双源CT低对比剂双能量肺动脉成像不同图像质量的对比研究
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摘要
CT肺动脉成像已经成为诊断肺栓塞的一线诊断方法。部分病人常常有心肺疾病等合并症,血流动力学较差,且不能长时间屏气,导致检查失败。小栓子能够引起较大面积肺组织的灌注不良,由于技术条件等的限制,亚段以下肺动脉内的小栓子检出率不高。CTPA只能提供肺栓塞的解剖学信息,而难以评价栓子引起的肺血流灌注变化。近年来双源CT已经广泛应用于临床,双能量成像不仅可以得到低能量、高能量、平均加权混合能量图像,同时也能够获得40-190keV单能量图像。利用不同能量数据获得碘对比剂在不同器官内的分布信息,显示器官的灌注状态。本文的目的是通过定量评价双能量肺动脉成像不同图像的质量,探讨各能量图像在临床中的应用价值以及双能量肺灌注成像的不同对比剂用量及扫描参数对图像的影响。
第一部分双源CT低对比剂双能量肺动脉成像各能量图像的临床价值
目的：
通过定量评价双源CT低对比剂用量双能量肺动脉成像各能量图像的质量,探讨各能量图像在临床中的应用价值。
方法：
2011年7月-2012年7月31名患者行双源CT双能量肺动脉成像,对比剂30ml获得100kVp(组1)、140kVp(组2)、混合能量(组3)及单能量图像。测量肺动脉CT值、SD值,计算SNR、CNR,得到SNR、CNR值高峰时单能量范围及峰值的单能量,低限单能量为组4,峰值单能量为组5,高限单能量为组6。分析6组图像肺动脉的CT值、SNR及CNR值是否有统计学差异。2名医师评价图像质量。
结果：
40-190keV图像中,SNR、CNR值在70-80keV之间较高(70keV为组4、80keV为组6),74keV时达到峰值(组5)。组1、4CT值高于其余各组。组5、6与组3CT值差异无统计学意义(P>0.05)。组1图像噪声高于其余各组。组4图像噪声高于组3、5、6(P<0.05)。组6SD值低于组2组(P<0.05)。组4与组2图像噪声差异无统计学意义。各组CNR值间差异无统计学意义(P均>0.05)。组1与组3SNR值差异无统计学意义(P>0.05)。组5、6SNR值高于组1(P<0.05)。组4、5、6与组3SNR值差异无统计学意义(P>0.05)。
结论：
对比剂30ml时各能量图像质量符合诊断要求。低能与混合能量图像质量无明显差异,70-80keV单能量图像质量与低能及混合能量图像相当。74keV为最佳单能量水平,可用于疾病的诊断。
第二部分双能量肺灌注成像不同对比剂用量及扫描方案的对比研究
目的：
探讨不同对比剂用量、扫描参数对双能量CTA、肺灌注图像质量的影响。方法：
2011年9月-2012年8月行双源CT双能量肺动脉成像共90例,随机分为30ml组(组1)、50ml组(组2)、40ml组(组3),每组30例。均采用人工智能触发扫描系统,其中组1、组2监测肺动脉主干50HU延迟3s扫描,组3监测肺动脉主干100HU延迟3s扫描。测量肺动脉主干、左右肺动脉、叶动脉及段动脉4级血管、上腔静脉、左房、右房、右室的CT值。2名医师判断肺灌注图像质量并分级(3级),将评价结果进行kappa检验。测量栓塞血管对应的灌注减低区与评分为3的正常灌注区的overlay及碘含量,并进行统计学分析。
结果：
4级肺动脉平均CT值组3>组1>组2。除肺动脉主干外其余各级肺动脉CT值组1与组3间差异无统计学意义(P<0.01)。上腔静脉CT值组2高于其余两组。组3的双能量肺灌注图像优于组1、2。2名观察者分析双能量肺灌注图像质量的一致性好(Kappa值=0.748,P<0.001)。灌注减低区与正常灌注区的overlay、碘含量的差异有统计学意义(P<0.001),灌注减低区的overlay、碘含量低于正常灌注区。
结论：
40ml对比剂用量结合人工智能监测肺动脉主干100HU延迟3s触发可获得满意的CTA、肺灌注图像。肺栓塞区域的灌注低于正常灌注区。
With the development of hardware and software of CT, multislice spiral CT pulmonary angiography has become the first-line diagnostic method for the diagnosis of pulmonary embolism. However, some patients are often accompanied by some complications, such as heart and lung diseases, whose hemodynamics are poor and can not hold one's breathe for a long time. These cause examination failed or images can not be diagnosed. In addition, small emboli can cause a large area poor perfusion of lung tissue, but due to the limitations of technical conditions, diagnosis rate of pulmonary emboli located in subsegments and distal pulmonary arteries is not high. CT pulmonary angiography(CTPA)only provide anatomical information of pulmonary embolism, but lung perfusion changes that emboli caused are difficult to evaluate. In recent years dual-source CT has been widely used in clinic. Dual-energy scanning mode can not only get low-energy, high-energy, mix energy image, but also be able to get40-190keV monochromatic energy images. The iodinated contrast material distribution in different organs can be obtained through material composition parsing algorithm with different data, which display organ perfusion status.
