采集时间窗对冠状动脉CT图像质量及辐射剂量的影响
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摘要
目的探讨冠状动脉CT成像(CCTA)最佳重建期相随心率变化的规律。依据结果设置最佳采集时间窗,并计算其降低辐射剂量的能力。方法回顾性分析2016年11月至2017年10月以心功能分析为检查目的接受全心动周期全剂量CCTA的616例患者资料。由2名诊断医师确定最佳重建期相,分析最佳重建期相随心率变化的规律。依据此结果设定根据心率决定的窄采集时间窗模式。采集时间窗位于最佳重建期相的平均值±标准差×2,即95%置信区间。计算此采集模式较全心动周期采集模式降低辐射剂量的程度。结果 616例受检者,心率(71±14)次/分(42～149次/分)。低心率组(<61次/分)最佳重建期相:(76±3)%RR间期,95%置信区间:70%～82%RR间期;中心率组(61～75次/分)最佳重建期相以60%RR间期为界位于(44±3)%及(76±3)%RR间期,95%置信区间:38%～50%RR间期及70%～82%RR间期;高心率组(>75次/分)最佳重建期相:(48±5)%RR间期,95%置信区间:38%～58%RR间期。以95%置信区间作为采集时间窗,较全心动周期采集模式降低CTDIvol约80%(低心率)、56%(中心率)、70%(高心率)。结论慢心率者冠状动脉运动相对静止期位于舒张中末期;高心率者位于收缩末期;中心率者位于收缩末期或舒张中末期。以最佳重建期相95%置信区间作为采集时间窗,可以在保证图像质量的前提下缩短曝光时间从而降低辐射剂量。
Objective To determine optimal reconstruction phase in relation to heart rate(HR). On the basis of these findings,an optimal acquisition window was designed,and the potential dose-saving effect was calculated. Methods 616 CCTA exams were performed(HR 71±14 bpm; range 42–149 bpm) using a wide acquisition window(0%–100% of the RR interval). Optimal reconstruction phases were determined by two observers. Based on the findings,a narrow HR-dependent acquisition window was centered at the mean of optimal reconstruction phase with a symmetric width of 2 standard deviation(SD)(95% confidence interval). The potential of dose-saving was calculated by comparing the volumetric CT dose index(CTDIvol) of different acquisition windows. Results At low HR(<61 bpm,133 patients),high-quality data sets were obtained during(76±3)% of the RR interval; at high HR(>75 bpm,190 patients),they were obtained during(48±5)%; and at intermediate HR(61–75 bpm,293 patients),they were obtained during either(44±3)% or(76±3)%. Based on the results above,narrow acquisition windows for low,high and intermediate HR were at 70%–82%,38%–58%,and both 38%–50% and 70%–82% of the RR interval,respectively. With narrow windows,the CTDIvol was decreased at low HR by around 80%,at intermediate HR by 56%,and at high HR by about 70%. Conclusion With narrow HR-dependent acquisition windows,radiation dose can be reduced with preserved image quality.
Objective To determine optimal reconstruction phase in relation to heart rate(HR). On the basis of these findings,an optimal acquisition window was designed,and the potential dose-saving effect was calculated. Methods 616 CCTA exams were performed(HR 71±14 bpm; range 42–149 bpm) using a wide acquisition window(0%–100% of the RR interval). Optimal reconstruction phases were determined by two observers. Based on the findings,a narrow HR-dependent acquisition window was centered at the mean of optimal reconstruction phase with a symmetric width of 2 standard deviation(SD)(95% confidence interval). The potential of dose-saving was calculated by comparing the volumetric CT dose index(CTDIvol) of different acquisition windows. Results At low HR(<61 bpm,133 patients),high-quality data sets were obtained during(76±3)% of the RR interval; at high HR(>75 bpm,190 patients),they were obtained during(48±5)%; and at intermediate HR(61–75 bpm,293 patients),they were obtained during either(44±3)% or(76±3)%. Based on the results above,narrow acquisition windows for low,high and intermediate HR were at 70%–82%,38%–58%,and both 38%–50% and 70%–82% of the RR interval,respectively. With narrow windows,the CTDIvol was decreased at low HR by around 80%,at intermediate HR by 56%,and at high HR by about 70%. Conclusion With narrow HR-dependent acquisition windows,radiation dose can be reduced with preserved image quality.
