256层螺旋CT前置心电门控冠状动脉成像低剂量技术的临床应用研究
|
摘要
目的:
随着多层螺旋CT冠状动脉成像(MSCTCA)成功率和图像质量的提高,其临床应用也越来越广泛,但是其较高的辐射剂量也引起了人们的注意。文献报道前置心电门控冠状动脉成像采取轴位扫描技术,在满足临床诊断所需的图像质量的同时能有效降低辐射剂量。但以往关于心脏冠状动脉CT成像低剂量技术的研究多基于64层螺旋CT。具有8厘米超宽探测器的飞利浦256层螺旋CT已经投入临床使用,但关于其辐射剂量方面的研究尚不多。本研究应用飞利浦256层螺旋CT对两组分别接受前置心电门控扫描和后置心电门控扫描的受检者进行辐射剂量及图像质量的评估。
方法:
收集2010年10～12月来我院行256层螺旋CT冠状动脉成像扫描的患者60例,随机分为两组,每组30例,对两组患者分别进行前置心电门控扫描和后置心电门控扫描,并评估辐射剂量及图像质量。记录由计算机生成的容积CT剂量指数(CTDIVOL),用CTDIVOL乘以扫描长度得出剂量长度乘积(DLP),再计算有效剂量(ED)。用有效剂量表达受检者所受到的射线剂量。对两组的平均有效剂量进行统计学分析,判断其差异是否具有统计学意义。图像质量的评估分为主观评价和客观评价。客观评价指在冠状动脉横断面图像上分别选取适当的感兴趣区,并分别测量感兴趣区的平均CT,即升主动脉、右冠状动脉、左主干及左前降支的平均CT值,并对平均CT值进行统计学分析,判断其差异是否具有统计学意义。主观评价为评估冠状动脉节段的显示程度。按照美国心脏协会( AHA )的分类方法将冠状动脉分为16个节段。由两名有经验的影像诊断医师以双盲法对两组图像进行评分,记录各组分值,进行统计学分析,判断两组图像质量评分差异是否具有统计学意义。评分有分歧时由两人共同商讨后达成一致。
结果:
本次研究得出,前门控组和后门控组的有效放射剂量平均值分别为(3.7±0.9) mSv和( 18.0±6.5) mSv。两组间比较差异有统计学意义(t=-11.82,p=0.00<0.05),前门控低于后门控79.0%。前门控组和后门控组客观图像质量评估结果为:两组升主动脉感兴趣区平均CT值分别为(342.0±47.5)HU和(322.6±37.7)HU,两组间比较差异无统计学意义(t=1.75,p=0.08>0 . 05) ;两组右冠状动脉感兴趣区平均CT值分别为(323.2±71.8)HU和(306.9±72.4)HU,两组间比较差异无统计学意义(t=-0.87,p=0.38>0.05);两组左主干感兴趣区平均CT值分别为(353.6±57.6)HU和( 326.0±72.2 ) HU ,两组间比较差异无统计学意义(t=1.63,p=0.10>0 . 05) ;两组左前降支感兴趣区平均CT值分别为(307.8±76.8)HU和(280.8±75.5)HU,两组间比较差异无统计学意义(t=1.37,p=0.17>0.05)。两组间冠状动脉图像平均CT值经t检验差异无统计学意义(P>0.05)。两组间主观图像质量评分经非参数检验(Mann-Whitney检验)差异无统计学意义(U=-1.2,P=0.19>0.05);两组图像质量均能满足诊断要求。
结论:
与后置心电门控比较,前置心电门控在保持冠脉成像质量的同时降低了辐射剂量。
Objective:
Computed tomography (CT) coronary angiography has been widely used since the introduction of multi-slice scanners technology, but high radiation doses have been reported. Prospective ECG-gating using‘step- and- shoot’axial scanning protocol has been shown to reduce radiation exposure effectively while maintaining diagnostic accuracy. 256-slice scanners with 80 mm detector coverage have been currently introduced into practice, but their impact on radiation exposure has not been adequately studied. The aim of this study was to assess radiation doses associated with CT coronary angiography using a 256-slice CT scanner. radiation doses were estimated for 60 patients scanned with either prospective or retrospective ECG-gating.
Methods:
Our initial study cohort included 60 patients who were referred for CTCA at our department . Radiation dose estimates were expressed in the volume CT dose index (CTDIvol), dose–length product (DLP) and effective dose (ED).The CTDIvol was provided by the CT scanner.The dose–length product is defined as the CTDIvol multiplied by scan length.To obtain the effective dose, dose–length product was multiplied by an appropriate gender and body habitus averaged conversion coefficient for the adult thorax (k =0.014 mSv mGy?1 cm?1).Image quality was assessed objectively in terms of mean CT attenuation at selected regions of interest on axial coronary images and subjectively by coronary segment quality scoring.
Results:
It was found that radiation doses associated with prospective ECG-gating were significantly lower than retrospective ECGgating (3.7±0.9 mSv versus 18.0±6.5 mSv),reducing radiation dose by 79%. No statistically significant differences in image quality were observed between the two scanning protocols for both objective and subjective quality assessments.
Conclusion:
With the use of PT CTCA , radiation dose is markedly reduced and optimal image quality is maintained.