The purpose is to quantitativly evaluate image quality and value of different images of dual-source CT dual-energy pulmonary angiography, to select preliminarily contrast media volume and scanning parameters applying to DEPI.
Part one The value of different energy images of dual-source CT dual-energy pulmonary angiography with low contrast medium doses
Objective:
To quantitatively evaluate the quality and value of different images of dual-source CT low contrast medium doses dual-energy pulmonary angiography.
Methods:
31patients underwent dual-source CT dual-energy pulmonary angiography from July2011to July2012, got100kVp (group1),140kVp (group2), mixing energy (group3) and monochromatic images that the volume of contrast agent was30ml. CT values and SD values of pulmonary arteries were measured. The signal-to-noise ratio (SNR), contrast to noise ratio (CNR) were calculated. Monochromatic images in the peak of SNR and CNR were group4、5、6. CT values, SNR and CNR values were analyzed statistically. Two radiologists evaluate the quality of images.
Results:
During40-190keV, SNR values and CNR values between70-80keV were higher(70keV、80keV were group4、6),that reached the peak at74keV(group5). CT values of groupl and4were higher than the others. CT values of group5、6were not statistically significant compared with group3(P＞0.05). Image noise of group1was higher than other groups. Image noise of group4was higher than group3、5、6(P＜0.05). Image noise of group6was lower than group3(P＜0.05).There was no significant difference for Image noise between group5and3(P＞0.05). There was no significant difference for CNR values between groups(P＞0.05). There was no significant difference forSNR values between groupl and3(P＞0.05).SNR values of group5、6were higher than groupl(P<0.05). There was no significant difference for SNR values group4、5、6compared with group3(P＞0.05).
Conclusion:
The image quality of different energy images can meet the diagnostic requirements when the volume of contrast agent is30ml. There is no significant difference in the image quality between low-energy image and mixed energy images. Image quality and CT value of70-80keV image are equivalent with the low energy and mixed-energy image.74keV is the optimum monochromatic energy of pulmonary arteries.
Part two Comparative study different contrast media volume and scanning parameters of dual energy lung perfusion imaging
Objective:
To compare image quality of dual-energy CT pulmonary angiography and lung perfusion blood volume (lung PBV) in different contrast media volume and scanning parameters groups.
Methods:
90patients underwent dual-sourceCT dual-energy pulmonary angiography from September2011to August2O12.Patients were randomly divided into30ml (group1) or50ml (group2) or40ml (group3),30cases in each group.The scan was initiated with a bolus-tracking technique. In group1and2, the arrival of the contrast bolus in the pulmonary trunk was detected at a threshold of50Hounsfield Units (HU) with delay3s, however, that is100HU in group3. Attenuation profiles of multiple pulmonary arteries bilaterally, superior vena cava, left atrium, right atrium, right ventricle were measured.The diagnostic quality of lung PBV was evaluated by two radiologists using a3-point scale and Kappa test. Measured the overlay and iodine content of perfusion defects and normal lung parenchyma which was scored3and analyzed statistically.
