Neck-chest-abdomen-pelvis Combined Enhanced CT in Breast Cancer Patients: Comparison between Dual-energy and Conventional Scanning Mode
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摘要: 目的：通过与常规扫描方案比较，探讨能谱扫描方案在乳腺癌患者颈胸腹盆联合增强CT中的应用价值。方法：回顾性分析我院因乳腺癌行颈胸腹盆联合增强CT的女性患者40例，其中行常规颈胸腹盆增强CT患者20例，能谱颈胸腹盆增强CT患者20例。比较两种扫描方案动脉期和延迟期辐射剂量；通过测量颈胸部淋巴结的信号噪声比（SNR）及对比噪声比（CNR）以及主观评分，评价两种扫描方案的图像质量。结果：常规和能谱颈胸腹盆联合增强CT扫描方案的动脉期和延迟时期的辐射剂量具有统计学差异，能谱的辐射剂量更低；颈部动脉期淋巴结的SNR值、CNR值在常规和能谱扫描之间不存在统计学差异；胸部动脉期腋窝淋巴结的SNR值、CNR值在常规和能谱扫描之间存在统计学差异；颈部淋巴结常规和能谱扫描的主观评分不存在统计学差异，胸部腋窝淋巴结常规和能谱扫描的主观评分存在统计学差异，能谱主观评分更高，主观评分一致性较好，Kappa值为0.916。结论：能谱颈胸腹盆联合增强CT扫描方案的辐射剂量更低，扫描流程更简便，患者配合度更高，对于胸部腋窝淋巴结的显示更清晰，加之能谱扫描可以提供多参数的图像数据，因此具有重要的应用推广价值。Abstract: Objective: To investigate the application value of dual-energy scanning scheme in neck-chest-abdomen-pelvis combined enhanced CT in patients with breast cancer patients by comparing with the conventional scanning scheme. Methods: A retrospective analysis was performed on 40 female patients with breast cancer who underwent neck-chest-abdomen-pelvis combined enhanced CT in Beijing hospital, including 20 patients scanned by conventional protocol and 20 patients scanned by dual-energy protocol. The radiation doses in arterial phase and delayed phase were compared between the two modes. The image qualities were evaluated by measuring signal-to-noise ratio (SNR), contrast noise ratio (CNR) and subjective scoring. Results: The radiation doses in arterial phase and delayed phase of conventional and dual-energy protocol were statistically different, and the radiation dose of dual-energy protocol was lower. There was no significant difference between the two modes in SNR and CNR of cervical arterial lymph nodes. There was significant difference between conventional and dual-energy mode in SNR and CNR value of axillary lymph nodes in thoracic artery phase. There was no significant difference in the subjective scores of conventional and dual-energy protocol of cervical lymph nodes. However, there was significant difference in the subjective scores of conventional and dual-energy protocol of axillary lymph nodes. The subjective score of dual-energy protocol was higher and the consistency of subjective score was better with Kappa value of 0.916. Conclusion: Compared with conventional scanning scheme, dual-energy scanning scheme for neck-chest-abdomen-pelvis combined enhanced CT shows lower radiation dose, simpler scanning process, higher patient cooperation degree, clearer display of axillary lymph nodes, which has important clinical application and promotion value.