引文
1 中华医学会放射学分会心胸学组.《中华放射学杂志》心脏冠状动脉多排CT临床应用指南写作专家组. 心脏冠状动脉CT血管成像技术规范化应用中国指南[J]. 中华放射学杂志,2017,51:732-743.
2 Leipsic J,Abbara S,Achenbach S,et al. SCCT guidelines for the interpretation and reporting of coronary CT angiography:a report of the Society of Cardiovascular Computed Tomography Guidelines Committee[J]. J CardiovascComputTomogr,2014,8:342-358.
3 Abbara S,Blanke P,Maroules CD,et al. SCCT guidelines for the performance and acquisition of coronary computed tomographic angiography:A report of the society of Cardiovascular Computed Tomography Guidelines Committee:Endorsed by the North American Society for Cardiovascular Imaging (NASCI)[J]. J CardiovascComputTomogr,2016,10:435-449.
4 邢桂荣,包丽丽,刘挨师. 320排CT前瞻性心电门控容积扫描窄采集窗设置的临床评价[J]. CT理论与应用研究,2016,25:445-452.
5 孙钢,李敏,李国英,等.320排容积CT冠状动脉血管成像心率与重组时相对图像质量的影响[J]. 中华医学杂志,2011,91:5-10.
6 汪芳,郝万庆,杨利莉,等.256排宽体探测器CT智能心电门控技术在不控制心率患者冠状动脉CTA中的应用[J].中国医学影像技术,2017,33:1080-1084.
7 梁俊福,王辉,徐磊,等.256层CT单个心动周期冠状动脉成像在高心率患者中应用的可行性研究[J].中华放射学杂志,2017,51:108-113.
8 Liang J,Wang H,Xu L,et al. Diagnostic performance of 256-row detector coronary CT angiography in patients with high heart rates within a single cardiac cycle:a preliminary study[J]. ClinRadiol,2017,72:694.
9 Steigner ML,Otero HJ,Cai T,et al. Narrowing the phase window width in prospectively ECG-gated single heart beat 320-detector row coronary CT angiography[J]. Int J Cardiovasc Imaging,2009,25:85-90.
10 Lee AM,Beaudoin J,EngelL C,et al. Assessment of image quality and radiation dose of prospectively ECG-triggered adaptive dual-source coronary computed tomography angiography (cCTA) with arrhythmia rejection algorithm in systole versus diastole:a retrospective cohort study[J]. Int J Cardiovasc Imaging,2013,29:1361-1370.
11 Labounty TM,Leipsic J,Min JK,et al. Effect of padding duration on radiation dose and image interpretation in prospectively ECG-triggered coronary CT angiography[J]. AJR Am J Roentgenol,2010,94:933-937.
12 Achenbach S,Manolopoulos M,Schuhb?ck A,et al. Influence of heart rate and phase of the cardiac cycle onthe occurrence of motion artifact in dual-source CT angiography of the coronary arteries[J]. J Cardiovasc Comput Tomogr,2012,6:91-98.
13 Stassi D,Dutta S,Ma H,et al. Automated selection of the optimal cardiac phase for single-beat coronary CT angiography reconstruction[J]. Med Phys,2016,43:324.
14 Weustink AC,Mollet NR,Pugliese F,et al. Optimal electrocardiographic pulsing windows and heart rate:effect on image quality and radiation exposure at dual-source coronary CT angiography[J]. Radiology,2008,248:792-798.
15 Mok GS,Yang CC,Chen LK,et al. Optimal systolic and diastolic image reconstruction windows for coronary 256-slice CT angiography[J]. AcadRadiol,2010,17:1386-1393.
16 Sun G,Li M,Li L,et al. Optimal systolic and diastolic reconstruction windows for coronary CT angiography using 320-detector rows dynamic volume CT[J]. ClinRadiol,2011,66:614-620.
17 柴学,张龙江,周长圣,等. 窦性心动过速患者双源CT冠状动脉成像:最佳期相及平均心率和心率变异性对影像质量影响的研究[J].中国医学影像技术,2008,24:1311-1314.
