[논문]MDCT를 이용한 역동적 간 컴퓨터단층촬영 검사에서 정맥과 동맥 주입법에 따른 영상의 화질 및 선량 비교

김지영; 조예진; 임희현; 이주형; 허영철

doi:10.7742/jksr.2023.17.1.123

초록
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본 연구에서는 정맥경유 역동적 간 조영 컴퓨터단층촬영 검사와 동맥경유 역동적 간 조영 컴퓨터단층촬영 검사의 영상의 질과 선량의 차이를 분석하고자 하였다. 간세포암종의 중재적 시술인 경도관동맥화학색전술 대상으로 정맥과 동맥 경유 역동적 간 조영 컴퓨터단층촬영 검사를 한 케이스를 후향적 블라인드 방법으로 신호대잡음비와 대조도대잡음비를 분석하였다. 또한 영상저장 및 전송체계에 저장된 Dose Length Product (DLP)값을 이용하여 유효선량을 구하여 두 검사의 선량 차이를 분석하였다. 신호대잡음비는 정맥경유 역동적 간 조영 컴퓨터단층촬영 검사가 간과 지라에서 높은 결과를 보였지만 대조도대잡음비는 동맥경유 역동적 간 조영 컴퓨터단층촬영 검사가 높았다. 하지만 DLP와 유효선량 비교에서는 두 검사 간 차이가 발생하지 않았다. 결론적으로 동맥경유 역동적 간 조영 컴퓨터단층촬영 검사가 정맥경유 역동적 간 조영 컴퓨터단층촬영 검사에 비해 선량차이가 발생하지 않으면서도 대조도대잡음비가 우수한 검사임을 확인하였다. 추가로 간세포암종의 중재적 시술에서 가장 중요한 부분이 섭식동맥의 구분이 명료한가에 대한 구분이 필요하기 때문에 간동맥의 삼차원 혈관조영 컴퓨터단층촬영 검사에 대한 분석이 필요하다고 사료된다.

Abstract ▼ AI-Helper

The purpose of this study was to analyze differences in imaging quality and dose difference between intra-venous (IV) and intra-arterial (IA) liver dynamic computed tomography (CT). Herein, retrospective, blinded analysis was conducted to analyze signal-to-noise and contrast-to-noise ratios in cases...

The purpose of this study was to analyze differences in imaging quality and dose difference between intra-venous (IV) and intra-arterial (IA) liver dynamic computed tomography (CT). Herein, retrospective, blinded analysis was conducted to analyze signal-to-noise and contrast-to-noise ratios in cases of patients who underwent IV or IA liver dynamic CT for transarterial chemoembolization (TACE), an interventional procedure for hepatocellular carcinoma. The dose length product (DLP) value stored in Picture Archive and Communication System (PACS) was used to calculate the effective dose and thereby compare differences in the dose between the two methods. The mean liver and spleen signal to noise ratio (SNR) was greater in IV-liver dynamic CT than in IA-liver dynamic CT; however, contrast to noise ratio (CNR) was higher in IA-liver dynamic CT than in IV-liver dynamic CT. However, there were no differences in DLP and effective dose between the two methods. In conclusion, our findings showed that IA-liver dynamic CT showed a similar effective dose and superior CNR compared with IV-liver dynamic CT. Further studies must analyze 3D angiography CT of the hepatic artery to clearly distinguish the feeding artery, which is the essential step in interventional procedures for hepatocellular carcinoma.

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표/그림 (4)

그림 Fig 1. Diagnosis of HCC with IV-liver dynamic CT using retrospectively collected data(A), catheter insertion for IA-liver dynamic CT (B), IA-liver dynamic CT(C), Post TACE image (D)
그림 Fig 2. Insertion of the 4-French sheath after right femoral artery puncture (A), 4-French diagnostic catheter (arrow) placed in the proper hepatic artery (B), examination in CT scan room (C), HCC feeding artery embolization in intervention room (D)
그림 Fig 3. Setting ROI in IV-liver dynamic CT (A), evaluating the mean value of set ROI (B), Avg indicates the mean value (C), IV-liver dynamic CT in the upper panel and IA-liver dynamic CT in the lower panel for the same method (D)
표 Table 1. Comparison of Liver dynamic CT with IV and IA

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문제 정의

In such cases, liver dynamic CT using MDCT can identify lesions to diagnose liver cancer, and IA-liver dynamic CT is used to differentiate the feeding artery and thereby conduct TACE. Herein, we aimed to compare the imaging quality and dose between IA-liver dynamic CT and liver dynamic CT using MDCT.

