P3T模块化注射技术在心脏“一站式”CT检查中的应用
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摘要
目的:探讨P3T模块化个性注射技术在双源CT心脏"一站式"检查中的优势。方法:将拟行心脏"一站式"检查的40例患者随机分为2组。对照组采用按公斤体质量计算用量的常规给药方案。试验组采用Medrad公司新研发的P3T模块化个性注射技术根据患者的情况计算得出的给药方案。对比剂均采用370 mgI/mL优维显,2组均在Siemens公司的二代双源CT机上完成心脏"一站式"检查,在其余相同参数下对比分析2组的图像质量及对比剂用量。结果:试验组及对照组共40例患者均成功完成检查,2组一般资料均无统计学差异(P>0.05)。图像质量在冠状动脉的显示上:2组冠脉近、中段的CT值均无统计学差异(右冠近段CT值P=0.829、右冠中段CT值P=0.837、前降支近段CT值P=0.927、前降支中段CT值P=0.731、回旋支近段CT值P=0.637、回旋支中段CT值P=0.949);2组冠脉近中段CT值差异均无统计学意义(右冠近中段CT值差异P=0.991、前降支近中段CT值差异P=0.512、回旋支近中段CT值差异P=0.164)。试验组冠状动脉远段的CT值均高于对照组,差异有统计学意义(右冠远段CT值P=0.016、前降支远段CT值P=0.012、回旋支远段CT值P=0.024);试验组冠脉中远段及近远段CT值差异均小于对照组,差异有统计学意义(右冠中远段CT值差异P=0.000、右冠近远段CT值差异P=0.011、前降支中远段CT值差异P=0.002、前降支近远段CT值差异P=0.002、回旋支中远段CT值差异P=0.000、回旋支近远段CT值差异P=0.006)。图像质量在心肌灌注分析上:对比剂产生的线束硬化伪影数目试验组明显少于对照组(44 vs. 69);2组在舒张期基底部层面及心腔中间层面各段正常心肌平均碘含量无统计学差异(基底部层面心肌碘含量P=0.236、中间部层面心肌碘含量P=0.624);试验组在舒张期心尖层面及心尖段的正常心肌平均碘含量高于对照组,差异有统计学意义(心尖层面心肌碘含量P=0.012、心尖段心肌碘含量P=0.014)。在对比剂用量方面:2组在正式扫描时对比剂的用量无统计学差异(P=0.734)。结论:在心脏"一站式"CT检查中,使用Medrad P3T模块化注射技术能有效显示心脏冠状动脉远端及细小分支血管,减少心肌灌注分析时对比剂产生的线束硬化伪影带来的假"阳性"结果,从而有效提高图像质量。
Objective:To investigate the advantages of the P3 T modularized and personalized injection technique in "one-stop-shop"cardiac inspection by dual-source computed tomography(CT). Methods:Forty patients undergoing "one-stop-shop"cardiac inspection were randomly assigned to two groups. The control group received a conventional dosage regimen based on the patients' body mass.The experimental group received a dosage regimen calculated by the P3 T modularized and personalized injection technique(Medrad,Inc.)based on the patients' condition. Both groups received "one-stop-shop"cardiac inspection by a second-generation dual-source CT scanner(Siemens,Inc.)using the contrast medium with an iodine concentration of 370 mg/mL(Ultravist). The image quality and contrast medium dosage were compared between the two groups with other parameters remaining the same. Results:All patients in the two groups were successfully inspected. There were no significant differences in general information between the two groups(P>0.05).In terms of the quality of coronary artery images,there were no significant differences in the CT values of the proximal or middle coronary arteries between the two groups(the proximal right coronary artery P =0.829,the middle right coronary artery P =0.837,the proximal anterior descending coronary artery P =0.927,the middle anterior descending coronary artery P=0.731,the proximal circumflex coronary artery P =0.637,the middle circumflex coronary artery P=0.949);there were also no significant differences in the CT values of the proximal and middle segments of coronary arteries between the two groups(the proximal and middle segment of the right coronary artery P=0.991,the proximal and middle segment of the anterior descending coronary artery P =0.512,the proximal and middle segment of the circumflex coronary artery P=0.164);the CT values of the distal coronary arteries were significantly higher in the experimental group than in the control group(the distal right coronary artery P=0.016,the distal anterior descending coronary artery P=0.012,the distal circumflex coronary artery P=0.024);the CT values of the middle distal and proximal distal coronary arteries were significantly lower in the experimental group than in the control group(the middle distal segment of the right coronary artery P=0.000,the proximal distal segment of the right coronary artery P=0.011,the middle distal segment of the anterior descending coronary artery P=0.002,the proximal distal segment of the anterior descending coronary artery P =0.002,the middle distal segment of the circumflex coronary artery P =0.000,the proximal distal segment of the circumflex coronary artery P=0.006). In terms of the image quality in the myocardial perfusion analysis,the number of beam-hardening artifacts caused by the contrast medium was significantly lower in the experimental group than in the control group(44 vs. 69);there were no significant differences in the mean iodine concentrations of the normal myocardium in the basal or middle layer of the heart during diastole between the two groups(the basal layer of the heart P=0.236,the middle layer of the heart P=0.624);the mean iodine concentrations of the normal myocardium in the apical layer and apical segment during diastole were significantly higher in the experimental group than in the control group(the apical layer of the heart P=0.012,the apical segment of the heart P=0.014). There was no significant difference in the contrast medium dose between the two groups(P=0.734). Conclusion:In the "one-stop-shop"cardiac inspection,the P3 T modularized injection technique(Medrad,Inc.) can effectively improve the image quality by effectively demonstrating the distal and minor branches of the coronary arteries and reducing the false-positive results caused by the contrast medium-induced beam-hardening artifacts during the myocardial perfusion analysis.