Results:
The average attenuation of pulmonary arteries in group3is greater than the other two groups. No statistically significant difference between groupl and group3was found regarding the pulmonary arteries attenuation except pulmonary trunk(P＜0.01). The CT value of superior vena cava in group2is greater than the other two groups. The image quality of lung PBV in group3is better than group1,2. Good interobserver agreement is found for lung PBV (Kappa=0.748, P＜0.001). The difference of overlay and iodine content of perfusion defects and normal lung parenchyma is statistically significant(P＜0.001). The overlay and iodine content of perfusion defects is lower than that of normal lung parenchyma.
Conclusion:
40ml contrast media combination with artificial intelligence monitor pulmonary trunk at a threshold of100HU with delay3s scanning is available for dual energy CTA and lung PBV. The perfusion of embolic parts is lower than normal lung parenchyma.
第一部分双源CT低对比剂双能量肺动脉成像各能量图像的临床价值
目的：
通过定量评价双源CT低对比剂用量双能量肺动脉成像各能量图像的质量,探讨各能量图像在临床中的应用价值。
方法：
2011年7月-2012年7月31名患者行双源CT双能量肺动脉成像,对比剂30ml获得100kVp(组1)、140kVp(组2)、混合能量(组3)及单能量图像。测量肺动脉CT值、SD值,计算SNR、CNR,得到SNR、CNR值高峰时单能量范围及峰值的单能量,低限单能量为组4,峰值单能量为组5,高限单能量为组6。分析6组图像肺动脉的CT值、SNR及CNR值是否有统计学差异。2名医师评价图像质量。
结果：
40-190keV图像中,SNR、CNR值在70-80keV之间较高(70keV为组4、80keV为组6),74keV时达到峰值(组5)。组1、4CT值高于其余各组。组5、6与组3CT值差异无统计学意义(P>0.05)。组1图像噪声高于其余各组。组4图像噪声高于组3、5、6(P<0.05)。组6SD值低于组2组(P<0.05)。组4与组2图像噪声差异无统计学意义。各组CNR值间差异无统计学意义(P均>0.05)。组1与组3SNR值差异无统计学意义(P>0.05)。组5、6SNR值高于组1(P<0.05)。组4、5、6与组3SNR值差异无统计学意义(P>0.05)。
结论：
对比剂30ml时各能量图像质量符合诊断要求。低能与混合能量图像质量无明显差异,70-80keV单能量图像质量与低能及混合能量图像相当。74keV为最佳单能量水平,可用于疾病的诊断。
第二部分双能量肺灌注成像不同对比剂用量及扫描方案的对比研究
目的：
探讨不同对比剂用量、扫描参数对双能量CTA、肺灌注图像质量的影响。方法：
2011年9月-2012年8月行双源CT双能量肺动脉成像共90例,随机分为30ml组(组1)、50ml组(组2)、40ml组(组3),每组30例。均采用人工智能触发扫描系统,其中组1、组2监测肺动脉主干50HU延迟3s扫描,组3监测肺动脉主干100HU延迟3s扫描。测量肺动脉主干、左右肺动脉、叶动脉及段动脉4级血管、上腔静脉、左房、右房、右室的CT值。2名医师判断肺灌注图像质量并分级(3级),将评价结果进行kappa检验。测量栓塞血管对应的灌注减低区与评分为3的正常灌注区的overlay及碘含量,并进行统计学分析。
结果：
4级肺动脉平均CT值组3>组1>组2。除肺动脉主干外其余各级肺动脉CT值组1与组3间差异无统计学意义(P<0.01)。上腔静脉CT值组2高于其余两组。组3的双能量肺灌注图像优于组1、2。2名观察者分析双能量肺灌注图像质量的一致性好(Kappa值=0.748,P<0.001)。灌注减低区与正常灌注区的overlay、碘含量的差异有统计学意义(P<0.001),灌注减低区的overlay、碘含量低于正常灌注区。
结论：
40ml对比剂用量结合人工智能监测肺动脉主干100HU延迟3s触发可获得满意的CTA、肺灌注图像。肺栓塞区域的灌注低于正常灌注区。
With the development of hardware and software of CT, multislice spiral CT pulmonary angiography has become the first-line diagnostic method for the diagnosis of pulmonary embolism. However, some patients are often accompanied by some complications, such as heart and lung diseases, whose hemodynamics are poor and can not hold one's breathe for a long time. These cause examination failed or images can not be diagnosed. In addition, small emboli can cause a large area poor perfusion of lung tissue, but due to the limitations of technical conditions, diagnosis rate of pulmonary emboli located in subsegments and distal pulmonary arteries is not high. CT pulmonary angiography(CTPA)only provide anatomical information of pulmonary embolism, but lung perfusion changes that emboli caused are difficult to evaluate. In recent years dual-source CT has been widely used in clinic. Dual-energy scanning mode can not only get low-energy, high-energy, mix energy image, but also be able to get40-190keV monochromatic energy images. The iodinated contrast material distribution in different organs can be obtained through material composition parsing algorithm with different data, which display organ perfusion status.
