CAJ | 학술논문

目的：探讨胸部宝石CT自动管电流调节（ATCM）结合自适应迭代重建（ASIR）低剂量扫描技术在肺结节检查中的应用。方法对80例常规胸部CT检查发现肺结节的患者采用宝石能谱CT行两次扫描。第1次扫描采用单纯ATCM技术，第2次扫描采用ATCM技术结合50% ASIR重建。噪声指数根据体重指数（BMI）确定，第1次扫描（纯ATCM组）：BMI≤22 kg/m2、噪声指数为14，BMI＞22 kg/m2、噪声指数为20；第2次扫描（ATCM结合ASIR组）：BMI≤22 kg/m2、噪声指数为20，BMI＞22 kg/m2、噪声指数为26。由2名放射科医师分别对图像质量和图像噪声进行主观评分（5分制），并采用Kappa检验观察不同医师间评定结果的一致性。记录两组的CT剂量容积指数（CTDIvol），并采用配对样本t检验比较。比较两次扫描肺结节的检出率，分析两次扫描影像显示结节的数目和大小。结果 ATCM结合ASIR组CTDIvol为（1.60±0.45）mGy，单纯ATCM组CTDIvol为（4.26±0.41）mGy，结合ASIR技术可以降低约62%的剂量，两组差异有统计学意义（t＝26.81，P＜0.05）。单纯ATCM组，2名医师的图像质量评分分别为（4.50±0.48）分和（4.35±0.27）分，Kappa＝0.862，P＜0.01；ATCM结合ASIR组，2名医师的图像质量评分分别为（4.96±0.36）分和（4.82±0.45）分，Kappa＝0.795，P＜0.01。单纯ATCM组，2名医师的图像噪声评分分别为（4.18±0.52）分和（3.90±0.42）分，Kappa＝0.648，P＜0.01；ATCM结合ASIR组，2名医师的图像噪声评分分别为（4.42±0.43）分和（4.41±0.26）分，Kappa＝0.788，P＜0.01。所有图像质量评分均达到满足影像诊断的要求。两种扫描方案扫描检出肺结节的数目相等，且肺结节的直径间差异无统计学意义（P＞0.05）。结论胸部CT扫描可提升噪声指数，并且应用ASIR技术获得的图像能够保证图像质量符合临床诊断要求，并进一步减少辐射剂量，更适合对肺结节进行筛查、初步诊断和随访。目的：探討胸部寶石CT自動管電流調節（ATCM）結閤自適應迭代重建（ASIR）低劑量掃描技術在肺結節檢查中的應用。方法對80例常規胸部CT檢查髮現肺結節的患者採用寶石能譜CT行兩次掃描。第1次掃描採用單純ATCM技術，第2次掃描採用ATCM技術結閤50% ASIR重建。譟聲指數根據體重指數（BMI）確定，第1次掃描（純ATCM組）：BMI≤22 kg/m2、譟聲指數為14，BMI＞22 kg/m2、譟聲指數為20；第2次掃描（ATCM結閤ASIR組）：BMI≤22 kg/m2、譟聲指數為20，BMI＞22 kg/m2、譟聲指數為26。由2名放射科醫師分彆對圖像質量和圖像譟聲進行主觀評分（5分製），併採用Kappa檢驗觀察不同醫師間評定結果的一緻性。記錄兩組的CT劑量容積指數（CTDIvol），併採用配對樣本t檢驗比較。比較兩次掃描肺結節的檢齣率，分析兩次掃描影像顯示結節的數目和大小。結果 ATCM結閤ASIR組CTDIvol為（1.60±0.45）mGy，單純ATCM組CTDIvol為（4.26±0.41）mGy，結閤ASIR技術可以降低約62%的劑量，兩組差異有統計學意義（t＝26.81，P＜0.05）。單純ATCM組，2名醫師的圖像質量評分分彆為（4.50±0.48）分和（4.35±0.27）分，Kappa＝0.862，P＜0.01；ATCM結閤ASIR組，2名醫師的圖像質量評分分彆為（4.96±0.36）分和（4.82±0.45）分，Kappa＝0.795，P＜0.01。單純ATCM組，2名醫師的圖像譟聲評分分彆為（4.18±0.52）分和（3.90±0.42）分，Kappa＝0.648，P＜0.01；ATCM結閤ASIR組，2名醫師的圖像譟聲評分分彆為（4.42±0.43）分和（4.41±0.26）分，Kappa＝0.788，P＜0.01。所有圖像質量評分均達到滿足影像診斷的要求。兩種掃描方案掃描檢齣肺結節的數目相等，且肺結節的直徑間差異無統計學意義（P＞0.05）。結論胸部CT掃描可提升譟聲指數，併且應用ASIR技術穫得的圖像能夠保證圖像質量符閤臨床診斷要求，併進一步減少輻射劑量，更適閤對肺結節進行篩查、初步診斷和隨訪。
목적：탐토흉부보석CT자동관전류조절（ATCM）결합자괄응질대중건（ASIR）저제량소묘기술재폐결절검사중적응용。방법대80례상규흉부CT검사발현폐결절적환자채용보석능보CT행량차소묘。제1차소묘채용단순ATCM기술，제2차소묘채용ATCM기술결합50% ASIR중건。조성지수근거체중지수（BMI）학정，제1차소묘（순ATCM조）：BMI≤22 kg/m2、조성지수위14，BMI＞22 kg/m2、조성지수위20；제2차소묘（ATCM결합ASIR조）：BMI≤22 kg/m2、조성지수위20，BMI＞22 kg/m2、조성지수위26。유2명방사과의사분별대도상질량화도상조성진행주관평분（5분제），병채용Kappa검험관찰불동의사간평정결과적일치성。기록량조적CT제량용적지수（CTDIvol），병채용배대양본t검험비교。비교량차소묘폐결절적검출솔，분석량차소묘영상현시결절적수목화대소。결과 ATCM결합ASIR조CTDIvol위（1.60±0.45）mGy，단순ATCM조CTDIvol위（4.26±0.41）mGy，결합ASIR기술가이강저약62%적제량，량조차이유통계학의의（t＝26.81，P＜0.05）。단순ATCM조，2명의사적도상질량평분분별위（4.50±0.48）분화（4.35±0.27）분，Kappa＝0.862，P＜0.01；ATCM결합ASIR조，2명의사적도상질량평분분별위（4.96±0.36）분화（4.82±0.45）분，Kappa＝0.795，P＜0.01。단순ATCM조，2명의사적도상조성평분분별위（4.18±0.52）분화（3.90±0.42）분，Kappa＝0.648，P＜0.01；ATCM결합ASIR조，2명의사적도상조성평분분별위（4.42±0.43）분화（4.41±0.26）분，Kappa＝0.788，P＜0.01。소유도상질량평분균체도만족영상진단적요구。량충소묘방안소묘검출폐결절적수목상등，차폐결절적직경간차이무통계학의의（P＞0.05）。결론흉부CT소묘가제승조성지수，병차응용ASIR기술획득적도상능구보증도상질량부합림상진단요구，병진일보감소복사제량，경괄합대폐결절진행사사、초보진단화수방。
