低剂量、等渗低浓度对比剂CT肺动脉血管成像技术在诊断肺动脉栓塞中的应用研究
저제량、등삼저농도대비제CT폐동맥혈관성상기술재진단폐동맥전새중적응용연구
Study of CT pulmonary angiography technique in pulmonary embolism-low dose and low concentration
  • 万方数据
    中华放射学杂志 중화방사학잡지
    Chinese Journal of Radiology
    2014年 10期 811-815 ,共5页

    胡学梅%马丽娅%张进华%李建军%李震%王秋霞%胡道予

    호학매%마려아%장진화%리건군%리진%왕추하%호도여

    肺栓塞%造影剂%体层摄影术,X线计算机 肺栓塞%造影劑%體層攝影術,X線計算機
    폐전새%조영제%체층섭영술,X선계산궤
    Pulmonary embolism%Contrast media%Tomography,X-ray computed
    目的 评估低剂量、等渗低浓度对比剂CT肺动脉血管成像(CTPA)技术的图像质量,以及在诊断肺动脉栓塞中的应用价值.方法 纳入临床怀疑肺动脉栓塞要求行CTPA检查且BMI＜28kg/m2的门诊或住院患者80例,采用随机数字表法等分为试验组(采用低剂量、等渗低浓度对比剂)和对照组(采用常规剂量和高渗对比剂)各40例.试验组扫描参数:80 kV,自动mA,对比剂为碘克沙醇(含碘270 mg/ml)20 ml,图像重建采用60％滤波反投影重建(FBP)+ 40％自适应统计迭代重建(ASIR);对照组扫描参数:120 kV,自动mA,对比剂为碘普胺(含碘370 mg/ml)40 ml,100％FBP.应用GE公司Discovery CT750 HD 64层螺旋CT进行扫描.用5分法目测评价图像质量,并测量肺动脉干及左、有肺动脉和各叶动脉CT值,计算其平均CT值.应用独立样本t检验比较2组间图像质量评分、平均CT值、噪声值、图像信噪比(SNR)、对比噪声比(CNR)、容积CT剂量指数(CTDIvol)和剂量长度乘积(DLP)差异,应用x2检验比较2组间上腔静脉硬化伪影显示率和肺动脉栓塞诊断阳性率差异.结果 CTPA共发现肺动脉栓塞33例(试验组14例,对照组19例),试验组显示肺动脉栓塞的阳性率(35.0％)与对照组(47.5％)差异无统计学意义(x2=1.289,P＞0.05).2组均可以显示4～6级肺动脉分支,试验组和对照组图像质量评分分别为(3.9±0.6)、(4.0±0.7)分,差异无统计学意义(t=0.632,P＞0.05).试验组出现上腔静脉周围条纹伪影的例数(28例)低于对照组(36例),差异有统计学意义(x2=10.362,P＜0.0l).试验组CT值和噪声分别为(426.8±84.8)、(14.9±1.5)HU,高于对照组[分别为(359.4±75.3)、(7.4±1.4) HU],差异有统计学意义(t值分别为3.758、22.848,p值均＜0.01).但是试验组SNR(28.8±6.3)和CNR(24.5±6.1)低于对照组(SNR、CNR分别为50.4±14.7、42.9±13.8),差异有统计学意义(t值分别为8.522、7.669,P值均＜0.01).试验组所接受辐射剂量CTDIvol[(3.3 ±0.3) mGy]和DLP[(101.4±11.9) mGy· cm]均低于对照组[CTDIvol、DLP分别为(9.6±0.6)mGy、(328.5±37.3)mGy· cm],差异均有统计学意义(t值分别为56.393、36.675,P值均＜0.01).结论 低剂量、等渗低浓度对比剂CTPA技术可显示4～6级肺动脉分支,减少碘对比剂用量和射线暴露,且对肺动脉栓塞的诊断阳性率与常规CTPA技术一致,可满足临床诊断的需要.
    목적 평고저제량、등삼저농도대비제CT폐동맥혈관성상(CTPA)기술적도상질량,이급재진단폐동맥전새중적응용개치.방법 납입림상부의폐동맥전새요구행CTPA검사차BMI＜28kg/m2적문진혹주원환자80례,채용수궤수자표법등분위시험조(채용저제량、등삼저농도대비제)화대조조(채용상규제량화고삼대비제)각40례.시험조소묘삼수:80 kV,자동mA,대비제위전극사순(함전270 mg/ml)20 ml,도상중건채용60％려파반투영중건(FBP)+ 40％자괄응통계질대중건(ASIR);대조조소묘삼수:120 kV,자동mA,대비제위전보알(함전370 mg/ml)40 ml,100％FBP.응용GE공사Discovery CT750 HD 64층라선CT진행소묘.용5분법목측평개도상질량,병측량폐동맥간급좌、유폐동맥화각협동맥CT치,계산기평균CT치.응용독립양본t검험비교2조간도상질량평분、평균CT치、조성치、도상신조비(SNR)、대비조성비(CNR)、용적CT제량지수(CTDIvol)화제량장도승적(DLP)차이,응용x2검험비교2조간상강정맥경화위영현시솔화폐동맥전새진단양성솔차이.결과 CTPA공발현폐동맥전새33례(시험조14례,대조조19례),시험조현시폐동맥전새적양성솔(35.0％)여대조조(47.5％)차이무통계학의의(x2=1.289,P＞0.05).2조균가이현시4～6급폐동맥분지,시험조화대조조도상질량평분분별위(3.9±0.6)、(4.0±0.7)분,차이무통계학의의(t=0.632,P＞0.05).시험조출현상강정맥주위조문위영적례수(28례)저우대조조(36례),차이유통계학의의(x2=10.362,P＜0.0l).시험조CT치화조성분별위(426.8±84.8)、(14.9±1.5)HU,고우대조조[분별위(359.4±75.3)、(7.4±1.4) HU],차이유통계학의의(t치분별위3.758、22.848,p치균＜0.01).단시시험조SNR(28.8±6.3)화CNR(24.5±6.1)저우대조조(SNR、CNR분별위50.4±14.7、42.9±13.8),차이유통계학의의(t치분별위8.522、7.669,P치균＜0.01).시험조소접수복사제량CTDIvol[(3.3 ±0.3) mGy]화DLP[(101.4±11.9) mGy· cm]균저우대조조[CTDIvol、DLP분별위(9.6±0.6)mGy、(328.5±37.3)mGy· cm],차이균유통계학의의(t치분별위56.393、36.675,P치균＜0.01).결론 저제량、등삼저농도대비제CTPA기술가현시4～6급폐동맥분지,감소전대비제용량화사선폭로,차대폐동맥전새적진단양성솔여상규CTPA기술일치,가만족림상진단적수요.