18 Yang CC,Mok GS,Law WY,et al. Potential dose reduction of optimal ECG-controlled tube current modulation for 256-slice CT coronary angiography[J]. AcadRadiol,2011,18:731-737.
2 Leipsic J,Abbara S,Achenbach S,et al. SCCT guidelines for the interpretation and reporting of coronary CT angiography:a report of the Society of Cardiovascular Computed Tomography Guidelines Committee[J]. J CardiovascComputTomogr,2014,8:342-358.
3 Abbara S,Blanke P,Maroules CD,et al. SCCT guidelines for the performance and acquisition of coronary computed tomographic angiography:A report of the society of Cardiovascular Computed Tomography Guidelines Committee:Endorsed by the North American Society for Cardiovascular Imaging (NASCI)[J]. J CardiovascComputTomogr,2016,10:435-449.
4 邢桂荣,包丽丽,刘挨师. 320排CT前瞻性心电门控容积扫描窄采集窗设置的临床评价[J]. CT理论与应用研究,2016,25:445-452.
5 孙钢,李敏,李国英,等.320排容积CT冠状动脉血管成像心率与重组时相对图像质量的影响[J]. 中华医学杂志,2011,91:5-10.
6 汪芳,郝万庆,杨利莉,等.256排宽体探测器CT智能心电门控技术在不控制心率患者冠状动脉CTA中的应用[J].中国医学影像技术,2017,33:1080-1084.
7 梁俊福,王辉,徐磊,等.256层CT单个心动周期冠状动脉成像在高心率患者中应用的可行性研究[J].中华放射学杂志,2017,51:108-113.
8 Liang J,Wang H,Xu L,et al. Diagnostic performance of 256-row detector coronary CT angiography in patients with high heart rates within a single cardiac cycle:a preliminary study[J]. ClinRadiol,2017,72:694.
9 Steigner ML,Otero HJ,Cai T,et al. Narrowing the phase window width in prospectively ECG-gated single heart beat 320-detector row coronary CT angiography[J]. Int J Cardiovasc Imaging,2009,25:85-90.
10 Lee AM,Beaudoin J,EngelL C,et al. Assessment of image quality and radiation dose of prospectively ECG-triggered adaptive dual-source coronary computed tomography angiography (cCTA) with arrhythmia rejection algorithm in systole versus diastole:a retrospective cohort study[J]. Int J Cardiovasc Imaging,2013,29:1361-1370.
11 Labounty TM,Leipsic J,Min JK,et al. Effect of padding duration on radiation dose and image interpretation in prospectively ECG-triggered coronary CT angiography[J]. AJR Am J Roentgenol,2010,94:933-937.
12 Achenbach S,Manolopoulos M,Schuhb?ck A,et al. Influence of heart rate and phase of the cardiac cycle onthe occurrence of motion artifact in dual-source CT angiography of the coronary arteries[J]. J Cardiovasc Comput Tomogr,2012,6:91-98.
13 Stassi D,Dutta S,Ma H,et al. Automated selection of the optimal cardiac phase for single-beat coronary CT angiography reconstruction[J]. Med Phys,2016,43:324.
14 Weustink AC,Mollet NR,Pugliese F,et al. Optimal electrocardiographic pulsing windows and heart rate:effect on image quality and radiation exposure at dual-source coronary CT angiography[J]. Radiology,2008,248:792-798.
15 Mok GS,Yang CC,Chen LK,et al. Optimal systolic and diastolic image reconstruction windows for coronary 256-slice CT angiography[J]. AcadRadiol,2010,17:1386-1393.
16 Sun G,Li M,Li L,et al. Optimal systolic and diastolic reconstruction windows for coronary CT angiography using 320-detector rows dynamic volume CT[J]. ClinRadiol,2011,66:614-620.
17 柴学,张龙江,周长圣,等. 窦性心动过速患者双源CT冠状动脉成像:最佳期相及平均心率和心率变异性对影像质量影响的研究[J].中国医学影像技术,2008,24:1311-1314.
18 Yang CC,Mok GS,Law WY,et al. Potential dose reduction of optimal ECG-controlled tube current modulation for 256-slice CT coronary angiography[J]. AcadRadiol,2011,18:731-737.