“双低”技术在胸部CT增强扫描中的可行性研究
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摘要
目的 :探讨CT"双低"技术(等渗低浓度对比剂、低管电压)对胸部增强扫描成像质量及辐射剂量的影响。方法 :选取85例行CT胸部平扫及增强扫描的初诊患者(18.5 kg/m2<体质量指数<28 kg/m2),随机分为A组(41例)和B组(44例)。A组采用高浓度对比剂(350 mg I/m L)、常规管电压(120 k V);B组采用等渗低浓度对比剂(270 mg I/m L)、低管电压(100 k V)。分别记录及计算每位患者的容积CT剂量指数(CTDIvol)、剂量长度乘积(DLP)、有效辐射剂量(ED)、血管及肌肉强化后的平均CT值、噪声及对比噪声比(CNR)。图像质量客观评价通过对各组血管及肌肉强化后的CT值、CNR分析得出;图像质量主观评价由2名不同年资诊断医师采用4分制对各组图像质量进行评分。各组间辐射剂量指标、客观评价指标及主观图像质量评价均采用t检验,以P<0.05为差异有统计学意义。结果:B组较A组平均CTDIvol降低36.87%,平均DLP值降低36.19%,平均ED值降低36.35%(均P<0.05)。A、B组强化后血管平均CT值、肌肉平均CT值差异均无统计学意义(均P<0.05),B组噪声较A组增加约28.3%,CNR降低约22.0%,差异均有统计学意义(均P<0.05),A、B组主观图像质量评分差异无统计学意义(P>0.05)。结论:使用"双低"技术行胸部CT增强扫描,可有效降低受检者辐射剂量,降低对比剂肾病及过敏风险,并能满足影像诊断需求,具有一定的可行性。
Objective:To explore the feasibility of CT low tube voltage combined with low concentration contrast agent in enhanced imaging of the chest. Methods:85 patients with chest enhanced CT scan were randomly divided into 2 groups. Group A(28 males,13 females) were performed with conventional k V and high concentration contrast agent(120 k V,350 mg/m L),group B(30 males,14 females) were performed with low k V and low concentration contrast agent(100 k V,270 mg/m L). The CTDIvol,DLP,ED,the average enhanced CT values of vessels and muscles,image noise,CNR and the subjective image quality in two groups were recorded and compared. Results:Comparing with group A,the average CTDIvol of group B decreased 36.87%,the average DLP decreased 36.19%,the average ED decreased 36.35%,the average SD increased 28.3%,the average CNR decreased22%. The average blood CT value and muscle CT value between two groups had no significant differences. Subjective image quality scores in two groups had no statistically significant difference. Conclusions:CT low tube voltage combined with low concentration contrast agent in enhanced imaging of the chest can decrease the radiation dose of patient,and reach the requirements of clinical diagnosis,and can be used in enhanced chest CT.
Objective:To explore the feasibility of CT low tube voltage combined with low concentration contrast agent in enhanced imaging of the chest. Methods:85 patients with chest enhanced CT scan were randomly divided into 2 groups. Group A(28 males,13 females) were performed with conventional k V and high concentration contrast agent(120 k V,350 mg/m L),group B(30 males,14 females) were performed with low k V and low concentration contrast agent(100 k V,270 mg/m L). The CTDIvol,DLP,ED,the average enhanced CT values of vessels and muscles,image noise,CNR and the subjective image quality in two groups were recorded and compared. Results:Comparing with group A,the average CTDIvol of group B decreased 36.87%,the average DLP decreased 36.19%,the average ED decreased 36.35%,the average SD increased 28.3%,the average CNR decreased22%. The average blood CT value and muscle CT value between two groups had no significant differences. Subjective image quality scores in two groups had no statistically significant difference. Conclusions:CT low tube voltage combined with low concentration contrast agent in enhanced imaging of the chest can decrease the radiation dose of patient,and reach the requirements of clinical diagnosis,and can be used in enhanced chest CT.
引文
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[13]朱维俊,窦小峰,陈敏.128层螺旋CT低碘流率、低管电压冠状动脉成像诊断冠状动脉斑块的临床价值[J].中国中西医结合影像学杂志,2017,15(1):22-23.
[14]陈建,高志鹏,李绪斌,等.低浓度碘对比剂、低剂量扫描技术联合体质量指数上腹部CT检查的辐射剂量和图像质量[J].中华放射学杂志,2017,51(2):141-144.