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图 1 常规和能谱颈胸腹盆联合增强CT颈部和胸部淋巴结图像
（a）常规颈胸腹盆联合增强CT颈部淋巴结图像；（b）能谱颈胸腹盆联合增强CT颈部淋巴结图像；（c）常规颈胸腹盆联合增强CT胸部淋巴结图像，静脉中对比剂对淋巴结的显示产生影响；（d）能谱颈胸腹盆联合增强CT胸部淋巴结图像，基本去除静脉中对比剂对周围软组织的影响，腋窝淋巴结可以清晰显示。
Figure 1. Cervical and axillary lymph nodes images of conventional and dual-energy scanning process of neck-chest-abdomen-pelvis combined enhanced CT
表 1 常规颈胸腹盆增强CT扫描流程
Table 1 Conventional scanning process of neck-chest-abdomen-pelvis combined enhanced CT
项目 扫描启时间/s 患者姿势 扫描范围 胸腹盆动脉期 25～30 上举双手在头颅两侧 肺尖至耻骨联合 颈部动脉期 40 放手在身体两侧 胸锁关节至乳突 胸腹盆静脉期 60 上举双手在头颅两侧 肺尖至耻骨联合 腹盆延时期 180 上举双手在头颅两侧 肝顶至耻骨联合 
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表 2 能谱颈胸腹盆增强CT扫描流程
Table 2 Dual-energy scanning process of neck-chest-abdomen-pelvis combined enhanced CT
项目 扫描启动时间/s 患者姿势 扫描范围 颈胸腹盆动脉期 25～30 上举双手在头颅两侧 乳突至耻骨联合 颈胸腹盆静脉期 60 上举双手在头颅两侧 乳突至耻骨联合 腹盆延时期 180 上举双手在头颅两侧 肝顶至耻骨联合
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表 3 常规和能谱颈胸腹盆联合增强CT扫描方案动脉期和延时期辐射剂量统计表
Table 3 Statistical table of radiation dose in arterial phase and extended phase of conventional and dual-energy scanning process of neck-chest-abdomen-pelvis combined enhanced CT
项目 指标 辐射剂量 统计检验 常规 能谱 统计值 P 动脉期 DLP 804.84±67.12 676.62±87.02 -5.218 <0.001 CTDvol 9.40±0.60 8.33±0.79 -4.851 <0.001 ED 12.07±1.01 10.15±1.31 -5.218 <0.001 延迟期 DLP 378.48±80.64 307.80±16.44 -3.841 0.001 CTDvol 8.14±1.37 6.25±0.26 -6.038 <0.001 ED 5.68±1.21 4.62±0.25 -3.841 0.001
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表 4 常规和能谱颈胸腹盆联合增强CT扫描方案动脉期颈部和胸部淋巴结客观图像质量评价表
Table 4 Evaluation table of objective image quality of cervical and thoracic lymph nodes in arterial phase in conventional and dual-energy scanning process of neck-chest-abdomen-pelvis combined enhanced CT
指标 项目 客观图像质量 统计检验 常规 能谱 统计值 P CT值 颈部淋巴结 52.47±13.03 45.29±9.58 -1.985 0.055 颈部同层面脂肪 -101.58±4.96 -100.27±5.26 -0.813 0.421 胸部淋巴结 36.92±16.09 39.35±15.94 0.480 0.634 胸部同层面脂肪 -106.72±8.46 -103.84±5.36 1.288 0.206 SD 颈部淋巴结 10.58±2.46 9.65±2.40 -1.206 0.235 颈部同层面脂肪 6.83±2.22 6.55±1.51 -0.463 0.647 胸部淋巴结 36.92±16.09 39.35±15.94 -4.871 0.001 胸部同层面脂肪 9.15±1.79 6.96±1.06 -4.722 ＜0.001 SNR 颈部淋巴结 5.26±1.99 5.12±2.12 -0.217 0.830 胸部淋巴结 2.88±1.48 4.32±1.84 2.726 0.010 CNR 颈部淋巴结 25.02±8.57 23.20±4.96 -0.825 0.416 胸部淋巴结 16.27±3.84 20.99±3.63 3.996 ＜0.001
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表 5 常规和能谱颈胸腹盆联合增强CT扫描方案主观图像质量评分表
Table 5 Subjective image quality evaluation table of conventional and dual-energy scanning process of neck-chest-abdomen-pelvis combined enhanced CT
项目 主观评分者 主观图像质量 统计检验 3分 4分 5分 Z P 颈部 观察者1 6 13 21 -0.763 0.495 观察者2 7 12 21 -0.596 0.602 胸部 观察者1 9 22 9 -3.724 0.001 观察者2 8 22 10 -3.756 ＜0.001
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