Objective:To investigate the advantages of the P3 T modularized and personalized injection technique in "one-stop-shop"cardiac inspection by dual-source computed tomography(CT). Methods:Forty patients undergoing "one-stop-shop"cardiac inspection were randomly assigned to two groups. The control group received a conventional dosage regimen based on the patients' body mass.The experimental group received a dosage regimen calculated by the P3 T modularized and personalized injection technique(Medrad,Inc.)based on the patients' condition. Both groups received "one-stop-shop"cardiac inspection by a second-generation dual-source CT scanner(Siemens,Inc.)using the contrast medium with an iodine concentration of 370 mg/mL(Ultravist). The image quality and contrast medium dosage were compared between the two groups with other parameters remaining the same. Results:All patients in the two groups were successfully inspected. There were no significant differences in general information between the two groups(P>0.05).In terms of the quality of coronary artery images,there were no significant differences in the CT values of the proximal or middle coronary arteries between the two groups(the proximal right coronary artery P =0.829,the middle right coronary artery P =0.837,the proximal anterior descending coronary artery P =0.927,the middle anterior descending coronary artery P=0.731,the proximal circumflex coronary artery P =0.637,the middle circumflex coronary artery P=0.949);there were also no significant differences in the CT values of the proximal and middle segments of coronary arteries between the two groups(the proximal and middle segment of the right coronary artery P=0.991,the proximal and middle segment of the anterior descending coronary artery P =0.512,the proximal and middle segment of the circumflex coronary artery P=0.164);the CT values of the distal coronary arteries were significantly higher in the experimental group than in the control group(the distal right coronary artery P=0.016,the distal anterior descending coronary artery P=0.012,the distal circumflex coronary artery P=0.024);the CT values of the middle distal and proximal distal coronary arteries were significantly lower in the experimental group than in the control group(the middle distal segment of the right coronary artery P=0.000,the proximal distal segment of the right coronary artery P=0.011,the middle distal segment of the anterior descending coronary artery P=0.002,the proximal distal segment of the anterior descending coronary artery P =0.002,the middle distal segment of the circumflex coronary artery P =0.000,the proximal distal segment of the circumflex coronary artery P=0.006). In terms of the image quality in the myocardial perfusion analysis,the number of beam-hardening artifacts caused by the contrast medium was significantly lower in the experimental group than in the control group(44 vs. 69);there were no significant differences in the mean iodine concentrations of the normal myocardium in the basal or middle layer of the heart during diastole between the two groups(the basal layer of the heart P=0.236,the middle layer of the heart P=0.624);the mean iodine concentrations of the normal myocardium in the apical layer and apical segment during diastole were significantly higher in the experimental group than in the control group(the apical layer of the heart P=0.012,the apical segment of the heart P=0.014). There was no significant difference in the contrast medium dose between the two groups(P=0.734). Conclusion:In the "one-stop-shop"cardiac inspection,the P3 T modularized injection technique(Medrad,Inc.) can effectively improve the image quality by effectively demonstrating the distal and minor branches of the coronary arteries and reducing the false-positive results caused by the contrast medium-induced beam-hardening artifacts during the myocardial perfusion analysis.
引文
[1]刘思宏,刘孝臣,吴平,等.双源双能量CT心肌灌注成像对冠心病的诊断价值[J].中国循证心血管医学杂志,2016,8(11):1351-1353.
[2]Schwarz F,Ruzsics B,Schorpf UJ,et al.Dual-energy CT of the heart-principles and protocols[J].Eur J Radiol,2008,68(3):423-433.
[3]Graser A,Johnson TR,Hecht EM,et al.Dual-energy CT in patients suspected of having renal masses:can virtual nonenhanced images replace true nonenhanced images[J].Radiology,2009,252(2):433-440.
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[5]魏淼,王思杭,温家华,等.双源双能量CT心肌灌注扫描的单能量成像对线束硬化伪影的校正研究[J].第三军医大学学报,2015,37(16):1662-1667.