[15]梁坚豪,朱新进,杨侃荣,等.低辐射剂量联合低剂量对比剂在甲状腺CT增强扫描中的应用[J].中国医学影像学杂志,2017,25(2):105-108.
[16]唐雷,王谦,曾宪春,等.家犬胸部低管电压扫描结合迭代重建SAFIRE技术的运用[J].实用医学杂志,2015,31(20):3298-3301.
[17]刘琦,徐凯,张秀莉,等.Dose Reduction技术结合低管电压技术在降低胸部增强CT辐射剂量的价值[J].临床放射学杂志,2015,34(8):1302-1306.
[18]Hojreh A,Kainberger F,Puig S.Low dose multislice CT in the pediatric patient[J].Radiology,2003,43:1051-1055.
[19]Paul JF,Abada HT.Strategies for reduction of radiation dose in cardiac multislice CT[J].Eur Radiol,2007,17:2028-2037.
[2]Buls N,Gompel GV,Cauteren TV,et al.Contrast agent and radiation dose reduction in abdominal CT by a combination of low tube voltage and advanced image reconstruction algorithms[J].Eur Radio,2015,25:1023-1031.
[3]European Commission’s Radiation Protection Actions.Guidelines on radiation dose on the patient//European guidelines on quality criteria for computed tomography.Report EUR 16262 EN[M].Luxembourg:Office for Official Publication of the European Communities,2006.
[4]王婕妤,乔伟,黎秋菊,等.低管电压结合低剂量对比剂在64层螺旋CT头颈部血管成像中的应用[J].中国医学影像学杂志,2015,23(7):481-485.
[5]谢惠,覃川,邓小林,等.低辐射剂量低浓度造影剂螺旋CT在肺动脉CTA扫描中的应用价值[J].河北医学,2017,23(2):225-228.
[6]吕婷婷,刘爱连,汪禾青,等.低浓度对比剂和低管电压结合适应性统计迭代技术对腹部动脉血管成像质量的影响[J].中国医学影像学杂志,2015,23(4):260-263.
[7]潘宇宁,李爱静,陈晓敏,等.低浓度等渗对比剂联合低管电压在肥胖患者冠状动脉成像中的应用[J].中华放射医学与防护杂志,2016,36(1):67-73.
[8]张栋青,柳澄.CT低剂量扫描研究进展[J].中国中西医结合影像学杂志,2013,11(2):209-212.
[9]Spearman JV,Schoepf UJ,Rottenkolber M,et al.Effect of automated attenuation-based tube voltage selection on radiation dose at CT:an observational study on a global scale[J].Radiology,2015,279:141507.
[10]张龙江,卢光明.双能量CT在胸部的应用和进展[J].中华放射学杂志,2011,45(1):92-94.
[11]崔效楠,叶兆祥.低辐射剂量和低浓度对比剂在胸部CT增强扫描中的应用及进展[J].肿瘤影像学,2013,22(4):300-304.
[12]栾贻新,张玉敏,巴照贵,等.低对比剂剂量、低管电压冠状动脉CTA在BMI>25 kg/m2患者中的应用[J].中国中西医结合影像学杂志,2016,14(4):433-436.
[13]朱维俊,窦小峰,陈敏.128层螺旋CT低碘流率、低管电压冠状动脉成像诊断冠状动脉斑块的临床价值[J].中国中西医结合影像学杂志,2017,15(1):22-23.
[14]陈建,高志鹏,李绪斌,等.低浓度碘对比剂、低剂量扫描技术联合体质量指数上腹部CT检查的辐射剂量和图像质量[J].中华放射学杂志,2017,51(2):141-144.
[15]梁坚豪,朱新进,杨侃荣,等.低辐射剂量联合低剂量对比剂在甲状腺CT增强扫描中的应用[J].中国医学影像学杂志,2017,25(2):105-108.
[16]唐雷,王谦,曾宪春,等.家犬胸部低管电压扫描结合迭代重建SAFIRE技术的运用[J].实用医学杂志,2015,31(20):3298-3301.
[17]刘琦,徐凯,张秀莉,等.Dose Reduction技术结合低管电压技术在降低胸部增强CT辐射剂量的价值[J].临床放射学杂志,2015,34(8):1302-1306.
[18]Hojreh A,Kainberger F,Puig S.Low dose multislice CT in the pediatric patient[J].Radiology,2003,43:1051-1055.
[19]Paul JF,Abada HT.Strategies for reduction of radiation dose in cardiac multislice CT[J].Eur Radiol,2007,17:2028-2037.