随着多层螺旋CT冠状动脉成像(MSCTCA)成功率和图像质量的提高,其临床应用也越来越广泛,但是其较高的辐射剂量也引起了人们的注意。文献报道前置心电门控冠状动脉成像采取轴位扫描技术,在满足临床诊断所需的图像质量的同时能有效降低辐射剂量。但以往关于心脏冠状动脉CT成像低剂量技术的研究多基于64层螺旋CT。具有8厘米超宽探测器的飞利浦256层螺旋CT已经投入临床使用,但关于其辐射剂量方面的研究尚不多。本研究应用飞利浦256层螺旋CT对两组分别接受前置心电门控扫描和后置心电门控扫描的受检者进行辐射剂量及图像质量的评估。
方法:
收集2010年10～12月来我院行256层螺旋CT冠状动脉成像扫描的患者60例,随机分为两组,每组30例,对两组患者分别进行前置心电门控扫描和后置心电门控扫描,并评估辐射剂量及图像质量。记录由计算机生成的容积CT剂量指数(CTDIVOL),用CTDIVOL乘以扫描长度得出剂量长度乘积(DLP),再计算有效剂量(ED)。用有效剂量表达受检者所受到的射线剂量。对两组的平均有效剂量进行统计学分析,判断其差异是否具有统计学意义。图像质量的评估分为主观评价和客观评价。客观评价指在冠状动脉横断面图像上分别选取适当的感兴趣区,并分别测量感兴趣区的平均CT,即升主动脉、右冠状动脉、左主干及左前降支的平均CT值,并对平均CT值进行统计学分析,判断其差异是否具有统计学意义。主观评价为评估冠状动脉节段的显示程度。按照美国心脏协会( AHA )的分类方法将冠状动脉分为16个节段。由两名有经验的影像诊断医师以双盲法对两组图像进行评分,记录各组分值,进行统计学分析,判断两组图像质量评分差异是否具有统计学意义。评分有分歧时由两人共同商讨后达成一致。
结果:
本次研究得出,前门控组和后门控组的有效放射剂量平均值分别为(3.7±0.9) mSv和( 18.0±6.5) mSv。两组间比较差异有统计学意义(t=-11.82,p=0.00<0.05),前门控低于后门控79.0%。前门控组和后门控组客观图像质量评估结果为:两组升主动脉感兴趣区平均CT值分别为(342.0±47.5)HU和(322.6±37.7)HU,两组间比较差异无统计学意义(t=1.75,p=0.08>0 . 05) ;两组右冠状动脉感兴趣区平均CT值分别为(323.2±71.8)HU和(306.9±72.4)HU,两组间比较差异无统计学意义(t=-0.87,p=0.38>0.05);两组左主干感兴趣区平均CT值分别为(353.6±57.6)HU和( 326.0±72.2 ) HU ,两组间比较差异无统计学意义(t=1.63,p=0.10>0 . 05) ;两组左前降支感兴趣区平均CT值分别为(307.8±76.8)HU和(280.8±75.5)HU,两组间比较差异无统计学意义(t=1.37,p=0.17>0.05)。两组间冠状动脉图像平均CT值经t检验差异无统计学意义(P>0.05)。两组间主观图像质量评分经非参数检验(Mann-Whitney检验)差异无统计学意义(U=-1.2,P=0.19>0.05);两组图像质量均能满足诊断要求。
结论:
与后置心电门控比较,前置心电门控在保持冠脉成像质量的同时降低了辐射剂量。
Objective:
Computed tomography (CT) coronary angiography has been widely used since the introduction of multi-slice scanners technology, but high radiation doses have been reported. Prospective ECG-gating using‘step- and- shoot’axial scanning protocol has been shown to reduce radiation exposure effectively while maintaining diagnostic accuracy. 256-slice scanners with 80 mm detector coverage have been currently introduced into practice, but their impact on radiation exposure has not been adequately studied. The aim of this study was to assess radiation doses associated with CT coronary angiography using a 256-slice CT scanner. radiation doses were estimated for 60 patients scanned with either prospective or retrospective ECG-gating.
Methods:
Our initial study cohort included 60 patients who were referred for CTCA at our department . Radiation dose estimates were expressed in the volume CT dose index (CTDIvol), dose–length product (DLP) and effective dose (ED).The CTDIvol was provided by the CT scanner.The dose–length product is defined as the CTDIvol multiplied by scan length.To obtain the effective dose, dose–length product was multiplied by an appropriate gender and body habitus averaged conversion coefficient for the adult thorax (k =0.014 mSv mGy?1 cm?1).Image quality was assessed objectively in terms of mean CT attenuation at selected regions of interest on axial coronary images and subjectively by coronary segment quality scoring.
Results:
It was found that radiation doses associated with prospective ECG-gating were significantly lower than retrospective ECGgating (3.7±0.9 mSv versus 18.0±6.5 mSv),reducing radiation dose by 79%. No statistically significant differences in image quality were observed between the two scanning protocols for both objective and subjective quality assessments.
Conclusion:
With the use of PT CTCA , radiation dose is markedly reduced and optimal image quality is maintained.
引文
[1]Leber A W,et al. Quantification of obstructive and nonobstructive coronary lesions by 64-slice computed tomography: a comparative study with quantitative coronary angiography and intravascular ultrasound[J]. Am.Coll. Cardiol,2005 ,46(1):147-54.
[2]Mollet N R, Cademartiri F, van Mieghem C A, Runza G, McFadden E P, Baks T, Serruys P W, Krestin G P, de Feyter P. High-resolution spiral computed tomography coronary angiography in patients referred for diagno stic conventional coronary angiography[J]. Circulation ,2005,112(15): 2318-23.
[3]Raff G L,Gallagher M J,O’Neill W W, Goldstein J A.Diagnostic accuracy of noninvasive coronary angiography using 64-slice spiral computed tomography [J]. Am. Coll. Cardiol,2005,46(3):552-7.
