| Part? Application research of double low dose spectral CT imagingin optimizing Budd-Chiari syndrome scanning protocol ObjectiveTo discuss the application of conventional scaning mode and spectral scanning mode with the Budd-Chiari syndrome of angiography, Through the comparison of the CT value of hepatic vein system, the radiation dose of three kinds scanning mode and image noise, to obtain the best Budd-Chiari syndrome scan protocol according to BMI value of patients, not only can obtain good image information at the same time reduce the dosage of contrast agent and radiation dose.Material and methodsOne hundred and twenty cases of BCS diagnosed with clinical were prospectively collected from May 2014 to June 2015 in our Hospital. The patients were randomly divided into three groups, conventional CT scan was performed with the mode of 120 k Vp and contrast agent 1.8 ml/kg(protocol A), spectral CT scan was performed with CT spectral imaging mode and contrast agent 1.4 ml/kg(protocol B),with ASSIST technique, spectral imaging modes were automatically selected and contrast agent 1.6 ml/kg(protocol C). All groups were reconstructed using filtered back-projection(FBP), the protocol A with 120 k Vp image and protocol B and C with140 k Vp polychromatic images and monochromatic images with energy levels from40 to 140 ke V reconstruction image about the CT value of portal vein and hepatic vein and the inferior vena cava with, contrast agent, image noise, were measured and compared. Patients were assigned into three groups based on BMI value:BMI18.5~21.9kg/m2, BMI22~24.9kg/m2, BMI25~29.9kg/m, CT value of PV, HV, IVC and subjective scoring between the three kinds of protocols were compared and analyzed statistically. Objective data and subjective rating were among these groups were determined with One-way ANOVA or Kruskal-Wallis H test. Pearson correlation analysis was used compare the BMI and CTDIvol correlation of the optimizing protocol. P?0.05 was statistically significant.Results1. The CT value of PV, HV and IVC with polychromatic images and monochromatic images with energy levels from 40 to 70 ke V among protocol B and C were higher than protocol A. Protocol A respectively comparison with protocol B and C about PV, HV and IVC, the difference was statistically significant(P?0.05).2. Compared with protocol A the contrast agent between protocol B and C were reduced 24.9% and 12.7%, respectively. The contrast agent were compared by the three protocols, the difference was statistically significant(P?0.05).3.The image noise about fat and erector spinae were the lowest when protocol A,three kinds of protocol image noise comparison difference was statistically significant(P< 0.05). Protocol B, respectively, compared with protocol A and C, fat and erector spinae image noise difference was statistically significant(P?0.05), but the fat and the noise of the erector spinae in protocol B although higher than protocol A, but there was no statistically significant difference(P > 0.05).4. CTDIvol, DLP and ED were the lowest when protocol A but the highest, when protocol B, the difference was statistically significant(P?0.05). Protocol B, respectively,comparing with protocol A and C, CTDIvol, DLP, ED differences were statisticallysignificant(P ? 0.05), the protocol A CTDIvol, DLP, ED values were greater than protocol C, but there was no statistically significant difference(P > 0.05).5. CTDIvol, DLP value were increased with the increase of BMI, but the CT value of PV, HV, and IVC were reduced. Under the condition of BMI consistent, CT value of PV,HV and IVC were compared between each protocol, the difference was statistically significant(P ? 0.05); CTDIvol, DLP comparison between three kinds of protocols difference was statistically significant(P?0.05).6. Three kinds of BMI grouping subjective rating had differences statistically significant(P?0.05). The subjective scoring was above 3 points in BMI18.5 ~ 21.9 and BMI22~ 24.9 group, and the image quality was batter, does not affect the diagnosis; he subjective scoring was above 3 points in the protocol B and C with the BMI25 ~ 29.9,however, the image quality was poor in 1 cases of protocol A, so, we can choose protocol C as the best protocol.7. The CTDIvol of protocol C has the positively correlated with BMI(r = 0.692, P?0.05).ConclusionsTo compared with conventional CT scanning mode the spectral scanning mode will reduces the amount of contrast agent and the incidence of CIN and the economic burden of the patients. The spectral scanning mode with low contrast medium use combine ASIST technique not only can obtain better than conventional CT scanning mode images but also can reduce the radiation dose of patients.Part? Image quality research of low-dose spectral CT imagingcombined with ASIR reconstruction in Budd-Chiari syndrome ObjectiveTo assess image quality of monochromatic imaging from spectral CT combinedwith ASIR reconstruction in patients with Budd-chiari syndrome, Comparative