The purpose is to quantitativly evaluate image quality and value of different images of dual-source CT dual-energy pulmonary angiography, to select preliminarily contrast media volume and scanning parameters applying to DEPI.
Part one The value of different energy images of dual-source CT dual-energy pulmonary angiography with low contrast medium doses
Objective:
To quantitatively evaluate the quality and value of different images of dual-source CT low contrast medium doses dual-energy pulmonary angiography.
Methods:
31patients underwent dual-source CT dual-energy pulmonary angiography from July2011to July2012, got100kVp (group1),140kVp (group2), mixing energy (group3) and monochromatic images that the volume of contrast agent was30ml. CT values and SD values of pulmonary arteries were measured. The signal-to-noise ratio (SNR), contrast to noise ratio (CNR) were calculated. Monochromatic images in the peak of SNR and CNR were group4、5、6. CT values, SNR and CNR values were analyzed statistically. Two radiologists evaluate the quality of images.
Results:
During40-190keV, SNR values and CNR values between70-80keV were higher(70keV、80keV were group4、6),that reached the peak at74keV(group5). CT values of groupl and4were higher than the others. CT values of group5、6were not statistically significant compared with group3(P＞0.05). Image noise of group1was higher than other groups. Image noise of group4was higher than group3、5、6(P＜0.05). Image noise of group6was lower than group3(P＜0.05).There was no significant difference for Image noise between group5and3(P＞0.05). There was no significant difference for CNR values between groups(P＞0.05). There was no significant difference forSNR values between groupl and3(P＞0.05).SNR values of group5、6were higher than groupl(P<0.05). There was no significant difference for SNR values group4、5、6compared with group3(P＞0.05).
Conclusion:
The image quality of different energy images can meet the diagnostic requirements when the volume of contrast agent is30ml. There is no significant difference in the image quality between low-energy image and mixed energy images. Image quality and CT value of70-80keV image are equivalent with the low energy and mixed-energy image.74keV is the optimum monochromatic energy of pulmonary arteries.
Part two Comparative study different contrast media volume and scanning parameters of dual energy lung perfusion imaging
Objective:
To compare image quality of dual-energy CT pulmonary angiography and lung perfusion blood volume (lung PBV) in different contrast media volume and scanning parameters groups.
Methods:
90patients underwent dual-sourceCT dual-energy pulmonary angiography from September2011to August2O12.Patients were randomly divided into30ml (group1) or50ml (group2) or40ml (group3),30cases in each group.The scan was initiated with a bolus-tracking technique. In group1and2, the arrival of the contrast bolus in the pulmonary trunk was detected at a threshold of50Hounsfield Units (HU) with delay3s, however, that is100HU in group3. Attenuation profiles of multiple pulmonary arteries bilaterally, superior vena cava, left atrium, right atrium, right ventricle were measured.The diagnostic quality of lung PBV was evaluated by two radiologists using a3-point scale and Kappa test. Measured the overlay and iodine content of perfusion defects and normal lung parenchyma which was scored3and analyzed statistically.
Results:
The average attenuation of pulmonary arteries in group3is greater than the other two groups. No statistically significant difference between groupl and group3was found regarding the pulmonary arteries attenuation except pulmonary trunk(P＜0.01). The CT value of superior vena cava in group2is greater than the other two groups. The image quality of lung PBV in group3is better than group1,2. Good interobserver agreement is found for lung PBV (Kappa=0.748, P＜0.001). The difference of overlay and iodine content of perfusion defects and normal lung parenchyma is statistically significant(P＜0.001). The overlay and iodine content of perfusion defects is lower than that of normal lung parenchyma.
