双低剂量冠状动脉CT血管成像在筛选老年冠心病中的应用价值
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摘要
目的评估应用128层螺旋CT(u CT 760)结合Karl 3D迭代技术进行低管电压、低对比剂碘摄入量冠状动脉CTA检查在老年群体的临床应用价值。方法前瞻性连续选取身体质量指数(BMI)在20～25 Kg/m~2临床怀疑或已知冠心病拟行冠状动脉CTA检查的200例老年患者。按随机数字表法选取60例为对照组(A组),其余140例为试验组(B组)。2组均行冠状动脉CTA检查,A组采用管电压120 kVp,碘对比剂浓度350 mgI/mL。B组再根据管电压和碘对比剂不同分为2个亚组,低剂量组B1组(60例)采用80 kVp、350 mgI/mL碘对比剂,双低剂量组B2组(80例)采用70 kVp、300 mgI/mL碘对比剂。并分别采用滤波反投影法(FBP)(A组)和Karl 3D迭代重建技术(B组)进行图像重建。对各组CT图像的辐射剂量[CT剂量容积指数(CTDIvol)和有效剂量(ED)]以及图像噪声(SD)、图像信噪比(SNR)、冠状动脉近段的对比噪声比(CNR)、对比剂碘摄入量进行系统测量。每例患者的冠状动脉CTA图像质量由2名放射科医师采用双盲法进行4分法主观评分。应用ANOVA单因素方差分析比较3组辐射剂量(CTDIvol和ED)、SD、SNR和冠状动脉近段CNR。采用秩和检验比较各组图像的主观评价指标差异。用Kappa检验评价2名观察者冠状动脉图像质量评分的一致性。结果 A组、B1组、B2组的CTDIvol分别为(17.81±0.92)mGy、(5.99±0.60)mGy和(4.87±1.35)mGy,ED分别为(3.59±0.15)m Sv、(1.21±0.13)m Sv和(0.97±0.29)m Sv,3组间两两比较差异有统计学意义(P<0.05)。A组、B1组、B2组在主、客观图像质量评分上差异无统计学意义(P>0.05)。双低剂量B2组较常规剂量A组对比剂碘摄入量减少了21.4%。结论 128层螺旋CT采用低管电压、低对比剂碘摄入量在老年群体中行冠状动脉CTA检查,通过结合Karl 3D迭代技术,在保证图像质量的前提下,可以有效降低辐射剂量及对比剂碘摄入量,从而达到老年群体低剂量冠状动脉成像的目的。
Objective To investigate the clinical application value of dual low dose coronary computed tomography angiography(CCTA) on 128 slices CT(u CT 760)using Karl 3 Diterative reconstruction technique(IRT)in elderly population. Methods Two hundred sequential patients with normal BMI(20-25 kg/m~2) who were suspected coronary heart disease(CHD)or had been diagnosed CHD underwent coronary CT angiography. Two hundred patients were divided into 2 groups at random:controlgroup(groupA) and experimental group(groupB).The tube voltage/Iodine contrast agent concentration was 120 kVp/350 mg/mL ingroup A. Group B was divided into the following two subgroups according to different tube voltage and Iodine contrast agent concentration:group B1(80 kVp/350 mg/mL),group B2(70 kVp/300 mg/mL).The imaging data were reconstructed by FBP(group A)or Karl IRT(group B). Two blinded readers graded image quality on a 4-point Likert scale. The differences in image noise,signal-tonoise ratio(SNR) contrast-to-noise ratio(CNR),CT dose volume index(CTDIvol),effective dose(ED),and image quality between the groups were compared by using ANOVA or ranks test. Results The CTDIvol and ED were respectively(17.81 ±0.92)mGy,(5.99 ±0.60)mGy,(4.87±1.35)mGy and(3.59±0.15)m Sv,(1.21±0.13)m Sv,(0.97±0.29)m Sv. There were significant differences of the CTDIvol and EDbetween group A,group B1 and group B2(P<0.05). There was no significant difference in subjective and objective image quality scores among the three groups(P>0.05). Compared with the conventional dose group,the dose of iodine contrast agent in low-dose group B2 decreased by 21.4%. Conclusion Dual low dose CCTA on 128 slices CT,by usingKarl 3 DIRT,can effectively reduce the radiation dose and contrast agent iodine intake without compromise of image quality,and achieve the purpose of low-dose coronary angiography in the elderly population.
