摘要
目的 探讨柔性减影CT联合单能去金属伪影(SEMAR)技术在膝关节周围骨肉瘤患者保肢术后随访中的价值。方法 前瞻性纳入2024年11月—2025年6月股骨下段或胫骨上段骨肉瘤保肢术后患者21例,四肢增强CT检查分别使用常规迭代重建(Enhanced-IR)、SEMAR重建(Enhanced-SEMAR)及基于SEMAR的柔性减影CT(SCT-SEMAR)。比较三组图像的伪影指数(AI),两名医师采用5分制Likert量表独立评估图像质量与诊断信心。采用Friedman检验及Dunn-Bonferroni事后比较进行统计分析,观察者间一致性采用加权Kappa评估。以病理或影像随访结果为金标准确认复发。结果 三组图像在所有测量区域的AI值差异均有统计学意义(P均<0.001)。SCT-SEMAR组的AI值显著低于Enhanced-SEMAR组与Enhanced-IR组(P均<0.05)。两名观察者评分一致性良好(Kappa值:0.708~0.889)。Enhanced-SEMAR与SCT-SEMAR图像质量评分[4.0(0.0)比4.0(0.0)]均显著高于Enhanced-IR[1.0(1.0)](P<0.05)。诊断信心评分在三组间差异显著(P<0.001),SCT-SEMAR组[4.0(1.0)]显著高于Enhanced-SEMAR组[4.0(0.0)]和Enhanced-IR组[1.0(1.0)](P<0.05)。3例复发灶在SCT-SEMAR图像上均显示清晰。结论 柔性减影CT联合SEMAR技术能协同降低金属伪影,优化图像质量,提高诊断信心,是骨肉瘤患者保肢术后随访的有效手段。
Objective To assess the value of subtraction iodine mapping combined with single-energy metal artifact reduction(SEMAR)in the follow-up of patients with osteosarcomas around the knees after limb-salvage surgery.Methods A total of 21 patients with osteosarcomas of the distal femora or proximal tibiae after limb-salvage surgery were prospectively enrolled from November 2024 to June 2025.All patients underwent contrast-enhanced CT of the extremities with image reconstructions using conventional iterative reconstruction(Enhanced-IR),SEMAR reconstruction(Enhanced-SEMAR),and SEMAR-based subtraction iodine mapping(SCT-SEMAR).The artifact index(AI)was compared among the three groups.Two radiologists independently scored the image quality and diagnostic confidence using a 5-point Likert scale.Statistical analysis was performed using the Friedman test and Dunn-Bonferroni post-hoc test.The inter-observer agreement was assessed with weighted Kappa.Local recurrence was confirmed by histopathology or imaging follow-up as the reference standard.Results Significant differences in AI values were observed among the three groups across all measured regions(all P<0.001).The AI in the SCT-SEMAR group was significantly lower than that in the Enhanced-SEMAR and Enhanced-IR groups(all P<0.05).Inter-observer agreement was good(Kappa 0.708-0.889).The image quality scores of Enhanced-SEMAR(4.0)and SCT-SEMAR(4.0)groups were significantly higher(all P<0.05)than that of Enhanced-IR(1.0).Diagnostic confidence scores differed significantly among the three groups(P<0.001)with significantly higher scores(all P<0.05)on SCT-SEMAR[4.0(1.0)]than those on Enhanced-SEMAR[4.0(0.0)]and Enhanced-IR[1.0(1.0)].All three recurrent lesions were clearly visualized on SCT-SEMAR images.Conclusion SCT-SEMAR can synergistically reduce metal artifacts,optimize image quality,and improve diagnostic confidence in the follow-up of patients after limb-salvage surgery for osteosarcomas around the knees.
作者
王洪光
孙馨
张畅
张滨
那曼丽
徐敏
王剑
常天静
WANG Hongguang;SUN Xin;ZHANG Chang;ZHANG Bin;NA Manli;XU Min;WANG Jian;CHANG Tianjing(Department of Medical Imaging,Peking University Shougang Hospital,Beijing 100041,China)
出处
《影像诊断与介入放射学》
2026年第1期3-9,共7页
Diagnostic Imaging & Interventional Radiology
关键词
骨肉瘤
保肢手术
单能去金属伪影技术
柔性减影CT
计算机断层扫描
Osteosarcoma
Limb-salvage surgery
Single-energy metal artifact reduction
Subtraction iodine mapping
Computed tomography