Conclusion:
40ml contrast media combination with artificial intelligence monitor pulmonary trunk at a threshold of100HU with delay3s scanning is available for dual energy CTA and lung PBV. The perfusion of embolic parts is lower than normal lung parenchyma.
引文
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[12]路莉,张龙江,周长圣,等.双源双能量不同管电压CT肺动脉成像质量的对比研究.中华放射学杂志,2011,45(12)：1127-1131.
[13]Johnson T R C,Krauss B, Sedlmair M, et al. Material differentiation by dual energy CT: initial experience[J]. European radiology,2007,17(6):1510-1517.
[14]Remy-Jardin M, Faivre J B, Pontana F, et al. Thoracic applications of dual energy[J]. Radiologic clinics of North America,2010,48(1):193.
[15]Hoey E T D, Mirsadraee S, Pepke-Zaba J, et al. Dual-energy CT angiography for assessment of regional pulmonary perfusion in patients with chronic thromboembolic pulmonary hypertension:initial experience [J]. American Journal of Roentgenology,2011, 196(3):524-532.
[16]Ferda J, Ferdova E, Mirka H, et al. Pulmonary imaging using dual-energy CT, a role of the assessment of iodine and air distribution[J]. European journal of radiology,2011,77(2): 287-293.
[17]Thieme S F, Johnson T R C, Lee C, et al. Dual-energy CT for the assessment of contrast material distribution in the pulmonary parenchyma [J]. American Journal of Roentgenology, 2009,193(1):144-149.
[18]Bauer R W, Kerl J M, Weber E, et al. Lung perfusion analysis with dual energy CT in patients with suspected pulmonary embolism—Influence of window settings on the diagnosis of underlying pathologies of perfusion defects[J]. European Journal of Radiology, 2011,80(3):e476-e482.
[19]Mitzner W, Wagner E M. Vascular remodeling in the circulations of the lung[J]. Journal of Applied Physiology,2004,97(5):1999-2004.
[20]吴华伟,程杰军,李剑颖等.CT能谱成像定量碘基物质图对肺栓塞的诊断价值[J].中华放射学杂志,2011,45(8)：727-730.
[1]方宏,王乐民.静脉血栓栓塞症的诊治现状[J].国际心血管病杂志,2010,37(6)327-330.
[2]Wolfe T R, Allen T L. Syncope as an emergency department presentation of pulmonary embolism[J]. The Journal of emergency medicine,1998,16(1):27-31.
[3]程显声,何建国.肺栓塞：肺栓塞的流行病学[J].中国循环杂志,1998,13(2)：65-66.
[4]郭雪梅.快速D二聚体检测在诊断静脉血栓形成中的应用进展[J].中国实验诊断学,2000,4(1)：41-43.
[5]张晓雷,王荣英.肺栓塞的诊断方法[J].河北医药,2012,34(20)：3135-3137.
[6]王建平,赵玉华,浦江,等.肺栓塞的超声诊断价值探讨[J].上海医学影像,2005,14(2)：107-109.
[7]Weg J G. Current diagnostic techniques for pulmonary embolism[C]//Seminars in Vascular Surgery. [Philadelphia, PA]:WB Saunders, [1988-,2000],13(3):182-188.
[8]宋荣坡,李爱钦,许公普.急性血栓性肺栓塞影像学诊断[J].河南科技大学学报：医学版,2006,24(2)：136-138.
[9]Wittram C, Waltman A C, Shepard J A O, et al. Discordance between CT and Angiography in the PIOPED II Studyl[J]. Radiology,2007,244(3):883-889.
[10]王雷,马庆杰,高识,等.肺灌注和肺通气显像诊断肺栓塞的临床应用价值[J].吉林医学,2006,27(2)：115-116.
[11]宋丽萍,刘秀杰,史蓉芳,等.肺灌注/通气显像与肺动脉造影诊断肺栓塞的对比分析[J].中华核医学杂志,2002,22(5)：296-298.
