CT Spectral Imaging Study in Patients with Carotid Body Tumors at High Altitudes
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摘要: 目的：探讨CT能谱成像对颈动脉体瘤（CBT）的研究价值。方法：收集30例接受CT能谱检查并经手术确诊的CBT患者，通过GSI Viewer重建60 keV和40 keV单能量图像，对40 keV、60 keV单能量图像及120 kVp like三组图像的CBT供血动脉CT值、背景噪声（SD）、对比噪声比（CNR）、信噪比（SNR）及主观评分进行统计分析，分析CBT能谱参数及影像特征与手术结果的关系。结果：CBT动脉期及静脉期能谱参数与手术结果均无相关性；CBT横径、纵径、Shamblin分型与术中出血量呈强相关，供血动脉数量与术中出血量呈中度相关；横径、纵径、Shamblin分型与颅神经损伤呈中度相关，供血动脉数量与颅神经损伤呈强相关；40 keV是CBT供血动脉显示的最佳能级，CT值、SD、CNR及SNR均显著高于60 keV组及120 kVp like组，60 keV组CT值、噪声显著高于120 kVp like组，二者CNR及SNR差异无统计学意义；40 keV组主观评价分值最高，两位放射科医师主观评分一致性良好。结论：①CBT动脉期及静脉期能谱参数与GAPP评分无相关性；②CBT供血动脉数量是评估手术并发症重要参数之一，40 keV单能量图像可明显优化CBT供血动脉显示。Abstract: Objective: To investigate the value of CT spectral imaging in the study of carotid body tumors (CBT). Methods: Thirty patients with CBT who underwent CT energy spectrum examination and were confirmed by operation were included. Subsequently, 60 keV and 40 keV single energy images were reconstructed through the GSI viewer. The CT value, background noise (SD), contrast noise ratio (CNR), signal-to-noise ratio (SNR), and subjective score of CBT feeding arteries of the 40 keV, 60 keV single energy images and 120 kVp like images were statistically analyzed to evaluate the relationship between CBT energy spectrum parameters and imaging features with surgical results. Results: There was no correlation between energy spectrum parameters in the arterial and venous phases of CBT and the surgical results. However, CBT transverse diameter, longitudinal diameter, and Shamblin classification were strongly correlated with intraoperative bleeding, and the number of feeding arteries was moderately correlated with intraoperative bleeding. Additionally, the transverse diameter, longitudinal diameter, and Shamblin classification were moderately correlated with cranial nerve injury, and the number of feeding arteries was strongly correlated with cranial nerve injury. We also found that 40 keV was the best energy level for the CBT feeding artery display. Furthermore, the CT value, SD, CNR, and SNR of the 60 keV group were significantly higher than those of the 60 keV and 120 kVp like groups, and the CT value and noise of the 60 keV group were significantly higher than those of the 120 kVp like group. However, there was no significant difference in CNR and SNR between the two groups. The subjective evaluation score of the 40 keV group was the highest, and the subjective evaluation of the two radiologists had good consistency. Conclusion: (1) There was no correlation between the energy spectrum parameters in the arterial and venous phases of CBT and GAPP score. (2) The number of CBT feeding arteries is one of the important parameters for evaluating surgical complications and 40 keV single energy imaging can significantly optimize the display of CBT feeding arteries.
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Key words:
- CT spectral imaging /
- carotid body tumor /
- image quality /
- differentiation degree
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图 1 女，53岁，右侧颈动脉体瘤
（a）～（c）分别为CBT 40 keV、60 keV及120 kVp like的VR图像，黑色箭头所指为供血动脉；（d）～（f）分别为CBT 40 keV、60 keV及120 kVp like的MIP图像，红色箭头所指为供血动脉。
Figure 1. A right carotid body tumor of a 53-year-old female
表 1 30例患者的一般资料（
$\bar x \pm s $ ）Table 1. The general information of 30 patients