Objective To investigate the feasibility to reduce radiation doses on lung nodules using the adaptive statistical iterative reconstruction technique(ASIR) associated with automated tube current modulation technique(ATCM). Methods Eighty patients revealed lung nodules with precious stones energy spectrum CT line scan twice with ATCM and the follow-up scan with ATCM cooperated with 50% ASIR.ATCM was used with age-dependent noise index(NI)settings: NI=14 for NI≤22 and NI=20 for>22 for simple ATCM group. NI=20 for NI≤22 and NI=26 for>22 for ATCM cooperated with 50%ASIR group(AISR group). Two radiologists independently evaluated images for diagnostic quality and image noise with subjectively image quality score and image noise score using a 5-point scale. Interobserver agreement was assessed by Kappa test. The volume CT dose indexes(CTDIv01) for the two groups were recorded.Statistical significance for the CTDIv01 value was analyzed by pair-sample t test. Compare two scanning detection of lung nodules, analysis two scanning images shows that the number and size of nodules. Results The average CTDIvol for the ASIR group was (1.60±0.45)mGy, about 62%lower than (4.26±0.41)mGy for the simple ATCM group, and the CTDIvol of two groups had statistically significant differences(t=26.81, P<0.05). The subjective image quality scores for the simple ATCM group were 4.50±0.48 and 4.39±0.61, Kappa=0.862, P<0.01 (ASIR group:4.96±0.36 and 4.82 ±0.45, Kappa=0.795, P<0.01), by two observers. The image noise score for the simple ATCM group were 4.18±0.52 and 3.90±0.42, Kappa=0.648, P<0.01 (ASIR group: 4.42±0.43 and 4.41±0.26, Kappa=0.788, P<0.01), by two observers. All images had acceptable diagnostic image quality.Two scanning scanning program number of detection of lung nodules is equal and difference between the diameter of the pulmonary nodules no statistical significance (P>0.05). Conclusion Lower radiation dose can be achieved by elevating N1 with ASIR in the CT chest studies, while maintaining diagnostically acceptable images for screening for lung nodules primary diagnosis and follow-up.