目的：探究深度学习图像重建（deep learning image reconstruction， DLIR)在基于能谱CT虚拟平扫(virtual non-contrast scan， VNC)的CT尿路成像（CT urography， CTU）中的图像质量和肾结石测量精度。方法: 回顾性分析2022年9月至2023年4月期间于我院行腹盆平扫和CTU的90例患者的临床和影像学资料。所有患者均在常规行腹盆CT平扫后，进行能谱模式的多期CTU扫描。真实平扫采用ASIR-V 70%权重进行重建（TNC-AR70组）。基于基于实质期及排泌期数据分别获得2组VNC图像，再分别结合DLIR中档和高档权重重建得到4组VNC图像，即实质期-VNC-DLIR中档（venous phase-VNC-DLIR medium， VP-VNC-DM）组、实质期-VNC-DLIR高档（venous phase-VNC-DLIR high， VP-VNC-DH）组、排泌期-VNC-DLIR中档（delay phase-VNC-DLIR medium， DP-VNC-DM）组、排泌期-VNC-DLIR高档（delay phase-VNC-DLIR high，DP-VNC-DH）组。记录平扫、实质期及排泌期的辐射剂量。在5组图像上分别测量CT值、噪声（SD）、信噪比(signal-to-noise ratio， SNR)和对比噪声比(contrast-to-noise ratio， CNR)，并进行组间比较。由2位资深放射诊断医师，用李克特五级量表法(Likert Scale)计分方法对图像质量和病灶显示度进行主观评价。此外，以TNC作为标准，采用Bland-Altman分析VNC上肾结石的CT值和体积的测量差异。结果：在客观图像质量评价上，VNC-DH组图像质量优于TNC-AR70，且5组图像间的CT值差异无统计学意义(P>0.05)；DP-VNC-DH组的图像噪声最低，SNR、CNR最高。在主观评价方面，DP-VNC-DH组的图像质量评分最高，而VP-VNC-DH组在病灶显示度方面表现最佳。在结石的CT值和体积测量上，4组VNC重建图像与真实平扫之间均无统计学差异(P>0.05)。 结论：在CTU检查中，基于DLIR重建技术的VNC图像质量优于基于ASIR-V 70%重建的真实平扫，推荐结合使用实质期和排泌期的DLIR-H重建VNC图像代替真实平扫，以减少CTU扫描的辐射剂量。

Objective To investigate the effect of dual-energy CT (DECT) virtual non-contrast (VNC) images reconstructed by deep learning image reconstruction (DLIR) on the image quality and measurements of renal calculus in CT urography (CTU). Methods The clinical and imaging data of 90 patients who underwent abdominal and pelvic non-contrast CT examination followed by a nephrographic-phase DE CTU during September 2022 to April 2023 were retrospectively analyzed. The non-contrast CT images were reconstructed with ASIR-V with 70% weight (TNC-AR70). Four groups of VNC images were reconstructed based on medium level and high level DLIR for venous phase and delay phase, namely venous phase-VNC-DLIR medium (VP-VNC-DM), venous phase-VNC-DLIR high (VP-VNC-DH), delay phase-VNC-DLIR medium (DP-VNC-DM), and delay phase-VNC-DLIR high (DP-VNC-DH). The radiation doses of TNC and VNC in venous phase and delay phase were recorded. The mean CT value, image noise (SD), signal-to-noise ratio (SNR) and contrast-to-noise (CNR) were recorded and compared among the five groups. Two radiologists independently assessed the overall image qua-lity and lesion visibility with 5-point Likert scale. Additionally, according to results of TNC, Bland-Altman was used to analyze the measurement differences between VNC and TNC in mean CT value and mean size of renal calculus. Results In the objective assessments, the image quality of the VNC-DH group was better than that of TNC-AR70, and there was no statistically significant difference in CT value among the five groups of images (P>0.05). DP-VNC-DH showed the lowest SD and the highest SNR and CNR values. In the subjective assessments, DP-VNC-DH achieved the best subject scores on image qua-lity, and VP-VNC-DH achieved the best subject scores on lesion visibility. Furthermore, Bland-Altman analysis showed that there was a strong overall agreement between VNC and TNC for renal calculus characterization (all P>0.005). Conclusions VNC generated by DLIR may provide high-quality image compared with the non-contrast images reconstructed with ASIR-V 70% in CTU.The combination of the VNC images generated by DLIR-H from venous phase and delay phase could replace TNC scanning,reducing the radiation dose of CTU scans.