CAJ | 학술논문

目的对比分析二代双源CT前瞻性心电触发高螺距螺旋扫描模式(Flash模式)和回顾性心电门控螺旋扫描模式(常规模式)下冠状动脉支架的显示质量和辐射剂量.方法常规模式和Flash模式下共计120例患者的155个冠状动脉植入支架纳入本研究,平均年龄(64.9±10.6)岁,所有患者的心率均控制在≤65次/min,且心律规则.所有患者分成两组,分别接受Flash模式和常规模式的冠状动脉成像.冠状动脉原始图像均进行Kernel B26和Kernel B46的数据重建,并由两位医师对支架的显示质量进行独立的4级评分.两种模式下的冠状动脉显示质量利用卡方检验进行统计分析,而不同冠状动脉扫描模式下的容积CT剂量指数值(CTDIvol)和剂量长度乘积值(DLP),利用t检验进行辐射剂量的对比研究.结果 2位医师对所有冠状动脉支架显示质量的评分具有较好的一致性(Kappa=0.764,P＜0.001),Flash模式和常规模式的平均评分分别为:1.61±0.77和1.65±0.82.两种冠状动脉扫描模式的图像质量差异无统计学意义(x2=0.865,P=0.834).Flash模式的CTDIvol(3.24±1.21)明显低于常规模式(31.26±10.79),差异有统计学意义(t=19.83,P<0.001);Flash模式的DLP(54.61±19.88)同样低于常规模式(468.30±174.88),差异有统计学意义(t=18.06,P＜0.001).结论控制患者心率≤65次/min且心律规则,Flash模式在降低辐射剂量的前提下可获得与常规模式相同质量的冠状动脉支架图像.
목적 대비분석이대쌍원CT전첨성심전촉발고라거라선소묘모식(Flash모식)화회고성심전문공라선소묘모식(상규모식)하관상동맥지가적현시질량화복사제량.방법 상규모식화Flash모식하공계120례환자적155개관상동맥식입지가납입본연구,평균년령(64.9±10.6)세,소유환자적심솔균공제재≤65차/min,차심률규칙.소유환자분성량조,분별접수Flash모식화상규모식적관상동맥성상.관상동맥원시도상균진행Kernel B26화Kernel B46적수거중건,병유량위의사대지가적현시질량진행독립적4급평분.량충모식하적관상동맥현시질량이용잡방검험진행통계분석,이불동관상동맥소묘모식하적용적CT제량지수치(CTDIvol)화제량장도승적치(DLP),이용t검험진행복사제량적대비연구.결과 2위의사대소유관상동맥지가현시질량적평분구유교호적일치성(Kappa=0.764,P＜0.001),Flash모식화상규모식적평균평분분별위:1.61±0.77화1.65±0.82.량충관상동맥소묘모식적도상질량차이무통계학의의(x2=0.865,P=0.834).Flash모식적CTDIvol(3.24±1.21)명현저우상규모식(31.26±10.79),차이유통계학의의(t=19.83,P<0.001);Flash모식적DLP(54.61±19.88)동양저우상규모식(468.30±174.88),차이유통계학의의(t=18.06,P＜0.001).결론 공제환자심솔≤65차/min차심률규칙,Flash모식재강저복사제량적전제하가획득여상규모식상동질량적관상동맥지가도상.
Objective To compare a prospective ECG-gated high-pitch spiral technique (Flash) and conventional retrospective ECG-gated spiral technique for the image quality of coronary artery stent and radiation dose with a dual source CT.Methods One hundred and fifty five coronary stents in one hundred and twenty patients (mean age 64.9 ± 10.6 years,heart rates≤65 bpm) were examined using a dual source CT.All patients were divided in two groups,receiving either Flash or conventional coronary artery CT angiography separately.After images of coronary artery were reconstructed using both the smooth (B26) and sharp (B46) kernel,the coronary stent image quality and stent lumen were scored by two observers individually using four point scale (1 = excellent,4 = unvaluable) .The effective radiation dose of volume CT dose index (CTDIvol,mGy) and dose length product (DLP,mGy x cm) were also calculated for each patient.x2-test analysis of image quality and t-test analysis of radiation dose were used respectively for statistical difference between two groups.Results Interobserver agreement for stent image quality was good (Kappa =0.764,P＜0.001).The mean scores were 1.61 ±0.77 and 1.65 ±0.82 in Flash group and conventional group respectively.There was no significant difference in image quality between the two groups (x2 = 0.865,P = 0.834).The effective radiation dose in Flash group was significantly lower than that in conventional group.The mean values of CTDIvol were 3.24 ± 1.21 in Flash group and 31.26 ± 10.79 in conventional group (t = 19.83,P < 0.001) ,and the mean values of DLP in Flash group and conventional group were 54.61 ±19.88 and 468.30 ± 174.88,respectively (t = 18.06,P < 0.001).Conclusions Compared with the conventiaonal coronary artery CT angiography,the Flash coronary artery CT angiography technique has a similar coronary stent image quality,but at a lower radiation dose in patients with heart rates lower than 65 beats per minute.