[4]Scheffel H ,et al. Accuracy of dual-source CT coronary angiography: first experience in a high pre-test probability population without heart rate contr ol [J].Eur. Radiol,2006,16(12): 2739-47.
[5]Budoff M J ,et al.Assessment of coronary artery disease by cardiac computed tomography: a scientific statement from the American Heart As sociation Committee on Cardiovascular Imaging and Intervention, Council on Cardiovascular Radiology and Intervention, and Committee on Cardiac Imaging, Council on Clinical[J]. Cardiology Circulation ,2006,114(16): 1761 -91.
[6] Nobuhiko Hirai,Jun Horiguchi,Chikako Fujioka, et al,Prospective versus Retrospective ECG-gated 64-Detector Coronary CT Angiography: Assessment of Image Quality, Stenosis, and Radiation Dose[J].Radiology, 2008,248(2):424-439.
[7]Hamon M, Morello R, Riddell J W,Hamon M. Coronary arteries: diagnostic performance of 16-versus 64-section spiral CT compared withinvasive coronary angiography-meta-analysis[J].Radiolgy ,2007,245 : 720-31.
[8]Brenner D J,Hall E J.Computed tomography-an increasing source of radiation exposure[J]. New Engl J. Med. 2007,357(22):2277-84.
[9]张博.CT检查辐射致癌风险的研究进展[J].国际医学放射学杂志,2009,32(3):217-220.
[10] Kuefner MA, Grudzenski S, Hamann J, Achenbach S, Lell M, Anders K Schwab SA, H?berle L, L?brich M, Uder M. Reduction of X-ray induced DNA double-strand breaks in blood lymphocytes during coronary CT angiography using high-pitch spiral data acquisition with prospective ECG-triggering[J].Eur Radiol, 2010 ,20(12):2917-24.
[11]Dill T. Use of automatic exposure control in multislice computed tomography of the coronaries: comparison of 16-slice and 64-slice scanner data with conventional coronary angiography[J]. Heart,2007 ,93(9): 1040–3.
[12]Kalra M K, Maher M M, Toth T L, Schmidt B, Westerman B L, Morgan H T,Saini S,Techniques and applications of automatic tube current modulation for CT[J]. Radiology 2004,233(3):649-57.
[13]Gutstein A ,et al. a Algorithm for radiation dose reductionwith helical dual source coronary computed tomography angiography in clinical practice [J]. Cardiovasc. Comput. Tomogr. 2008,2(5) :311-22.
[14]Hausleiter J, Meyer T,Hadamitzky M, Huber E, Zankl M, Martinoff S, Kastrati A,Schomig A. Radiation dose estimates from cardiac multislice computed tomography in daily practice:impact of different scanning protocols on effective dose estimates[J].Circulation 2006,113(10):1305-10.
[15]Nakayama Y, et al. Abdominal CT with low tube voltage: preliminary observations about radiation dose, contrast enhancement, image quality, and noise[J]. Radiology ,2005,237(3): 945-51.
[16]Earls J P, Berman E L, Urban B A, Curry C A, Lane J L, Jennings R S, McCulloch C C, Hsieh J, Londt J H. Prospectively gated transverse coronaryCT angiography versus retrospectively gated helical techniq ue:improved image quality and reduced radiation dose [J].Radiology 2008, 246(3) :742-53.
[17]Hirai N, Horiguchi J, Fujioka C, Kiguchi M, Yamamoto H, Matsuura N, Kitagawa T, Teragawa H, Kohno N ,Ito K.Prospective versus retrospective ECG-gated 64-detector coronary CT angiography: assessment of image quality, stenosis, and radiation dose [J].Radiology,2008,248(2): 424-30.
[18]Klass O, Jeltsch M, Feuerlein S, Brunner H, Nagel H D, Walker M J, Brambs H J ,Hoffmann M H. Prospectively gated axial CT coronary angiography: preliminary experiences with a novel low-dose technique[J]. Eur. Radiol,2009, 19(4) :829-36.
[19]Shuman W P, Branch K R, May J M, Mitsumori L M, Lockhart D W, Dubinsky T J, Warren B H, Caldwell J H. Prospective versus retrospective ECG gating for 64-detector CT of the coronary arteries: comparison of image quality and patient radiation dose[J]. Radiology ,2008,248(2):431-7.
[20]Weigold W G, Olszewski M E ,Walker M J. Low-dose prospectively gated 256-slice coronary computed tomographic angiography[J].Int.J. Cardiovasc. Imaging, 2009, 25 (Suppl. 2): 217-30.
[21]姜荣,吴晓华,贺文.心率波动对多层螺旋56冠脉造影图像质量的影响[J].中国医学影像技术,2004,20(10):1574-1576.
[22] Nieman K,Rensing BJ,Van Genns RJ,et al.Non -invasive coronary angiography with multislice computed tomography impact of heart rate[J] .heart,2002,88(5):470-474.
[23] Wang K,Hou Y.Scanning technique of multi-slice computed tomography coronary angiography[J].Chin J Med Imaging Technol,2003,19(9):1239-1240.王凯,侯阳.多层螺旋CT冠脉造影扫描方法研究[J].中国医学影像技术,2003,19(9):1239-1240.
[24]Xiao Y,Tian JM,Wang PJ,et al.Multi-slice spiral CT angiography:technique and clinical applications[J].Chin J Radiol,2002,36(4):357-367.萧毅,田建明,王培军,等.多层螺旋CT冠状动脉造影的扫描技术及临床应用[J].中华放射学杂志,20002,36(4):357-361.