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[13]王建平,迟翔宇.肺栓塞的诊断方法[J].山东医药,2004,44(7)：61-62.
[14]Reittner P, Muller N L. Spiral CT in the diagnosis of pulmonary embolism[J]. Applied Radiology,1999,28(12):32-36.
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[17]Kang M J, Park C M, Lee C H, et al. Focal iodine defects on color-coded iodine perfusion maps of dual-energy pulmonary CT angiography images:a potential diagnostic pitfall [J]. American Journal of Roentgenology,2010,195(5):W325-W330.
[18]European Commission. European guidelines on quality criteria for computed tomography[J]. Report EUR,1999,16262:69-78.
[19]张月俏,任宏,沈国惠.双源CT Flash Spiral技术在胸部扫描中的应用和防护价值[J].中华放射医学与防护杂志,2011,31(3)：370-371.
[20]Kucher N, Goldhaber S Z. Cardiac biomarkers for risk stratification of patients with acute pulmonary embolism[J]. Circulation,2003,108(18):2191-2194.
[21]朱智明,周漠玲,刘进康,等.多层螺旋CT肺灌注成像技术优化与标准化探讨[J].第三军医大学学报,2008,30(20)：1893-1896
[22]赵艳娥.肺栓塞CT灌注成像的研究进展[J].中国医学影像技术,2009,24(11)：1844-1846.
[23]王琳琳,董振东.开启动态容积时代：Aquilion ONE320排CT[J].医疗卫生装备,2010(001)：13-16.
[24]叶贤旺,黄求理,任大卫,等.320排动态容积CT血管造影在烟雾病诊断中的应用价值[J].实用放射学杂志,2012,28(10)：1502-1505.
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[26]古杰洪,黄云海,郭永梅,等.320排CT全肝灌注成像临床应用初探[J].中国CT和MRI杂志,2012,10(2)：62-64.
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[30]吴华伟,程杰军,李剑颖,等.CT能谱成像定量碘基物质图对肺栓塞的诊断价值[J].中华放射学杂志,2011,45(8)：727-730.
[31]Geyer L L, Scherr M, Korner M, et al. Imaging of acute pulmonary embolism using a dual energy CT system with rapid kVp switching:initial results[J]. European Journal of Radiology,2012,81 (12):3711-3718..
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[3]Pontana F,Faivre J B,Remy-Jardin M,et al. Lung perfusion with dual-energy multidetector-row CT (MDCT):feasibility for the evaluation of acute pulmonary embolism in 117 consecutive patients[J]. Academic radiology,2008,15(12):1494-1504.
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[1]Thieme S F, Becker C R, Hacker M, et al. Dual energy CT for the assessment of lung perfusion—correlation to scintigraphy[J]. European journal of radiology,2008,68(3): 369-374.
[2]Zhang L J, Chai X, Wu S Y, et al. Detection of pulmonary embolism by dual energy CT: correlation with perfusion scintigraphy and histopathological findings in rabbits[J]. European radiology,2009,19(12):2844-2854.
[3]Winer-Muram H T, Rydberg J, Johnson M S, et al. Suspected Acute Pulmonary Embolism: Evaluation with Multi-Detector Row CT versus Digital Subtraction Pulmonary Arteriographyl[J]. Radiology,2004,233(3):806-815.
[4]Pontana F, Faivre J B, Remy-Jardin M, et al. Lung perfusion with dual-energy multidetector-row CT (MDCT):feasibility for the evaluation of acute pulmonary embolism in 117 consecutive patients[J]. Academic radiology,2008,15(12):1494-1504.
[5]Fink C, Johnson T R, Michaely H J, et al. Dual-energy CT angiography of the lung in patients with suspected pulmonary embolism:initial results[J]. RoFo:Fortschritte auf dem Gebiete der Rontgenstrahlen und der Nuklearmedizin,2008,180(10):879-883.
[6]Hoey E T, Gopalan D, Ganesh V, et al. Dual-energy CT pulmonary angiography:a novel technique for assessing acute and chronic pulmonary thromboembolism[J]. Clinical radiology,2009,64(4):414.