$(\bar x \pm s )$ 变量 参数 数值（％） 变量 参数 数值（％） 年龄/岁 55.8±10.3 供血动脉数量/例 1支 15（50.0） 性别/例 男性 3（10.0） 2支 10（33.3） 女性 27（90.0） 3支及以上 5（16.7） 位置/例 左侧 13（43.3） Shamblin分型/例 Ⅰ型 13（43.3） 右侧 12（40.0） Ⅱ型 7（23.3） 双侧 5（16.7） Ⅲ型 10（33.3） 影像学特征 横径/cm 3.07±1.34 并发症 术中出血量/mL 157.3±237.5 纵径/cm 3.37±1.38 颅神经损伤 18（60.0） 
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表 2 CBT能谱参数及影像特征与手术结果的相关性分析
Table 2. Correlation analysis between CBT energy spectrum parameters, image characteristics, and surgical results
变量 参数 术中出血量 颅神经损伤 GAPP评分 r1 P1 r2 P2 r3 P3 动脉期能谱参数 碘浓度 0.104 0.791 0.414 0.268 -0.393 0.296 能谱曲线斜率 0.104 0.790 0.416 0.266 -0.341 0.369 有效原子序数 0.052 0.894 0.416 0.266 -0.366 0.332 静脉期能谱参数 碘浓度 -0.207 0.593 0.268 0.456 0.243 0.529 能谱曲线斜率 -0.311 0.416 0.151 0.699 0.076 0.847 有效原子序数 -0.156 0.689 0.192 0.620 0.117 0.765 影像特征 横径 0.788 0.000 0.476 0.008 0.296 0.112 纵径 0.669 0.000 0.550 0.002 0.287 0.124 供血动脉数量 0.583 0.001 0.629 0.000 0.209 0.268 Shamblin分型 0.672 0.000 0.529 0.003 0.276 0.140 注：r1、P1：术中出血量相关性分析结果；r2、P2：颅神经损伤相关性分析结果；r3、P3：GAPP评分相关性分析结果。
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表 3 CBT术中出血量多因素线性回归分析
Table 3. Multivariate linear regression analysis of the intraoperative bleeding volume in CBT
变量 回归参数 统计校验 偏回归系数 标准误 标准回归系数 t P 常数 -184.039 97.241 -1.893 0.070 横径 96.770 39.797 0.538 2.432 0.023 纵径 -91.715 47.085 -0.521 -1.948 0.063 供血动脉数量 82.816 55.992 0.264 1.479 0.152 Shamblin分型 111.139 67.763 0.421 1.640 0.114
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表 4 CBT颅神经损伤多因素线性回归分析
Table 4. Multivariate linear regression analysis of cranial nerve injury in CBT
变量 回归参数 统计校验 偏回归系数 标准误 标准回归系数 t P 常数 -0.889 0.392 -2.268 0.032 横径 -0.108 0.161 -0.143 -.676 0.505 纵径 0.177 0.190 0.239 0.931 0.361 供血动脉数量 0.709 0.226 0.538 3.140 0.004 Shamblin分型 0.229 0.273 0.206 0.838 0.410
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表 5 供血动脉数量与影像特征及手术结果分析（
$\bar x \pm s $ ）Table 5. Analysis of the number of feeding arteries, imaging characteristics and surgical results
$(\bar x \pm s) $ 变量 1支/％ 2支/％ 3支及以上/％ P Shamblin分型 横径/cm 2.27±1.00 3.66±1.19a 4.20±1.05b 0.001 纵径/cm 2.61±1.40 3.81±0.81a 4.16±1.23b 0.019 Ⅰ型 10（33.33） 3（10.00） 0 0.005 Ⅱ型 3（10.00） 3（10.00） 1（3.33） Ⅲ 型 2（6.67） 4（13.33） 4（13.33） 术中出血量/mL 56.00±35.01 178.00±121.36a 420.00±495.72b 0.001 颅神经损伤/支 6（20.69） 12（41.38）a 11（37.93）b 0.000 GAPP评分 4.27±1.10 5.10±0.57a 4.20±0.84 0.073 注：供血动脉数量1支与2支相比，a：P＜0.05；1支与3支及以上相比，b：P＜0.05。
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表 6 各组图像CT值、噪声、SNR及CNR比较（
$\bar x \pm s $ ）Table 6. Comparison of the CT values, noise, SNR and CNR of each group
$(\bar x \pm s )$ 项目 组别 统计检验 40 keV组 60 keV组 120 kVp like组 F P CT供血动脉/HU 679.17±216.65 337.28±96.82c 228.54±60.82d 129.64 0.000 SD脂肪/HU 23.11±4.83 13.10±2.73c 9.78±2.17d 143.091 0.000 CNR 27.71±12.02 22.28±8.65c 18.84±7.82d 9.768 0.001 SNR 30.62±12.37 26.64±9.13c 24.39±8.60d 4.858 0.010 注：40 keV组与60 keV组比较，c：P＜0.05；40 keV组与120 kVp like组比较，d：P＜0.05。
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表 7 颈动脉体瘤供血动脉主观评分（
$\bar x \pm s $ ）Table 7. Subjective scores of the feeding artery of the carotid body tumor
$(\bar x \pm s) $ 评分者 组别 统计检验 40 keV组 60 keV组 120 kVp like组 H P 医师A 4.85±0.72 3.68±0.68 2.55±0.36 58.305 0.000 医师B 4.80±0.71 3.53±0.66 2.41±0.41 54.765 0.000
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