[25] Hsieh J, Londt J, Vass M, Li J, Tang X, OkerlundD. Step-and-shoot data acquisition and reconstruction for cardiac x-ray computed tomography[J]. Med Phys, 2006,33(11):4236–4248.
[26] Hausleiter J, Meyer T, Hadamitzky M, et al.Radiation dose estimates from cardiac multislice computed tomography in daily practice:impact of different scanning protocols on effective dose estimates[J]. Circulation ,2006,113(10):1305–1310.
[27] Abada HT, Larchez C, Daoud B, et al. MDCTof the coronary arteries: feasibility of low-dose CT with ECG-pulsed tube current modulation to reduce radiation dose[J]. AJR Am J Roentgenol, 2006, 186(6 suppl 2):S387–S390.
[28] Nobuhiko Hirai,Jun Horiguchi,Chikako Fujioka, Masao Kiguchi, Hideya Yamamoto,Noriaki Matsuura,Toshiro Kitagawa,Hiroki Teragawa,Nobuoki Kohno,Katsuhide Ito. Prospective versus Retrospective ECG-gated 64-Detector Coronary CT Angiography: Assessment of Image Quality,Stenosis, and Radiation Dose[J].Radiology,2008,248(2):424-430
[29] Ohnesorge B, Flohr T, Becker C,Knez A,Kopp AF, Fukuda K,Reiser MF. Cardiac imaging with rapid, retrospective ECG synchronized multilevel spiral CT[J]. Radiologe,2000, 40(2):111-117.
[30] Kachelriess M,Ulzheimer S,Kalender WA.ECG-correlated image reconstruction from subsecond multi-slice spiral CT scans of the heart[J]. Med Phys,2000, 27(8):1881-902.
[31] Hunold P,Vogt FM,Schmemmnd A,et al.Radiation exposure during cardiac CT:effective doses at multi-detector row CT and electron-beam CT [J].Radiology,2003,226(1):145-52.
[32] Leschka S,Stolzmann P,Schmid FT,et al. Low kilovoltage cardiac dualsource CT:attenuation,noise, and radiation dose[J].Eur Radiol.2008,18(9):1809–17.
[33] Jakobs TF,Becker CR, Ohnesorge B, et al. Multislice helical CT of the heart with retrospective ECG gating: reduction of radiation exposure by ECG -controlled tube current modulation[J].Eur Radiol 2002,12(5):1081–6.
[34]戴汝平,高建华,等.冠状动脉多排螺旋CT成像[M].第1版.北京:科学出版社,2007:178.
[35] Hsieh J, Londt J, Vass M, et al. Step-and-shoot data acquisition and reconstruction for cardiac x-ray computed tomography[J]. Med Phys, 2002 ,33(11):4236-48.
[36] Scheffel H, Alkadhi H, Leschka S, et al.Low-dose CT coronary angiography in the step-and-shoot mode: diagnostic performance[J]. Heart,2008,94(9):1132-7.
[37] Stolzmann P, Leschka S, Scheffel H, et al. Dual-source CT in step-andshoot mode:noninvasive coronary angiography with low radiation dose[J]. Radi ology, 2008,249(1):71-80.
[38] Stolzmann P,Scheffel H,Leschka S,et al.Influence of calcifications on diagnostic accuracy of coronary CT angiography using prospective ECG triggering[J]. AJR Am J Roentgenol,2008,191(6):1684-9.
[39] Rybicki FJ,Otero HJ, Steigner ML, et al. Initial evaluation of coronary images from 320-detector rowcomputed tomography[J]. Int J Cardiovasc Imaging, 2008,24(5):535-46.
[40]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,2008,25(1):85-90.
[41]Mori S,Nishizawa K, Kondo C,et al. Effective doses in subjects undergoing computed tomography cardiac imaging with the 256-multislice CT scanner[J]. Eur J Radiol, 2007,65(3):442-8.
[42]Kido T, Kurata A, Higashino H, et al. Cardiac imaging using256-detector row four-dimensional CT:preliminary clinical report[J].Radiat M ed ,200 7,25(1):38-44.
[43]Motoyama S, Anno H, Sarai M, et al. Noninvasive coronary angiography with a prototype 256-row area detector computed tomography system: comparison with conventional invasive coronary angiography[J]. J Am Coll Cardiol,2008,51(7):773-5.
[44]Sun G,Li M,Li GY,Ding J,Li SH .Influence of heart rate and cardiac phases on image quality using 320-detector row CT[J].Zhonghua Yi Xue ZA ZHI,2011,91(1):5-10.
[45] Satoshi Goshima,Masayuki Kanematsu, Hironori Nishibori,Kota Sakurai, Daisuke Miyazawa,Haruo Watanabe, Hiroshi Kondo, Yoshimune Shiratori, Minoru Onozuka, Noriyuki Moriyama, Kyongtae T. Bae.CT of the Pancreas: Comparison of Anatomic Structure Depiction, Image Quality, and Radiation Exposure between 320-Detector Volumetric Images and 64-Detector Helical Images [J].Radiology,2011.
[46] Tabibian B,Roach EH,Wynn BL,Orrison WW Jr.Clinical indications and utilization of 320-detector row CT in 2500 outpatients[J].Comput Med Imaging Graph,2011.
[47] Hideyuki Matsutani, Tomonari Sano, Takeshi Kondo,Shinichiro Fujimoto, Takako Sekine,Takehiro Arai,Hitomi Morita,Shinichi Takase. Comparison of Radiation Dose Reduction of Prospective ECG-gated One Beat Scan Using 320 Area Detector CT Coronary Angiography and Prospective ECG-gated Helical Scan with High Helical Pitch (FlashScan) Using 64 Multidetector-row CT Coronary Angiography[J]. Japanese Journal of Radiological Technology,2010,66(12):1548-1554.