[7]Chae E J, Seo J B, Jang Y M, et al. Dual-energy CT for assessment of the severity of acute pulmonary embolism:pulmonary perfusion defect score compared with CT angiographic obstruction score and right ventricular/left ventricular diameter ratio [J]. American Journal of Roentgenology,2010,194(3):604-610.
[8]Primak A N, Giraldo J C R, Eusemann C D, et al. Dual-source dual-energy CT with additional tin filtration:Dose and image quality evaluation in phantoms and in vivo[J]. American Journal of Roentgenology,2010,195(5):1164-1174.
[9]Zhang L J, Zhao Y E, Wu S Y, et al. Pulmonary Embolism Detection with Dual-Energy CT: Experimental Study of Dual-Source CT in Rabbitsl[J]. Radiology,2009,252(1):61-70.
[10]Sueyoshi E, Tsutsui S, Hayashida T, et al. Quantification of lung perfusion blood volume (lung PBV) by dual-energy CT in patients with and without pulmonary embolism: Preliminary results[J]. European Journal of Radiology,2011,80(3):e505-e509.
[11]Sangwaiya M J, Kalra M K, Sharma A, et al. Dual-energy computed tomographic pulmonary angiography:a pilot study to assess the effect on image quality and diagnostic confidence[J]. Journal of computer assisted tomography,2010,34(1):46.
[12]路莉,张龙江,周长圣,等.双源双能量不同管电压CT肺动脉成像质量的对比研究.中华放射学杂志,2011,45(12)：1127-1131.
[13]Johnson T R C,Krauss B, Sedlmair M, et al. Material differentiation by dual energy CT: initial experience[J]. European radiology,2007,17(6):1510-1517.
[14]Remy-Jardin M, Faivre J B, Pontana F, et al. Thoracic applications of dual energy[J]. Radiologic clinics of North America,2010,48(1):193.
[15]Hoey E T D, Mirsadraee S, Pepke-Zaba J, et al. Dual-energy CT angiography for assessment of regional pulmonary perfusion in patients with chronic thromboembolic pulmonary hypertension:initial experience [J]. American Journal of Roentgenology,2011, 196(3):524-532.
[16]Ferda J, Ferdova E, Mirka H, et al. Pulmonary imaging using dual-energy CT, a role of the assessment of iodine and air distribution[J]. European journal of radiology,2011,77(2): 287-293.
[17]Thieme S F, Johnson T R C, Lee C, et al. Dual-energy CT for the assessment of contrast material distribution in the pulmonary parenchyma [J]. American Journal of Roentgenology, 2009,193(1):144-149.
[18]Bauer R W, Kerl J M, Weber E, et al. Lung perfusion analysis with dual energy CT in patients with suspected pulmonary embolism—Influence of window settings on the diagnosis of underlying pathologies of perfusion defects[J]. European Journal of Radiology, 2011,80(3):e476-e482.
[19]Mitzner W, Wagner E M. Vascular remodeling in the circulations of the lung[J]. Journal of Applied Physiology,2004,97(5):1999-2004.
[20]吴华伟,程杰军,李剑颖等.CT能谱成像定量碘基物质图对肺栓塞的诊断价值[J].中华放射学杂志,2011,45(8)：727-730.
[1]方宏,王乐民.静脉血栓栓塞症的诊治现状[J].国际心血管病杂志,2010,37(6)327-330.
[2]Wolfe T R, Allen T L. Syncope as an emergency department presentation of pulmonary embolism[J]. The Journal of emergency medicine,1998,16(1):27-31.
[3]程显声,何建国.肺栓塞：肺栓塞的流行病学[J].中国循环杂志,1998,13(2)：65-66.
[4]郭雪梅.快速D二聚体检测在诊断静脉血栓形成中的应用进展[J].中国实验诊断学,2000,4(1)：41-43.
[5]张晓雷,王荣英.肺栓塞的诊断方法[J].河北医药,2012,34(20)：3135-3137.
[6]王建平,赵玉华,浦江,等.肺栓塞的超声诊断价值探讨[J].上海医学影像,2005,14(2)：107-109.
[7]Weg J G. Current diagnostic techniques for pulmonary embolism[C]//Seminars in Vascular Surgery. [Philadelphia, PA]:WB Saunders, [1988-,2000],13(3):182-188.
