背景与目的 计算机断层扫描(computed tomography,CT)随访评估结节体积及密度变化是临床针对不定性肺结节采用的常用策略.在保证测量精度前提下降低CT剂量是需要考虑的问题.本研究旨在评估不同管电流及重建算法对肺体模结节容积定量及CT值测量的影响.方法 应用64排螺旋CT,管电压120 kV,7种管电流(10 mA、20 mA、50 mA、80 mA、100 mA、150 mA、350 mA)对肺结节体模进行扫描,采用滤波反投影(filtered back projection,FBP)、自适应迭代重建(ASIR:30%,50%,80%)算法进行重建,获取28套CT图像.应用肺结节分析软件对3种直径(2.5 mm,5 mm,10 mm)、三种CT值(-100 HU,60 HU,100 HU)共9个球型结节测量容积及平均CT值数据.应用重复测量方差分析评估不同管电流及原始数据重建算法对容积及CT值测量的影响.结果 直径为2.5 mm结节的容积测量相对误差(100.8%±28%)及三维CT值绝对误差(-756±80)HU最大;直径为5 mm及10 mm结节的容积相对误差小[(-0.9%±1.1%)vs(0.9%±1.4%)],但CT值绝对误差大[(-243±26)HUvs(-129±7)HU].针对直径为5 mm及10 mm结节使用重复测量方差分析结果显示,应用不同管电流及原始数据重建算法时容积测量相对误差没有显著性差异(F=5.60,P=0.10 vs F=11.13,P=0.08),三维CT值的绝对误差有显著影响(F=34.79,P<0.001 vs F=156.14,P<0.001).结论 不同管电流及重建算法对直径5 mm及10 mm的结节容积定量影响很小,因此较低管电流及迭代重建算法可以应用在5 mm以上肺结节的CT随访中.结节分析软件提供的平均CT值与标准CT值在不同大小、密度结节中均具有较大误差,不能应用于临床.%Background and objective The computed tomography (CT) follow-up of indeterminate pulmonary nodules aiming to evaluate the change of the volume and CT value is the common strategy in clinic. The CT dose needs to considered on serious CT scans in addition to the measurement accuracy. The purpose of this study is to quantify the preci-sion of pulmonary nodule volumetric measurement and CT value measurement with various tube currents and reconstruction algorithms in a phantom study with dual-energy CT.Methods A chest phantom containing 9 artificial spherical solid nodules with known diameter (D=2.5 mm, 5 mm, 10 mm) and density (-100 HU, 60 HU and 100 HU) was scanned using a 64-row detector CT canner at 120 Kilovolt & various currents (10 mA, 20 mA, 50 mA, 80 mA,100 mA, 150 mA and 350 mA). Raw data were reconstructed with filtered back projection and three levels of adaptive statistical iterative reconstruction algorithm (FBP, ASIR; 30%, 50% and 80%). Automatic volumetric measurements were performed using commercially available software. The relative volume error (RVE) and the absolute attenuation error (AAE) between the software measures and the reference-standard were calculated. Analyses of the variance were performed to evaluate the effect of reconstruction methods, different scan parameters, nodule size and attenuation on the RPE.Results The software substantially overestimated the very small (D=2.5 mm) nodule's volume [mean RVE: (100.8%±28%)] and underestimated it attenuation [mean AAE: (-756±80) HU]. The mean RVEs of nodule with diameter as 5 mm and 10 mm were small [(-0.9%±1.1%)vs (0.9%±1.4%)], however, the mean AAEs [(-243±26) HUvs (-129±7) HU)] were large. The ANOVA analysis for repeated measurements showed that different tube current and reconstruction algorithm had no significant effect on the volumetric measurements for nodules with diameter of 5 mm and 10 mm (F=5.60,P=0.10 vs F=11.13,P=0.08), but significant effects on the measurement of CT value (F=34.79, P<0.001 vs F=156.14, P<0.001).Conclusion An infinitesimally small errors of volumetric measurement of 5 mm or 10 mm nodule could achieved with very low current and ASIR reconstruction, suggesting a possibility of remarkable radiation dose reductions, while it is not applicable for 5 mm nodule. The attenuation acquired through three dimensional software has large measurement error and can not applied in clinical currently.
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