能谱CT最佳单能量成像在胃底静脉曲张出血内镜术前的应用价值

目的：通过对肝门静脉、胃底静脉曲张及胃肾分流等的显示情况，评价能谱CT最佳单能量成像在胃底静脉曲张出血患者内镜术前的参考应用价值。方法：选取2016年9月至2021年1月期间收治的60例胃底静脉曲张出血患者，进行肝门静脉能谱CTA检查。比较最佳单能量、70keV及混合能量（QC）3组图像肝门静脉CT值、图像噪声（IN）、信噪比（SNR）、对比噪声比（CNR）及图像质量主观评分，将图像质量最佳组用于影像诊断。结果：最佳单能量、70keV、QC组肝门静脉平均CT值分别为273.12±25.48、168.70±20.16、164.92±20.74；IN分别为31.22±4.13、17.72±3.09、24.25±2.98；SNR分别为8.95±1.80、9.92±2.64、6.93±1.37；CNR分别为6.18±1.52、4.82±1.71、3.22±0.99；主观质量评分分别为4.57±0.63、3.10±0.98、2.47±0.93；除70keV、QC组肝门静脉平均CT值组间无统计学差异外，其余均有统计学差异；最佳单能量组图像质量最佳，并能清晰显示胃肾分流、胃底静脉曲张、肝门静脉血栓等征象。结论：肝门静脉能谱CT最佳单能量成像可优化图像质量，在胃底静脉曲张出血患者内镜术前具有较高的应用价值。

The Value of Optimal Monochromatic Spectral CT Imaging in Gastric Variceal Bleeding before Endoscopic Treatment

Objective: We intend to evaluate the application value of optimal monochromatic spectral CT imaging performed on patients with gastric variceal bleeding before endoscopic treatment by way of observing the manifestation of portal vein, gastric varies gastro renal shunt etc. Methods: A total of 60 patients with gastric variceal bleeding admitted to our hospital from September 2016 to January 2021 were selected for spectral CT portal venography. By comparing the CT value of hepatic portal vein, the image noise (IN), the signal-to-noise ratio (SNR), contrast noise ratio (CNR) and subjective evaluation of the image quality among the 3 sets of images of optimal monochromatic energy group, 70keV group and mixed energy group (QC), we obtained the spectral CT portal venography with the best image quality for the imaging diagnosis. Results: The average CT values of hepatic portal vein of the 3 groups (the optimal monochromatic energy group, 70keV group and QC group) vein were 273.12±25.48, 168.70±20.16 and 164.92±20.74, respectively. the average IN value were 31.22±4.13, 17.72±3.09 and 24.25±2.98, respectively. The SNR were 8.95±1.80, 9.92±2.64 and 6.93±1.37, respectively. The CNR were 6.18±1.52, 4.82±1.71 and 3.22±0.99, respectively. While the subjective evaluation scores of image quality were 4.57±0.63, 3.10±0.98 and 2.47±0.93, respectively. All showed significant statistical difference except the average CT value of hepatic portal vein between the 70keV group and QC group. The CT portal venography with optimal monochromatic energy was the best, and it showed clear manifestation of gastric renal shunt, gastric varices, portal vein thrombosis, etc. Conclusion: The optimal monochromatic spectral CT imaging can optimize the image quality and it shows high application value when treated patients with gastric variceal bleeding before endoscopic surgery.