study on the image quality of different types of BCS, to explore the application value in improving the Budd-Chiari syndrome angiography imaging quality.Material and methodsSixty-five cases of BCS diagnosed with clinical were prospectively collected from May 2015 to June 2016 in our Hospital. Plain CT scan was performed with the mode of 120 k Vp and two-phase contrast enhanced CT scan was performed with CT spectral imaging mode combined with ASSIST technique. All patients underwent spectral CT to generate conventional 140-k Vp polychromatic images(group A) and monochromatic images with energy levels from 40 to 140 ke V(group B) during the the portal venous phase(PVP) and the hepatic venous phase(HVP). The contrast to noise ratio(CNR), signal-to-noise ratio(SNR) and subjective ratings of PV, HV,IVC were measured and calculated among group A and group B, then choose the best ke V for hepatic venous vascular imaging system; Measure and calculate all group of noise reduction rate between the best ke V combine with(10% ~ 100%)ASIR and FBP(0% ASIR). The values of calculation of CNR and SNR of PV, HV, IVC and pancreas were measured and calculated respectively, and subjective scores were also analyzed according to the display situation of the Budd-chiari syndrome. Objective data among these groups were determined with independent sample t test, One-way ANOVA or paired t test. The Overall image quality scores of three groups were determined with Kruskal-Wallis H test. Multiple assessors Kappa analysis was used compare the consistency between two radiologists. P ? 0.05 was statistically significant.Results1. The noise of fat between Group B(40, 50, 80 ke V) and group A(140k Vp polychromatic) was statistically significant(P?0.05). The noise of fat in Group B(60 ke V) is slightly higher than group A(140k Vp polychromatic), but there was no statistically significant difference(P > 0.05).2. Besides the SNR values of IVC(80ke V) higher than group A but there was nostatistically significant difference(P > 0.05), the differences between the groups were statistically significant(P ? 0.05). The CNR value of PV, HV in Group B(40~80ke V) were higher than group A, differences were statistically significant(P?0.05).The CNR value of IVC in group B( 40~70 ke V) were higher than group A,differences were statistically significant(P?0.05). The CNR value of IVC in group B the(80 ke V) is slightly lower than group A, but there was no statistically significant difference(P > 0.05).3. The subjective score was lowest at 40 ke V and highest at 60 ke V. The subjective score in Group B(60~70 ke V) were higher than that of group A. The subjective score about 70 ke V had no statistically significant difference compared with group A(P > 0.05). The subjective score in group B(40, 50, 80 ke V) were lower than group A, the difference was statistically significant(P?0.05).4. Image noise reduction rate increased with the increases of ASIR weight, the HV image noise reduction rate is highest, PV image noise reduction rate is lowest.5. SNR and CNR was increased With the increase of ASIR weight, and the difference was statistically significant(P?0.05).6. The consistency between two radiologists was 0.784, P?0.05, we considered that the score is better consistency between the two groups. Overall image scores the highest under 50% ASIR weight, we can be considered 50% ASIR weight was the best image.7. SNR and CNR of PV, HV, IVC at 60 + 50% ASIR is higher than that of conventional CT scanning, the noise of the liver parenchyma and subcutaneous fat were lower than conventional CT scanning, the difference was statistically significant(P?0.05).8. CNR of PV trunk, HV, liver parenchyma and pancreas at inferior vena cava type were greater than hybrids type and hepatic vein type, in addition to the PV main differences were statistically significant(P?0.05). Hepatic vein type of IVC CNR value is greater than the mixed type and inferior vena cava, the difference was statistically significant(P ?0.05). Hybrid IVC CNR value is less than the hepatic vein type, P value is 0.028, the difference was statistically significant(P ? 0.05);Hybrid HV and liver parenchyma CNR value type is smaller than that of inferior venacava(P=0.016, 0.038), the difference was statistically significant(P?0.05);Inferior vena cava CNR value higher than that of hepatic vein of the pancreas(P=0.037), the difference was statistically significant(P?0.05).9. Inferior vena cava type the patient's diagnosis confidence degree higher than that of hybrid and hepatic vein type, the diagnosis of hepatic vein type minimum confidence degree(P=0.043), the difference was statistically significant(P?0.05).ConclusionsSpectral CT imaging combined ASIR reconstruction technology and intelligent matching scanning technology can not only improve BCS image quality, but also reduce the radiation dose. 60 ke V single energy image for BCS of vascular imaging as the best energy; 60 ke V + 50% ASIR reconstruction images on the basis of reducing the noise of the image to improve the image quality.Part? Diagnostic value research of low-dose spectral CT imagingcombined with ASIR reconstruction in Budd-Chiari syndrome ObjectiveNormalized iodine concentration and energy spectrum curve slope were compared based on the different types of BCS and BCS of liver function classification of liver ?