    Objective To evaluate the image quality and the diagnostic value of low radiation,low dose and isotonic low concentration iodine contrast pulmonary computed tomography angiography (CTPA) protocol in pulmonary embolism.Methods Eighty patients with clinic ally suspected pulmonary embolism and BMI＜28 kg/m2 underwent pulmonary CTA on a 64-MDCT scanner (GE Discovery CT750 HD).Eighty patients were divided into two groups (group A:n=40,80 kV,Auto mA,20 ml 270 mg I/ml,60％FBP+40％ ASIR; group B:n=40,120 kV,Auto mA,40 ml 370 mg I/ml,100％FBP).Image quality was assessed,using a five-point scoring scale.Intraarterial density was measured in the common pulmonary artery trunk,the main right and left pulmonary arteries,lobar arteries,and then the average CT value was calculated.Image quality score,Average CT value,noise,SNR,CNR,CTDIvol and DLP were compared between the two groups using t-test.The occurrence rate of the superior vena cava iodine contrast agent sclerosis artifacts and the positive rate of pulmonary embolism were compared between the two groups,using Chi-square test.Results PE was found in 33 patients (14 in group A,19 in group B),and there was no difference of the positive rate of PE between two groups (35.0％ vs 47.5％,x2=1.289,P＞0.05).Overall 4-6 pulmonary artery branches were clearly displayed in all the cases.The image quality scores for two groups were 3.9±0.6 and 4.0 ± 0.7,respectively.There was no statistical difference between two groups (t=0.632,P＞0.05).The superior vena cava iodine contrast agent sclerosis artifacts were reduced in group A (28 cases vs.36 cases,x 2=10.362,P＜0.01).The average CT value and noise in group A [(426.8 ± 84.8),(14.9 ± 1.5)HU,respectively] was higher than those in group B [(359.4±75.3),(7.4± 1.4)HU,respectively],which was statistically significant(t=3.758,22.848,respectively; P＜0.01).However,the SNR (28.8 ±6.3)and CNR (24.5±6.1) in group A were lower than those in group B(SNR 50.4± 14.7,CNR 42.9± 13.8).There was statistically significant difference between two groups (t=8.522,7.669,respectively; P＜0.01 both).The CTDIvol[(3.3±0.3)mGy]and DLP[(101.4± 11.9)mGy· cm] in group A were significantly lower than those in group B [CTDI vol (9.6±0.6)mGy,DLP (328.5 ± 37.3)mGy· cm].The difference between two groups was statistically significant(t=56.393,36.675,respectively,P＜0.01 both).Conclusions The low radiation,low dose and isotonic low concentration iodine contrast CTPA protocol shows pulmonary artery branches of 4-6 levels,reduces radiation exposure and contrast media volume compared with the conventional pulmonary CTA,and achieves the same positive rate of PE in comparison of the conventional CTPA.It can meet the clinical needs.
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