[8]宋荣坡,李爱钦,许公普.急性血栓性肺栓塞影像学诊断[J].河南科技大学学报：医学版,2006,24(2)：136-138.
[9]Wittram C, Waltman A C, Shepard J A O, et al. Discordance between CT and Angiography in the PIOPED II Studyl[J]. Radiology,2007,244(3):883-889.
[10]王雷,马庆杰,高识,等.肺灌注和肺通气显像诊断肺栓塞的临床应用价值[J].吉林医学,2006,27(2)：115-116.
[11]宋丽萍,刘秀杰,史蓉芳,等.肺灌注/通气显像与肺动脉造影诊断肺栓塞的对比分析[J].中华核医学杂志,2002,22(5)：296-298.
[12]Giuntini C, Goldhaber S Z. Invasive and noninvasive diagnosis of pulmonary embolism: Preliminary results of the Prospective Investigative Study of Acute Pulmonary Embolism Diagnosis (PISA-PED)[J]. Chest,1995,107(1):33S-38S.
[13]王建平,迟翔宇.肺栓塞的诊断方法[J].山东医药,2004,44(7)：61-62.
[14]Reittner P, Muller N L. Spiral CT in the diagnosis of pulmonary embolism[J]. Applied Radiology,1999,28(12):32-36.
[15]Pipavath S N J, Godwin J D. Acute pulmonary thromboembolism:a historical perspective[J]. American Journal of Roentgenology,2008,191(3):639-641.
[16]Stein P D, Fowler S E, Goodman L R, et al. Multidetector computed tomography for acute pulmonary embolism[J]. New England Journal of Medicine,2006,354(22):2317-2327.
[17]Kang M J, Park C M, Lee C H, et al. Focal iodine defects on color-coded iodine perfusion maps of dual-energy pulmonary CT angiography images:a potential diagnostic pitfall [J]. American Journal of Roentgenology,2010,195(5):W325-W330.
[18]European Commission. European guidelines on quality criteria for computed tomography[J]. Report EUR,1999,16262:69-78.
[19]张月俏,任宏,沈国惠.双源CT Flash Spiral技术在胸部扫描中的应用和防护价值[J].中华放射医学与防护杂志,2011,31(3)：370-371.
[20]Kucher N, Goldhaber S Z. Cardiac biomarkers for risk stratification of patients with acute pulmonary embolism[J]. Circulation,2003,108(18):2191-2194.
[21]朱智明,周漠玲,刘进康,等.多层螺旋CT肺灌注成像技术优化与标准化探讨[J].第三军医大学学报,2008,30(20)：1893-1896
[22]赵艳娥.肺栓塞CT灌注成像的研究进展[J].中国医学影像技术,2009,24(11)：1844-1846.
[23]王琳琳,董振东.开启动态容积时代：Aquilion ONE320排CT[J].医疗卫生装备,2010(001)：13-16.
[24]叶贤旺,黄求理,任大卫,等.320排动态容积CT血管造影在烟雾病诊断中的应用价值[J].实用放射学杂志,2012,28(10)：1502-1505.
[25]刘家祎,李宇,温兆赢,等.正常肾脏皮质320排CT容积灌注研究[J].中国医刊,2012,47(1)：71-73.
[26]古杰洪,黄云海,郭永梅,等.320排CT全肝灌注成像临床应用初探[J].中国CT和MRI杂志,2012,10(2)：62-64.
[27]Schueller-Weidekamm C, Schaefer-Prokop C M, Weber M, et al. CT Angiography of Pulmonary Arteries to Detect Pulmonary Embolism:Improvement of Vascular Enhancement with Low Kilovoltage Settingsl[J]. Radiology,2006,241(3):899-907.
[28]Bahner M L, Bengel A, Brix G, et al. Improved vascular opacification in cerebral computed tomography angiography with 80 kVp[J]. Investigative radiology,2005,40(4):229-234.
[29]Wintersperger B, Jakobs T, Herzog P, et al. Aorto-iliac multidetector-row CT angiography with low kV settings:improved vessel enhancement and simultaneous reduction of radiation dose[J]. European radiology,2005,15(2):334-341.
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