[6]Jung SC,Kim SH,Cho JY.A comparison of the use of contrast media with different iodine concentrations for multidetector CT of the kidney[J].Korean J Radiol,2011,12(6):714-721.
[7]薛波.P3T心脏模块个性化患者注射技术在心脏冠状动脉成像中的初步探讨[J].实用放射学杂志,2014,30(9):1553-1555.
[8]祁荣兴,王天乐,崔磊,等.双能量CT心肌灌注碘图图像质量与重组时相的关系[J].中国医学影像技术,2017,33(5):760-763.
[9]Kern MJ,Samady H.Current concepts of integrated coronary physiology in the catheterization laboratory[J].J Am Coll Cardiol,2010,55(3):173-185.
[10]Weininger M,Schoepf UJ,Ramachandra A,et al.Adenosinestress dynamic real-time myocardial perfusion CT and adenosine-stress firstpass dual-energy myocardial perfusion CT for the assessment of acute chest pain:Initial results[J].Eur J Radiol,2012,81(12):3703-3710.
[11]史金雁.高压注射器在CT增强扫描中的应用与探讨[J].中国医药指南,2016,14(18):81.
[12]Chae EJ,Seo JB,Krauss B,et al.Dual-energy CT for assessment of the severity of acute pulmonary embolism:pulmonary perfusion defect score compared with CT angiographic obstruction ccore and right ventricular/left ventricular diameter ratio[J].AJR,2010,194(3):604-610.
[13]Okayama S,Seno A,Soeda T,et al.Optimization of energy level for coronary angiography with dual-energy and dual-source computed tomography[J].Int J Cardiovasc Imaging,2012,28(4):901-909.
[14]Rodriguez-Granillo GA,Rosales MA,Degrossi E,et al.Signal density of left ventricular myocardial segments and impact of beam hardening artifact:implication for myocardial perfusion assessment by multidetector CT coronary angiography[J].Int J Cardiovasc Imaging,2010,26(3):345-354.
[2]Schwarz F,Ruzsics B,Schorpf UJ,et al.Dual-energy CT of the heart-principles and protocols[J].Eur J Radiol,2008,68(3):423-433.
[3]Graser A,Johnson TR,Hecht EM,et al.Dual-energy CT in patients suspected of having renal masses:can virtual nonenhanced images replace true nonenhanced images[J].Radiology,2009,252(2):433-440.
[4]Yoon MA,Kim SH,Lee JM,et al.Adaptive statistical iterative reconstruction and Veo:assessment of image quality and diagnostic performance in CT colonography at various radiation doses[J].J Comput Assist Tomogr,2012,36(5):596-601.
[5]魏淼,王思杭,温家华,等.双源双能量CT心肌灌注扫描的单能量成像对线束硬化伪影的校正研究[J].第三军医大学学报,2015,37(16):1662-1667.
[6]Jung SC,Kim SH,Cho JY.A comparison of the use of contrast media with different iodine concentrations for multidetector CT of the kidney[J].Korean J Radiol,2011,12(6):714-721.
[7]薛波.P3T心脏模块个性化患者注射技术在心脏冠状动脉成像中的初步探讨[J].实用放射学杂志,2014,30(9):1553-1555.
[8]祁荣兴,王天乐,崔磊,等.双能量CT心肌灌注碘图图像质量与重组时相的关系[J].中国医学影像技术,2017,33(5):760-763.
[9]Kern MJ,Samady H.Current concepts of integrated coronary physiology in the catheterization laboratory[J].J Am Coll Cardiol,2010,55(3):173-185.
[10]Weininger M,Schoepf UJ,Ramachandra A,et al.Adenosinestress dynamic real-time myocardial perfusion CT and adenosine-stress firstpass dual-energy myocardial perfusion CT for the assessment of acute chest pain:Initial results[J].Eur J Radiol,2012,81(12):3703-3710.
[11]史金雁.高压注射器在CT增强扫描中的应用与探讨[J].中国医药指南,2016,14(18):81.
[12]Chae EJ,Seo JB,Krauss B,et al.Dual-energy CT for assessment of the severity of acute pulmonary embolism:pulmonary perfusion defect score compared with CT angiographic obstruction ccore and right ventricular/left ventricular diameter ratio[J].AJR,2010,194(3):604-610.
[13]Okayama S,Seno A,Soeda T,et al.Optimization of energy level for coronary angiography with dual-energy and dual-source computed tomography[J].Int J Cardiovasc Imaging,2012,28(4):901-909.
[14]Rodriguez-Granillo GA,Rosales MA,Degrossi E,et al.Signal density of left ventricular myocardial segments and impact of beam hardening artifact:implication for myocardial perfusion assessment by multidetector CT coronary angiography[J].Int J Cardiovasc Imaging,2010,26(3):345-354.