제안 방법

Patients who underwent TACE were followed-up for nine months to retrospectively analyze data of 50 patients who underwent IA-liver dynamic CT during liver dynamic CT and TACE. Arterial phase axial images were acquired from the two tests to extract the HU value of background, liver, and spleen and hence calculated SNR, CNR, DLP, and effective dose. DLP and effective dose were not significantly different between IV-liver dynamic CT and IA-liver dynamic CT.
An 18-G needle was used to secure the medium injection path. IA-liver dynamic CT was conducted using MDCT (IQon Spectral CT, PHILPS, Netherlands) with AEC function, and 4-French Introducer Set and 0.035-inch Guide Wire (150 cm, Terumo, Japan, Tokyo) were injected, and a 4-French Yashrio Catheter (Yashiro, JUNGUNG MEDICAL, Korea) was used. IV-liver dynamic CT conditions were as follows: tube voltage 120 kVp, tube current 92 mAs, slice thickness 3 mm, rotation time 0.
Patients who underwent TACE were followed-up for nine months to retrospectively analyze data of 50 patients who underwent IA-liver dynamic CT during liver dynamic CT and TACE. Arterial phase axial images were acquired from the two tests to extract the HU value of background, liver, and spleen and hence calculated SNR, CNR, DLP, and effective dose.

대상 데이터

PACS data collected from 50 patients who completed the described procedures were analyzed. Patient information was blinded, and this study was exempted from review by the Institutional Review Board (IRB).

성능/효과

A limitation of the study was that as this was a retrospective study, independent variables were already observed, making it impossible to control the variables that had occurred during the study. However, despite this limitation, our study is significant as our findings showed that IA-liver dynamic CT has no difference in the effective dose and higher CNR compared with IV-liver dynamic CT. Further studies must compare 3D CT angiography images of the two methods for accurate image analysis of the hepatic artery.
In conclusion, IA-liver dynamic CT using MDCT showed a similar effective dose and higher CNR compared with IV-liver dynamic CT. However, as IA-liver dynamic CT is a test to identify the feeding artery of liver cancer in HCC patients rather than a test to investigate the signal amplitude of the liver parenchyma, there are limitations in the interpretation of this study's findings.
There were no differences in DLP and effective dose between IV-liver dynamic CT and IA-liver dynamic CT (p > 0.05).

후속연구

However, as IA-liver dynamic CT is a test to identify the feeding artery of liver cancer in HCC patients rather than a test to investigate the signal amplitude of the liver parenchyma, there are limitations in the interpretation of this study's findings. Therefore, an additional study is required to analyze the 3D Angiography images of the Hepatic Artery, and it is expected that this study will provide basic data.

참고문헌 (12)

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[국내논문] MDCT를 이용한 역동적 간 컴퓨터단층촬영 검사에서 정맥과 동맥 주입법에 따른 영상의 화질 및 선량 비교
Comparison of Image Quality and Dose between Intra-Venous and Intra-Arterial Liver Dynamic CT using MDCT 원문보기

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[국내논문] MDCT를 이용한 역동적 간 컴퓨터단층촬영 검사에서 정맥과 동맥 주입법에 따른 영상의 화질 및 선량 비교 Comparison of Image Quality and Dose between Intra-Venous and Intra-Arterial Liver Dynamic CT using MDCT 원문보기

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[국내논문] MDCT를 이용한 역동적 간 컴퓨터단층촬영 검사에서 정맥과 동맥 주입법에 따른 영상의 화질 및 선량 비교
Comparison of Image Quality and Dose between Intra-Venous and Intra-Arterial Liver Dynamic CT using MDCT 원문보기

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