[48] Van Abbema JK, Van der Schaaf A, Kristanto W, Groen JM, Greuter MJ.Feasibility and accuracy of tissue characterization with dual source computed tomography[J]. Phys Med, 2011.
[49]Yang ZY, Wang Q, Guo SX, Zhang Y, Fang XM, Cui ZM. Value of detecting in-stent restenosis by dual source coronary computed tomography coronaryangiography[J].Zhonghua Xin Xue Guan Bing Za Zhi, 2011 ,39(1): 49-52.
[50] Puqliese F,Weustink,Van Mieqhem C,Alberqhina F,Otsuka M,Meijboom WB,Van pelt N,Mollet NR,Cademartiri F,Krestin GP,Hunik MG , de Feyter PJ.Dual source coronary computed tomography angiography for detecting in-stent restenosis[J]. Heart,2008 ,94(7):848-54.
[51]郝涛,罗宏,CT探测器的技术特点和发展趋势[J],中国医疗设备,2008,23(1):55-8.
[52]聂聪,多层CT探测器的发展[J],中国医学装备,2008,5(7):68—71. gated 256-slice coronary computed tomographic angiography[J].Int.J. Cardiovasc. Imaging, 2009, 25 (Suppl. 2): 217-30.
[53]Efstathopoulos E P, Kelekis N L,Pantos I ,Ziaka D,Katritsis D G,Seimenis I.Reduction of the estimated radiation dose and associated patient risk with prospective ECG-gated 256-slice CT coronary angiography[J], Phys Med Biol,2009,54(17):5209-22.
[54]袁庆海,崔虎永,刘建华,姜微.256层螺旋CT前门控及后门控冠脉成像质量和辐射剂量的比较[J].中国老年学杂志,2010,30(15):2122-2124.
[55]金龙,邹国林,刘斌,包义红,周长青. 64层螺旋CT前置心电门控冠状动脉成像临床应用初探[J].安徽医学,2009,30(5):512-514.
[56]Brenner DJ,Elliston CD,Hall E,et al . Estimated risks of radiation-Induced fatal cancer from pediatric CT[J].AJR,2001,176(2):289-296.
[57]Brenner DJ,Elliston CD.Estimated radiation risks potentiallyassociated with full-body CT sereening[J].Radiology,2004,232(3):735-738.
[58]王妍,焱吴国,庚周诚,高建华,焦晟,曹会志. 64层螺旋CT前门控冠状动脉横断面扫描低剂量技术的初步研究[J].中华放射学杂志,2008,42(10):1018-1021.
[59]高建华,王贵生,李剑颖,孙宪昶,韩文娟,赵雯,戴汝平.64层螺旋CT冠状动脉成像低剂量技术的应用价值[J],临床放射学杂志,2008,27(3):388-391.
[60]Hausleiter J, et al. Estimated radiation dose associated with cardiac CT angiography [J].JAMA ,2009,301(5):500-7.
[61]Achenbach S, et al.Contrast-enhanced coronary artery visualization by dual-source computed tomography—initial experience [J].Eur. J. Ra diol,2006, 57(3): 331-5.
[62]CordeiroMA, Lima J A. Atherosclerotic plaque characterization bymult idetector row computed tomography angiography [J]. Am. Coll. Cardio l,2006 ,47(8 Suppl):C40-7.
[63]Motoyama S, Anno H, Sarai M, Sato T, Sanda Y, Ozaki Y, Mochizuki T, Katada K , Hishida H . Noninvasive coronary angiography with a prototype 256-row area detector computed tomography system: comparison with conv entional invasive coronary angiography [J].Am. Coll. Cardiol,2008,51(7): 773-5.
[64]Choi S I, George R T, Schuleri K H, Chun E J, Lima J A , Lardo A C. Recent developments in wide-detector cardiac computed tomography[J]. Int. J. Cardiovasc. Imaging ,2009,25 (Suppl. 1): 23-9.
[65]Scheffel H, et al.Low-dose CT coronary angiography in the step- and-shoot mode: diagnostic performance[J].Heart,2008, 94(9):1132-7.
[66]Stolzmann P,et al . Dual-source CT in step-and-shoot mode: noninvasive coronary angiography with lowradiation dose [J].Radiology,2008, 249(1) :71-80.
[67]Gutstein A, et al . Predicting success of prospective and retrospective gatin g with dual-source coronary computed tomography angiography: develop ment of selection criteria and initial experience[J]. Cardiovasc. Com put.Tomogr. 2008b ,2 (2):81-90.
[68]Mori S, et al. Physical performance evaluation of a 256-slice CT-scanner for four-dimensional imaging[J]. Med.Phys, 2004,31(6) :1348-56.
[69]Steigner M L, Otero H J, Cai T, Mitsouras D, Nallamshetty L, Whitmore A G, Ersoy H, Levit N A, Di Carli M F, Rybicki F J. 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(1) : 85-90.
[70]Slovis TL.CT and computed radiography:the pictures are great.But is the radiation dose greater than required?[J].AJR,2002,179:39.
[2]Mollet N R, Cademartiri F, van Mieghem C A, Runza G, McFadden E P, Baks T, Serruys P W, Krestin G P, de Feyter P. High-resolution spiral computed tomography coronary angiography in patients referred for diagno stic conventional coronary angiography[J]. Circulation ,2005,112(15): 2318-23.