Objective To investigate the clinical application value of dual low dose coronary computed tomography angiography(CCTA) on 128 slices CT(u CT 760)using Karl 3 Diterative reconstruction technique(IRT)in elderly population. Methods Two hundred sequential patients with normal BMI(20-25 kg/m~2) who were suspected coronary heart disease(CHD)or had been diagnosed CHD underwent coronary CT angiography. Two hundred patients were divided into 2 groups at random:controlgroup(groupA) and experimental group(groupB).The tube voltage/Iodine contrast agent concentration was 120 kVp/350 mg/mL ingroup A. Group B was divided into the following two subgroups according to different tube voltage and Iodine contrast agent concentration:group B1(80 kVp/350 mg/mL),group B2(70 kVp/300 mg/mL).The imaging data were reconstructed by FBP(group A)or Karl IRT(group B). Two blinded readers graded image quality on a 4-point Likert scale. The differences in image noise,signal-tonoise ratio(SNR) contrast-to-noise ratio(CNR),CT dose volume index(CTDIvol),effective dose(ED),and image quality between the groups were compared by using ANOVA or ranks test. Results The CTDIvol and ED were respectively(17.81 ±0.92)mGy,(5.99 ±0.60)mGy,(4.87±1.35)mGy and(3.59±0.15)m Sv,(1.21±0.13)m Sv,(0.97±0.29)m Sv. There were significant differences of the CTDIvol and EDbetween group A,group B1 and group B2(P<0.05). There was no significant difference in subjective and objective image quality scores among the three groups(P>0.05). Compared with the conventional dose group,the dose of iodine contrast agent in low-dose group B2 decreased by 21.4%. Conclusion Dual low dose CCTA on 128 slices CT,by usingKarl 3 DIRT,can effectively reduce the radiation dose and contrast agent iodine intake without compromise of image quality,and achieve the purpose of low-dose coronary angiography in the elderly population.
引文
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[8]朱莉,周慧. Karl 3D迭代重建技术对胸部低剂量CT图像质量的影响[J].实用放射学杂志,2017,33(2):280-282.
[9] Mangold S,Wichmann JL,Schoepf UJ,et al. Diagnostic accuracy of coronary CT angiography using 3rd-generation dual-source CT and automated tube voltage selection:Clinical application in a non-obese and obese patient population[J].Eur Radiol,2017,27(6):2298-2308.
[10] Zhang C,Yu Y,Zhang Z,et al. Imaging quality evaluation of low tube voltage coronary CT angiography using low concentration contrast medium[J]. PLo S One, 2015, 10(3):e0120539.
[11] Cho ES, Chung TS, Oh DK, et al. Cerebral computed tomography angiography using a low tube voltage(80 kVp)and a moderate concentration of iodine contrast material:a quantitative and qualitative comparison with conventional computed tomography angiography[J]. Invest Radiol,2012,47(2):142-147.
[12] Nakaura T,Awai K,Maruyama N,et al. Abdominal dynamic CT in patients with renal dysfunction:contrast agent dose reduction with low tube voltage and high tube current-time product settings at 256-detector row CT[J]. Radiology,2011,261(2):467-476.
[13] Duan Y, Wang X, Yang X, et al. Diagnostic efficiency of low-dose CT angiography compared with conventional angiography in peripheral arterial occlusions[J]. AJR Am J Roentgenol,2013,201(6):W906-W914.
[2]王海林,纪建松,卢陈英,等.胸围调节管电压技术冠状动脉CT血管成像的图像质量和辐射剂量[J].中华放射学杂志,2016,50(4):284-288.
[3] Hur G, Hong SW, Kim SY, et al. Uniform image quality achieved by tube current modulation using SD of attenuation in coronary CT angiography[J]. AJR Am J Roentgenol,2007,189(1):188-196.
[4]张静,郑君惠.冠状动脉CT血管成像双低扫描技术应用进展[J].中华放射医学与防护杂志,2018,38(10):796-800.
[5] Oda S,Utsunomiya D,Yuki H,et al. Low contrast and radiation dose coronary CT angiography using a 320-row system and a refined contrast injection and timing method[J]. J Cardiovasc Comput Tomogr,2015,9(1):19-27.
[6]徐超,杨琳,于薇,等.迭代重建在双源CT冠状动脉成像中的应用[J].中国医学影像技术,2012,28(1):168-171.
[7] Zhang C,Zhang Z,Yan Z,et al. 320-row CT coronary angiography:effect of 100-kV tube voltages on image quality,contrast volume, and radiation dose[J]. Int J Cardiovasc Imaging,2011,27(7):1059-1068.
[8]朱莉,周慧. Karl 3D迭代重建技术对胸部低剂量CT图像质量的影响[J].实用放射学杂志,2017,33(2):280-282.
[9] Mangold S,Wichmann JL,Schoepf UJ,et al. Diagnostic accuracy of coronary CT angiography using 3rd-generation dual-source CT and automated tube voltage selection:Clinical application in a non-obese and obese patient population[J].Eur Radiol,2017,27(6):2298-2308.
[10] Zhang C,Yu Y,Zhang Z,et al. Imaging quality evaluation of low tube voltage coronary CT angiography using low concentration contrast medium[J]. PLo S One, 2015, 10(3):e0120539.
[11] Cho ES, Chung TS, Oh DK, et al. Cerebral computed tomography angiography using a low tube voltage(80 kVp)and a moderate concentration of iodine contrast material:a quantitative and qualitative comparison with conventional computed tomography angiography[J]. Invest Radiol,2012,47(2):142-147.
[12] Nakaura T,Awai K,Maruyama N,et al. Abdominal dynamic CT in patients with renal dysfunction:contrast agent dose reduction with low tube voltage and high tube current-time product settings at 256-detector row CT[J]. Radiology,2011,261(2):467-476.
[13] Duan Y, Wang X, Yang X, et al. Diagnostic efficiency of low-dose CT angiography compared with conventional angiography in peripheral arterial occlusions[J]. AJR Am J Roentgenol,2013,201(6):W906-W914.