE 第三代：FORCE 第三代：FORCE 采集模式 SECT SECT DECT DECT 管电压/KV 120 CARE KV
（22例90 KV,
25例100 KV）100/Sn150
（等效KV约120 KV）100/Sn150
（等效KV约120 KV）管电流/（ref.mAs） CAREDose4 D
（210）CARE Dose4 D
（204）CARE Dose4 D
（180/90）CARE Dose4 D
（180/90）螺距 0.9 0.6 0.6 0.6 旋转时间/s 0.5 0.5 0.5 0.5 准直 32×1.2 192×0.6 128×0.6 128×0.6 迭代重建算法 SAFIRE（3级） ADMIRE（3级） ADMIRE（3级） ADMIRE（3级） 卷积核 B30 f Br40 Br40 Br40 双能量模式下
线性混合比例− − 100 Kv时为60%，
Sn150 Kv时为40%100 Kv时为60%，
Sn150 Kv时为40%动脉期扫描范围 胸廓入口至髂骨上缘 胸廓入口至髂骨上缘 胸廓入口至髂骨上缘 胸廓入口至髂骨上缘 延迟扫描时间/s 35 35 35 35 重建层厚/mm 5 5 5 5 重建间隔/mm 5 5 5 5 对比剂注射速度/（mL/s） 2.5 2.5 3.0 3.0 
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表 2 客观数据分析及统计结果
Table 2 Quantitative (SNR, CNR) analysis and image comparisons
客观数据 平均值 Z/t值 P 平均值 Z/t值 P A组 C组 B组 D组 注射侧腋静脉CT值 2285.00 (1387.50 ,2598.00 )1753.80 ±842.53−2.23① 0.03 2306.80 ±690.231420.85 ±825.18−7.62② 0 锁骨下动脉CT值 234.53±44.93 258.86±47.98 2.43② 0.02 332 (271.50, 381.75) 303.54±83.78 −2.34① 0.02 BHA 15.84 (10.25, 34.60) 10.95 (6.30, 18.27) −3.01① 0 19.37 (10.25, 30.99) 7.55 (4.36, 13.27) −4.00① 0 伪影区双侧对称区域
胸大肌CT值差69.5 (20.75, 136.50) 33.50 (7.75, 70) −2.79① 0 110.87±91.14 43.33±57.38 −4.93② 0 伪影区双侧对称
区域脂肪CT差29.00 (18.00, 40.25) 13.83±16.11 −3.46① 0 46.09±38.69 16.96±20.70 −3.96② 0 动脉SNR 19.24±6.93 23.55±10.02 2.41② 0.02 25.03±16.35 20.39 (12.80, 26.88) −1.58① 0.12 肌肉SNR 4.65±1.31 6.14±1.19 9.27② 0 6.61 (5.45, 7.92) 6.94 (5.95, 7.85) −0.71① 0.48 腹壁脂肪SNR −11.04±2.92 −12.66 (−14.57, −9.65) −2.58① 0.01 −17.62 (−23.04, −14.22) −13.50 (−16.36, −11.79) −4.13① 0 骨骼SNR 3.74 (2.80, 4.65) 3.40 (2.52, 4.84) −0.96① 0.34 4.41±1.92 4.74±2.26 1.36② 0.18 动脉与肌肉CNR 6.66 (4.38, 11.88) 7.07 (4.52, 17.71) −1.12① 0.26 21.65±11.84 35.38±25.26 −3.29② 0 骨骼与肌肉CNR 22.42 (14.03, 41.30) 25.96 (14.02, 52.55) −0.94① 0.35 53.86±42.92 88.16±60.14 −4.06② 0 注：SNR为信噪比；CNR为对比噪声比；①不符合正态分布的计量资料以中位数（四分位数间距）格式表示，统计量为Z值； ②符合正态分布的计量资料用平均值±标准差表示，统计量为t值。
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表 3 硬化伪影主观评分及统计结果
Table 3 Subjective scoring of beam-hardening artifacts and comparisons conducted by two doctors
分值 医生1 医生2 医生1 医生2 A C A C B D B D 1 4 17 6 17 6 21 5 17 2 16 11 15 11 5 10 5 15 3 10 2 9 2 6 5 4 5 4 0 0 0 0 11 10 13 9 5 0 0 0 0 19 1 20 1 Z −3.72 −3.35 −4.78 −4.98 p 0 0 0 0
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表 4 图像质量主观评分及统计结果
Table 4 Subjective scoring of image quality and comparisons made by two doctors
分值 医生1 医生2 医生1 医生2 A C A C B D B D 5 2 28 7 28 43 45 45 43 4 28 2 23 2 4 2 2 4 3 0 0 0 0 0 0 0 0 2 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 Z −4.75 −4.38 −1.41 −1.41 P 0 0 0.16 0.16
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表 5 扫描辐射剂量表
Table 5 Radiation dose comparison
辐射剂量 平均值 Z/t值 P 平均值 Z/t值 P A C B D CTDI 10.24 (8.80, 12.44) 6.87 (5.05, 8.46) −4.76① 0 7.60 (6.12, 9.62) 5.80±1.92 −5.04① 0 DLP 485.45 (399.60, 592.38) 326.05 (252.13, 417.55) −4.54① 0 366.51 (285.32, 456.91) 290.92±102.89 −4.79① 0 ED 6.80 (5.59, 8.29) 4.56 (3.53, 5.85) −4.54① 0 5.37±1.81 4.07±1.44 −6.54② 0 注：①不符合正态分布的计量资料以中位数（四分位数间距）格式表示，统计量为Z值；②符合正态分布的计量资料用平均值±标准差表示，统计量为t值。
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