[3]Raff G L,Gallagher M J,O’Neill W W, Goldstein J A.Diagnostic accuracy of noninvasive coronary angiography using 64-slice spiral computed tomography [J]. Am. Coll. Cardiol,2005,46(3):552-7.
[4]Scheffel H ,et al. Accuracy of dual-source CT coronary angiography: first experience in a high pre-test probability population without heart rate contr ol [J].Eur. Radiol,2006,16(12): 2739-47.
[5]Budoff M J ,et al.Assessment of coronary artery disease by cardiac computed tomography: a scientific statement from the American Heart As sociation Committee on Cardiovascular Imaging and Intervention, Council on Cardiovascular Radiology and Intervention, and Committee on Cardiac Imaging, Council on Clinical[J]. Cardiology Circulation ,2006,114(16): 1761 -91.
[6] Nobuhiko Hirai,Jun Horiguchi,Chikako Fujioka, et al,Prospective versus Retrospective ECG-gated 64-Detector Coronary CT Angiography: Assessment of Image Quality, Stenosis, and Radiation Dose[J].Radiology, 2008,248(2):424-439.
[7]Hamon M, Morello R, Riddell J W,Hamon M. Coronary arteries: diagnostic performance of 16-versus 64-section spiral CT compared withinvasive coronary angiography-meta-analysis[J].Radiolgy ,2007,245 : 720-31.
[8]Brenner D J,Hall E J.Computed tomography-an increasing source of radiation exposure[J]. New Engl J. Med. 2007,357(22):2277-84.
[9]张博.CT检查辐射致癌风险的研究进展[J].国际医学放射学杂志,2009,32(3):217-220.
[10] Kuefner MA, Grudzenski S, Hamann J, Achenbach S, Lell M, Anders K Schwab SA, H?berle L, L?brich M, Uder M. Reduction of X-ray induced DNA double-strand breaks in blood lymphocytes during coronary CT angiography using high-pitch spiral data acquisition with prospective ECG-triggering[J].Eur Radiol, 2010 ,20(12):2917-24.
[11]Dill T. Use of automatic exposure control in multislice computed tomography of the coronaries: comparison of 16-slice and 64-slice scanner data with conventional coronary angiography[J]. Heart,2007 ,93(9): 1040–3.
[12]Kalra M K, Maher M M, Toth T L, Schmidt B, Westerman B L, Morgan H T,Saini S,Techniques and applications of automatic tube current modulation for CT[J]. Radiology 2004,233(3):649-57.
[13]Gutstein A ,et al. a Algorithm for radiation dose reductionwith helical dual source coronary computed tomography angiography in clinical practice [J]. Cardiovasc. Comput. Tomogr. 2008,2(5) :311-22.
[14]Hausleiter J, Meyer T,Hadamitzky M, Huber E, Zankl M, Martinoff S, Kastrati A,Schomig A. Radiation dose estimates from cardiac multislice computed tomography in daily practice:impact of different scanning protocols on effective dose estimates[J].Circulation 2006,113(10):1305-10.
[15]Nakayama Y, et al. Abdominal CT with low tube voltage: preliminary observations about radiation dose, contrast enhancement, image quality, and noise[J]. Radiology ,2005,237(3): 945-51.
[16]Earls J P, Berman E L, Urban B A, Curry C A, Lane J L, Jennings R S, McCulloch C C, Hsieh J, Londt J H. Prospectively gated transverse coronaryCT angiography versus retrospectively gated helical techniq ue:improved image quality and reduced radiation dose [J].Radiology 2008, 246(3) :742-53.
[17]Hirai N, Horiguchi J, Fujioka C, Kiguchi M, Yamamoto H, Matsuura N, Kitagawa T, Teragawa H, Kohno N ,Ito K.Prospective versus retrospective ECG-gated 64-detector coronary CT angiography: assessment of image quality, stenosis, and radiation dose [J].Radiology,2008,248(2): 424-30.
[18]Klass O, Jeltsch M, Feuerlein S, Brunner H, Nagel H D, Walker M J, Brambs H J ,Hoffmann M H. Prospectively gated axial CT coronary angiography: preliminary experiences with a novel low-dose technique[J]. Eur. Radiol,2009, 19(4) :829-36.
[19]Shuman W P, Branch K R, May J M, Mitsumori L M, Lockhart D W, Dubinsky T J, Warren B H, Caldwell J H. Prospective versus retrospective ECG gating for 64-detector CT of the coronary arteries: comparison of image quality and patient radiation dose[J]. Radiology ,2008,248(2):431-7.
[20]Weigold W G, Olszewski M E ,Walker M J. Low-dose prospectively gated 256-slice coronary computed tomographic angiography[J].Int.J. Cardiovasc. Imaging, 2009, 25 (Suppl. 2): 217-30.
[21]姜荣,吴晓华,贺文.心率波动对多层螺旋56冠脉造影图像质量的影响[J].中国医学影像技术,2004,20(10):1574-1576.
[22] Nieman K,Rensing BJ,Van Genns RJ,et al.Non -invasive coronary angiography with multislice computed tomography impact of heart rate[J] .heart,2002,88(5):470-474.
[23] Wang K,Hou Y.Scanning technique of multi-slice computed tomography coronary angiography[J].Chin J Med Imaging Technol,2003,19(9):1239-1240.王凯,侯阳.多层螺旋CT冠脉造影扫描方法研究[J].中国医学影像技术,2003,19(9):1239-1240.