~? section, PV, HV, IVC and spleen, analysis the clinical value of spectral quantitative parameter values in assessment of patients with BCS treatment and curative effect, and through the comparison with DSA study effectiveness evaluation of spectral CT imaging in the diagnosis of BCS.Material and methodsOne hundred and two cases of BCS diagnosed with clinical were prospectively collected from January 2015 to June 2016 in our Hospital. All enrolled patientsunderwent dual-phase enhanced spectral CT examination, iodine-based IC value on hepatic ?~? section, PV trunk, HV, IVC and the spleen the scope of ROI could be generated automatically by GSI Viewer software. The energy spectrum curve slope of40~70ke V, 70~ 100 ke V and 100~140 ke V in hepatic?~? segment, PV trunk, HV,IVC and spleen were measured and analyzed. Objective data among these groups were determined with One-way ANOVA or paired t test. Pearson correlation analysis was used compare the different kinds of BCS hepatic NIC and linical liver function index correlation. P?0.05 was statistically significant.Results1. There were 22 cases of ascites, 43 cases of enhanced scan in typical tinea sample reinforcement, 72 cases of collateral circulation formation, 56 cases of portal broadening(> 1.4 cm), 81 cases of splenomegaly, 23 cases of inferior vena cava embolus, 9 cases of merger liver cancer, 6 cases of hepatic vein occlusion, 4 cases of portal sponge samples. The PV trunk diameter and SPV diameter difference between three groups was statistically significant(P?0.05). The SMV diameter of group A is slightly higher than the group B and group C, but the difference between three groups have no statistical significance(P > 0.05).2. Pearson correlation analysis showed that excluding ALT and AST, PT, ALB,TBi L and hepatic NIC was positively correlated(P?0.05) between three groups.3. The hepatic NIC in group C were greater than group A and group B, and hepatic?~? NIC of the three groups was statistically significantly differenct(P?0.05). The hepatic NIC in grade A were greater than grade B and grade C, and hepatic?~?, spleen NIC of the different classification of liver function was statistically significantly differenct(P?0.05).4. The NIC of PV trunk, HV, IVC and spleen in group C were greater than group A and group B, and group B have the lowest NIC at PV trunk, HV, IVC and spleen,excluding PV trunk NIC(F = 0.163, P > 0.163), HV and IVC and spleen except there was statistically significantly differenct P?0.05). The NIC of PV trunk, HV, IVC and spleen in grade A were greater than the NIC and grade B and grade C, excluding PV trunk NIC, HV and IVC and spleen except there was statistically significantlydifferenct(P=0.010, 0.049, 0.008).5. The energy spectrum curve slope reduced with the increases of ke V, and there is obvious difference at low energy levels(40~70 ke V) between three BCS types, the inferior vena cava type has the bigger slope at liver parenchyma and the spleen,hybrid type slope is smaller. The hepatic ? segment has the largest slope between different types of BCS, but there is no statistical significance between the hepatic?~? segment(P > 0.05). The spleen slope of different types of BCS was statistically significantly differenct(P?0.05).6. The NIC compared between treatment before and after in patients, we see that after treatment of liver eight NIC were greater than before the treatment, hepatic?~? NIC difference was statistically significant(P ? 0.05). Comparison of liver function related indicators before and after treatment, the results show that after treatment PT shortened, propagated up from before the treatment, TBi L was reduced,the ALT and AST is lower before treatment.7. To compared CT with DSA on BCS diagnostic, a sensitivity of 93.8%, the diagnosis coincidence rate is 94%. Compared with DSA, CT of hepatic vein or vice hepatic vein trunk shows coincidence rate was 96.8%, the hepatic vein end shows that coincidence rate of 96.7%, for the display of the inferior vena cava coincidence rate was 98%.ConclusionsBCS patients the liver parenchyma, PV trunk, HV, IVC and spleen type spectrum curve of the slope in the downhill, different types of BCS and Child-Pugh classification of liver parenchyma, PV trunk, HV, IVC and spleen of NIC and spectral curve slope with different characteristics. Many parts and multi-parameter of the spectral CT combined Help to liver function in patients with BCS state and prognosis evaluation. Spectral CT and DSA in the diagnosis of BCS coincidence rate was 94%,has a good consistency with DSA. |
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