Diagnostic value of spectral images derived from dual-layer spectral detector CT in bronchial-pulmonary shunts in patients with hemoptysis

doi:10.19982/j.issn.1000-6621.20220190

Abstract

Abstract:

Objective: To explore the diagnostic value of spectral images derived from dual-layer spectral detector CT (DLCT) in bronchial-pulmonary shunts (BPS). Methods: Conventional and spectral images (monoenergetic images and iodine density images) of spectral CT body arterial phase reconstruction of 28 patients with hemoptysis diagnosed as BPS by digital subtraction angiography (DSA) in Shandong Provincial Chest Hospital from December 2019 to December 2020 were retrospectively analyzed. Using DSA as the standard, the positive rates of spectral single level image and conventional image in the diagnosis of BPS were compared. The CT attenuation value or iodine density of the main pulmonary artery trunk (ROI1), the abnormally developed pulmonary artery lumen (ROI2) and the most obvious pulmonary artery enhancement area (ROI3) at the root of the lobe in the three groups of images were measured respectively, and the change trend was analyzed. Besides, of the same level and location of ROI2 and ROI3, the pulmonary artery lumen (ROI4) and lobar root lumen (ROI5) in the contralateral normal and diseased pulmonary artery were examined, and the measured values and differences with the contralateral changes were analyzed. Results: A total of 39 BPS positive pulmonary arteries were diagnosed by DSA images. Staggered development of pulmonary artery branches by 40 keV virtual monoenergetic images (VMI 40 keV) showed that the positive rates of BPS were 76.9% (30/39) and 69.2% (27/39), respectively. In the three groups of images on the abnormal side, the measured value of ROI3 ((539.00±152.09) HU) was significantly higher than those of ROI1 ((398.10±102.31) HU) and RO2 ((441.40±115.52) HU) (F=9.990, P <0.001). Compared with the pulmonary artery in the contralateral normal lung tissue, the measured value of ROI1 ((393.95±120.03) HU) was slightly greater than those of ROI4 ((396.40±146.01) HU) and ROI5 ((361.00±135.40) HU). There was no statistically significant difference (F=0.290, P=0.753). Compared with the pulmonary artery in the contralateral normal pulmonary tissue, the enhancement degree of pulmonary artery distribution along the blood flow in the three images showed a certain trend: the contrast agent concentration in the pulmonary artery lumen of the BPS positive side increased gradually along the blood flow direction, with the average value rising from (398.10±102.31) HU to (539.00±152.09) HU; however, the contrast agent concentration of normal pulmonary vessels changes little, increased from (361.00±135.40) HU to (393.95±120.03) HU. Conclusion: Spectral images based on DLCT could improve the diagnosis of BPS responsible vessels in patients with hemoptysis, which is helpful to predict the abnormal blood vessels of BPS before DSA.

Key words: Hemoptysis, Pulmonary circulation, Tomography, X-ray computed, Angiography

CLC Number:

Qu Huifang, Wang Wuzhang, Wang Liming, Deng Weiwei, Liu Xiaomin, Yang Jisheng, Guo Xiaowen, Zhang Yunzeng, Lu Yinan, Jin Feng. Diagnostic value of spectral images derived from dual-layer spectral detector CT in bronchial-pulmonary shunts in patients with hemoptysis[J]. Chinese Journal of Antituberculosis, 2022, 44(11): 1180-1186. doi: 10.19982/j.issn.1000-6621.20220190

Figures/Tables 6

References 13

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病变部位编号	例数	常规混合能级图像(HU)	40keV单能级图像(HU)	碘密度图 (mg/ml)	对侧正常组织编号	例数	常规混合能级图像(HU)	40keV单能级图像(HU)	碘密度图 (mg/ml)
ROI1	30	144.87±31.45	398.10±102.31	4.23±1.17	ROI1	20	142.00±35.38	393.95±120.03	4.19±1.39
ROI2	30	158.17±33.69	441.40±115.52	4.68±1.34	ROI4	20	142.10±45.83	396.40±146.01	4.18±1.68
ROI3	30	195.07±44.49	539.00±152.09	5.78±1.80	ROI5	20	118.85±38.57	361.00±135.40	3.84±1.42
F值		14.850	9.990	9.990	F值		0.820	0.290	0.710
P值		<0.001	<0.001	<0.001	P值		0.446	0.753	0.494

分类	常规混合能级图像	40keV单能级图像	碘密度图
ROI2>ROI1	83.33(25/30)	83.33(25/30)	73.33(22/30)
ROI4>ROI1	45.00(9/20)	30.00(6/20)	25.00(5/20)
χ²值	17.376	14.488	11.286
P值	<0.001	<0.001	<0.001
ROI3>ROI2	100.00(30/30)	90.00(27/30)	73.33(22/30)
ROI5>ROI4	15.00(3/20)	10.00(2/20)	15.00(3/20)
χ²值	38.636	31.527	16.333
P值	<0.001	<0.001	<0.001
ROI3>ROI1	96.67(29/30)	100.00(30/30)	93.33(28/30)
ROI5>ROI1	5.00(1/20)	25.00(5/20)	20.00(4/20)
χ²值	42.014	32.143	28.009
P值	<0.001	<0.001	<0.001