[24]Xiao Y,Tian JM,Wang PJ,et al.Multi-slice spiral CT angiography:technique and clinical applications[J].Chin J Radiol,2002,36(4):357-367.萧毅,田建明,王培军,等.多层螺旋CT冠状动脉造影的扫描技术及临床应用[J].中华放射学杂志,20002,36(4):357-361.
[25] Hsieh J, Londt J, Vass M, Li J, Tang X, OkerlundD. Step-and-shoot data acquisition and reconstruction for cardiac x-ray computed tomography[J]. Med Phys, 2006,33(11):4236–4248.
[26] Hausleiter J, Meyer T, Hadamitzky M, et al.Radiation dose estimates from cardiac multislice computed tomography in daily practice:impact of different scanning protocols on effective dose estimates[J]. Circulation ,2006,113(10):1305–1310.
[27] Abada HT, Larchez C, Daoud B, et al. MDCTof the coronary arteries: feasibility of low-dose CT with ECG-pulsed tube current modulation to reduce radiation dose[J]. AJR Am J Roentgenol, 2006, 186(6 suppl 2):S387–S390.
[28] Nobuhiko Hirai,Jun Horiguchi,Chikako Fujioka, Masao Kiguchi, Hideya Yamamoto,Noriaki Matsuura,Toshiro Kitagawa,Hiroki Teragawa,Nobuoki Kohno,Katsuhide Ito. Prospective versus Retrospective ECG-gated 64-Detector Coronary CT Angiography: Assessment of Image Quality,Stenosis, and Radiation Dose[J].Radiology,2008,248(2):424-430
[29] Ohnesorge B, Flohr T, Becker C,Knez A,Kopp AF, Fukuda K,Reiser MF. Cardiac imaging with rapid, retrospective ECG synchronized multilevel spiral CT[J]. Radiologe,2000, 40(2):111-117.
[30] Kachelriess M,Ulzheimer S,Kalender WA.ECG-correlated image reconstruction from subsecond multi-slice spiral CT scans of the heart[J]. Med Phys,2000, 27(8):1881-902.
[31] Hunold P,Vogt FM,Schmemmnd A,et al.Radiation exposure during cardiac CT:effective doses at multi-detector row CT and electron-beam CT [J].Radiology,2003,226(1):145-52.
[32] Leschka S,Stolzmann P,Schmid FT,et al. Low kilovoltage cardiac dualsource CT:attenuation,noise, and radiation dose[J].Eur Radiol.2008,18(9):1809–17.
[33] Jakobs TF,Becker CR, Ohnesorge B, et al. Multislice helical CT of the heart with retrospective ECG gating: reduction of radiation exposure by ECG -controlled tube current modulation[J].Eur Radiol 2002,12(5):1081–6.
[34]戴汝平,高建华,等.冠状动脉多排螺旋CT成像[M].第1版.北京:科学出版社,2007:178.
[35] Hsieh J, Londt J, Vass M, et al. Step-and-shoot data acquisition and reconstruction for cardiac x-ray computed tomography[J]. Med Phys, 2002 ,33(11):4236-48.
[36] Scheffel H, Alkadhi H, Leschka S, et al.Low-dose CT coronary angiography in the step-and-shoot mode: diagnostic performance[J]. Heart,2008,94(9):1132-7.
[37] Stolzmann P, Leschka S, Scheffel H, et al. Dual-source CT in step-andshoot mode:noninvasive coronary angiography with low radiation dose[J]. Radi ology, 2008,249(1):71-80.
[38] Stolzmann P,Scheffel H,Leschka S,et al.Influence of calcifications on diagnostic accuracy of coronary CT angiography using prospective ECG triggering[J]. AJR Am J Roentgenol,2008,191(6):1684-9.
[39] Rybicki FJ,Otero HJ, Steigner ML, et al. Initial evaluation of coronary images from 320-detector rowcomputed tomography[J]. Int J Cardiovasc Imaging, 2008,24(5):535-46.
[40]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,2008,25(1):85-90.
[41]Mori S,Nishizawa K, Kondo C,et al. Effective doses in subjects undergoing computed tomography cardiac imaging with the 256-multislice CT scanner[J]. Eur J Radiol, 2007,65(3):442-8.
[42]Kido T, Kurata A, Higashino H, et al. Cardiac imaging using256-detector row four-dimensional CT:preliminary clinical report[J].Radiat M ed ,200 7,25(1):38-44.
[43]Motoyama S, Anno H, Sarai M, et al. Noninvasive coronary angiography with a prototype 256-row area detector computed tomography system: comparison with conventional invasive coronary angiography[J]. J Am Coll Cardiol,2008,51(7):773-5.
[44]Sun G,Li M,Li GY,Ding J,Li SH .Influence of heart rate and cardiac phases on image quality using 320-detector row CT[J].Zhonghua Yi Xue ZA ZHI,2011,91(1):5-10.
[45] Satoshi Goshima,Masayuki Kanematsu, Hironori Nishibori,Kota Sakurai, Daisuke Miyazawa,Haruo Watanabe, Hiroshi Kondo, Yoshimune Shiratori, Minoru Onozuka, Noriyuki Moriyama, Kyongtae T. Bae.CT of the Pancreas: Comparison of Anatomic Structure Depiction, Image Quality, and Radiation Exposure between 320-Detector Volumetric Images and 64-Detector Helical Images [J].Radiology,2011.
[46] Tabibian B,Roach EH,Wynn BL,Orrison WW Jr.Clinical indications and utilization of 320-detector row CT in 2500 outpatients[J].Comput Med Imaging Graph,2011.
