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首页> 外文期刊>Radiotherapy and oncology: Journal of the European Society for Therapeutic Radiology and Oncology >Imaging of regional ventilation: Is CT ventilation imaging the answer? A systematic review of the validation data
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Imaging of regional ventilation: Is CT ventilation imaging the answer? A systematic review of the validation data

机译：区域通风的成像：CT通风成像答案吗？ 对验证数据的系统审查

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Computed Tomography Ventilation Imaging (CTVI) is an experimental imaging modality that derives regional lung function information from non-contrast respiratory-correlated CT datasets. Despite CTVI being extensively studied in cross-modality imaging comparisons, there is a lack of consensus on the state of its clinical validation in humans. This systematic review evaluates the CTVI clinical validation studies to date, highlights their common strengths and weaknesses and makes recommendations. We performed a PUBMED and EMBASE search of all English language papers on CTVI between 2000 and 2018. The results of these searches were filtered in accordance to a set of eligibility criteria and analysed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Guidelines. One hundred and forty-four records were identified, and 66 full text records were reviewed. After detailed assessment, twenty-three full text papers met the selection criteria and were included in the final review. This included thirteen prospective studies, with 579 human subjects. Studies used diverse methodologies, with a large amount of heterogeneity between different studies in terms of the reference ventilation imaging modality (e.g. nuclear medicine, hyperpolarised gas MRI), imaging parameters, DIR algorithm(s) used, and ventilation metric(s) applied. The most common ventilation metrics used deformable image registration to evaluate the exhale-to-inhale motion field Jacobian determinant (DIR-Jac) or changes in air volume content based on Hounsfield Units (DIR-HU). The strength of correlation between CTVI and the reference ventilation imaging modalities was moderate to strong when evaluated at the lobar or global level, with the average ± S.D. {number of studies) linear regression correlation coefficients were 0.73 ± 0.25 (n = 6) and 0.86 ± 0.11 (n = 12) for DIR-Jac and DIR-HU respectively, and the SPC were 0.45 ± 0.31 (n = 6) and 0.41 ± 0.11 (n = 5) for DIR-Jac and DIR-HU respectively. We concluded that it is difficult to make a broad statement about the validity of CTVI due to the diverse methods used in the validation literature. Typically, CTVI appears to show reasonable cross-modality correlations at the lobar/whole lung level but poor correlations at the voxel level. Since CTVI is seeing new implementations in prospective trials, it is clear that refinement and standardization of the clinical validation methodologies are required. CTVI appears to be of relevance in radiotherapy planning, particularly in patients whose main pulmonary impairment is not a gas exchange problem but alternative imaging approaches may need to be considered in patients with other pulmonary diseases (i.e. restrictive or gas exchange problems).
机译：计算机断层摄影通风成像（CTVI）是一种实验成像模型，其来自非对比呼吸相关的CT数据集的区域肺功能信息。尽管CTVI在跨型成像比较中进行了广泛研究，但对人类临床验证的状态缺乏共识。这种系统评论评估了迄今为止的CTVI临床验证研究，突出了他们的共同优势和劣势并提出了建议。我们在2000年和2018年间CTVI的所有英语语言论文进行了PubMed和Embase搜索。根据一套资格标准，根据一组资格标准进行过滤，并根据首选报告项目进行系统评价和荟萃分析（PRISMA）指导方针。确定了一百四十四个记录，并审查了66条全文记录。经过详细的评估后，二十三篇全文论文符合选定标准，并包含在最终审查中。这包括十三个前瞻性研究，人类受试者有579名。研究使用不同的方法，在参考通风成像模态（例如核医学，超极化气体MRI），使用的成像参数，使用的DIR算法，应用通风公制的不同研究之间的不同研究之间具有大量的异质性。最常见的通风指标使用可变形的图像配准，以评估呼气到吸气运动场雅可比决定簇（DIR-JAC）或基于Hounsfield单元（Dir-Hu）的空气量含量的变化。当在洛巴塔或全球水平评估时，CTVI与参考通风成像模态之间的相关强度适度至强度，平均±S.D。 {研究数量）线性回归相关系数分别为dir-jac和dir-hu的0.73±0.25（n = 6）和0.86±0.11（n = 12），SPC为0.45±0.31（n = 6）和对于Dir-Jac和Dir-Hu，分别为0.41±0.11（n = 5）。我们得出结论，由于验证文献中使用的不同方法，难以对CTVI的有效性作出广泛的声明。通常，CTVI似乎在叶片/全肺水平下显示合理的横向形态相关性，但在体素水平上的相关性差。由于CTVI在预期试验中看到了新的实现，因此可以清楚地说明需要细化和标准化临床验证方法。 CTVI似乎在放射治疗计划中具有相关性，特别是在主要肺部损伤不是气体交换问题的患者中，但可能需要在其他肺部疾病患者中考虑替代成像方法（即限制性或气体交换问题）。

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