[47] Hideyuki Matsutani, Tomonari Sano, Takeshi Kondo,Shinichiro Fujimoto, Takako Sekine,Takehiro Arai,Hitomi Morita,Shinichi Takase. Comparison of Radiation Dose Reduction of Prospective ECG-gated One Beat Scan Using 320 Area Detector CT Coronary Angiography and Prospective ECG-gated Helical Scan with High Helical Pitch (FlashScan) Using 64 Multidetector-row CT Coronary Angiography[J]. Japanese Journal of Radiological Technology,2010,66(12):1548-1554.
[48] Van Abbema JK, Van der Schaaf A, Kristanto W, Groen JM, Greuter MJ.Feasibility and accuracy of tissue characterization with dual source computed tomography[J]. Phys Med, 2011.
[49]Yang ZY, Wang Q, Guo SX, Zhang Y, Fang XM, Cui ZM. Value of detecting in-stent restenosis by dual source coronary computed tomography coronaryangiography[J].Zhonghua Xin Xue Guan Bing Za Zhi, 2011 ,39(1): 49-52.
[50] Puqliese F,Weustink,Van Mieqhem C,Alberqhina F,Otsuka M,Meijboom WB,Van pelt N,Mollet NR,Cademartiri F,Krestin GP,Hunik MG , de Feyter PJ.Dual source coronary computed tomography angiography for detecting in-stent restenosis[J]. Heart,2008 ,94(7):848-54.
[51]郝涛,罗宏,CT探测器的技术特点和发展趋势[J],中国医疗设备,2008,23(1):55-8.
[52]聂聪,多层CT探测器的发展[J],中国医学装备,2008,5(7):68—71. gated 256-slice coronary computed tomographic angiography[J].Int.J. Cardiovasc. Imaging, 2009, 25 (Suppl. 2): 217-30.
[53]Efstathopoulos E P, Kelekis N L,Pantos I ,Ziaka D,Katritsis D G,Seimenis I.Reduction of the estimated radiation dose and associated patient risk with prospective ECG-gated 256-slice CT coronary angiography[J], Phys Med Biol,2009,54(17):5209-22.
[54]袁庆海,崔虎永,刘建华,姜微.256层螺旋CT前门控及后门控冠脉成像质量和辐射剂量的比较[J].中国老年学杂志,2010,30(15):2122-2124.
[55]金龙,邹国林,刘斌,包义红,周长青. 64层螺旋CT前置心电门控冠状动脉成像临床应用初探[J].安徽医学,2009,30(5):512-514.
[56]Brenner DJ,Elliston CD,Hall E,et al . Estimated risks of radiation-Induced fatal cancer from pediatric CT[J].AJR,2001,176(2):289-296.
[57]Brenner DJ,Elliston CD.Estimated radiation risks potentiallyassociated with full-body CT sereening[J].Radiology,2004,232(3):735-738.
[58]王妍,焱吴国,庚周诚,高建华,焦晟,曹会志. 64层螺旋CT前门控冠状动脉横断面扫描低剂量技术的初步研究[J].中华放射学杂志,2008,42(10):1018-1021.
[59]高建华,王贵生,李剑颖,孙宪昶,韩文娟,赵雯,戴汝平.64层螺旋CT冠状动脉成像低剂量技术的应用价值[J],临床放射学杂志,2008,27(3):388-391.
[60]Hausleiter J, et al. Estimated radiation dose associated with cardiac CT angiography [J].JAMA ,2009,301(5):500-7.
[61]Achenbach S, et al.Contrast-enhanced coronary artery visualization by dual-source computed tomography—initial experience [J].Eur. J. Ra diol,2006, 57(3): 331-5.
[62]CordeiroMA, Lima J A. Atherosclerotic plaque characterization bymult idetector row computed tomography angiography [J]. Am. Coll. Cardio l,2006 ,47(8 Suppl):C40-7.
[63]Motoyama S, Anno H, Sarai M, Sato T, Sanda Y, Ozaki Y, Mochizuki T, Katada K , Hishida H . Noninvasive coronary angiography with a prototype 256-row area detector computed tomography system: comparison with conv entional invasive coronary angiography [J].Am. Coll. Cardiol,2008,51(7): 773-5.
[64]Choi S I, George R T, Schuleri K H, Chun E J, Lima J A , Lardo A C. Recent developments in wide-detector cardiac computed tomography[J]. Int. J. Cardiovasc. Imaging ,2009,25 (Suppl. 1): 23-9.
[65]Scheffel H, et al.Low-dose CT coronary angiography in the step- and-shoot mode: diagnostic performance[J].Heart,2008, 94(9):1132-7.
[66]Stolzmann P,et al . Dual-source CT in step-and-shoot mode: noninvasive coronary angiography with lowradiation dose [J].Radiology,2008, 249(1) :71-80.
[67]Gutstein A, et al . Predicting success of prospective and retrospective gatin g with dual-source coronary computed tomography angiography: develop ment of selection criteria and initial experience[J]. Cardiovasc. Com put.Tomogr. 2008b ,2 (2):81-90.
[68]Mori S, et al. Physical performance evaluation of a 256-slice CT-scanner for four-dimensional imaging[J]. Med.Phys, 2004,31(6) :1348-56.
[69]Steigner M L, Otero H J, Cai T, Mitsouras D, Nallamshetty L, Whitmore A G, Ersoy H, Levit N A, Di Carli M F, Rybicki F J. 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(1) : 85-90.
[70]Slovis TL.CT and computed radiography:the pictures are great.But is the radiation dose greater than required?[J].AJR,2002,179:39.