目的 比较团注对比剂跟踪技术和小剂量团注测试技术对第二代双源CT双能量肺灌注扫描成像质量和伪影的影响.方法 对60例临床疑似肺动脉栓塞的患者,采用第二代双源CT行双能量肺灌注扫描,根据随机表法将患者随机分为2组,每组30例.使用60 ml对比剂,扫描延迟时间分别采用团注对比剂跟踪技术(B组)和小剂量团注测试技术(T组)确定,2名影像医师测量并统计比较各目标血管(锁骨下静脉、上腔静脉、左心房、肺动脉主干、肺动脉S1段及S10段)的CT值、肺组织增强幅度、CT肺动脉成像(CTPA)图像质量主观评分及肺灌注图像伪影主观评分.采用Student t检验、方差分析、四格表卡方检验、非参数秩和检验、Kappa一致性检验进行统计学分析.结果 B组与T组比较,锁骨下静脉[(1042 ±639)、(2200±724) HU,F=43.196,P=0.001]、上腔静脉[(529±237)、(904±329) HU,F=25.654,P=0.001]、肺动脉主干[(325±112)、(383±69) HU,F=5.94,P=0.018]、肺动脉S1段[(320±118)、(385±73) HU,F=6.549,P=0.013]及肺动脉S10段[(307±78)、(360±82) HU,F=6.658,P=0.012]CT值均低于T组；左心房的CT值B组高于T组[(270±53)、(219±57) HU,F=12.823,P=0.001].肺动脉主干CT值高于诊断需求CT值(＞250 HU)的比例B组低于T组[21例(70.0％)和29例(96.7％),x2=5.88,P＜0.05].B组肺组织增强幅度均低于T组[右肺(29±8)和(34±8) HU,t=-2.401,P=0.020;左肺(30±7)和(36±9)HU,t=-2.493,P=0.016;全肺(30±7)和(35±8) HU,t=-2.495,P=0.016].B组的肺动脉成像质量评分4.4分,低于T组的4.9分(U=619.5,P＜0.05),在2名观察者间取得了较好的一致性(kappa=0.708).B组肺灌注图像伪影评分为3.9分,高于T组的2.6分(U=162.5,P＜0.05),在2名观察者间取得了较好的一致性(Kappa=0.796).结论 在使用60 ml对比剂的情况下,小剂量团注测试技术比团注对比剂跟踪技术能获得更好的肺动脉成像质量,更充分的对比剂灌注,同时提示存在进一步减少对比剂的可能性,值得临床推荐.
目的 比較糰註對比劑跟蹤技術和小劑量糰註測試技術對第二代雙源CT雙能量肺灌註掃描成像質量和偽影的影響.方法 對60例臨床疑似肺動脈栓塞的患者,採用第二代雙源CT行雙能量肺灌註掃描,根據隨機錶法將患者隨機分為2組,每組30例.使用60 ml對比劑,掃描延遲時間分彆採用糰註對比劑跟蹤技術(B組)和小劑量糰註測試技術(T組)確定,2名影像醫師測量併統計比較各目標血管(鎖骨下靜脈、上腔靜脈、左心房、肺動脈主榦、肺動脈S1段及S10段)的CT值、肺組織增彊幅度、CT肺動脈成像(CTPA)圖像質量主觀評分及肺灌註圖像偽影主觀評分.採用Student t檢驗、方差分析、四格錶卡方檢驗、非參數秩和檢驗、Kappa一緻性檢驗進行統計學分析.結果 B組與T組比較,鎖骨下靜脈[(1042 ±639)、(2200±724) HU,F=43.196,P=0.001]、上腔靜脈[(529±237)、(904±329) HU,F=25.654,P=0.001]、肺動脈主榦[(325±112)、(383±69) HU,F=5.94,P=0.018]、肺動脈S1段[(320±118)、(385±73) HU,F=6.549,P=0.013]及肺動脈S10段[(307±78)、(360±82) HU,F=6.658,P=0.012]CT值均低于T組；左心房的CT值B組高于T組[(270±53)、(219±57) HU,F=12.823,P=0.001].肺動脈主榦CT值高于診斷需求CT值(＞250 HU)的比例B組低于T組[21例(70.0％)和29例(96.7％),x2=5.88,P＜0.05].B組肺組織增彊幅度均低于T組[右肺(29±8)和(34±8) HU,t=-2.401,P=0.020;左肺(30±7)和(36±9)HU,t=-2.493,P=0.016;全肺(30±7)和(35±8) HU,t=-2.495,P=0.016].B組的肺動脈成像質量評分4.4分,低于T組的4.9分(U=619.5,P＜0.05),在2名觀察者間取得瞭較好的一緻性(kappa=0.708).B組肺灌註圖像偽影評分為3.9分,高于T組的2.6分(U=162.5,P＜0.05),在2名觀察者間取得瞭較好的一緻性(Kappa=0.796).結論 在使用60 ml對比劑的情況下,小劑量糰註測試技術比糰註對比劑跟蹤技術能穫得更好的肺動脈成像質量,更充分的對比劑灌註,同時提示存在進一步減少對比劑的可能性,值得臨床推薦.
목적 비교단주대비제근종기술화소제량단주측시기술대제이대쌍원CT쌍능량폐관주소묘성상질량화위영적영향.방법 대60례림상의사폐동맥전새적환자,채용제이대쌍원CT행쌍능량폐관주소묘,근거수궤표법장환자수궤분위2조,매조30례.사용60 ml대비제,소묘연지시간분별채용단주대비제근종기술(B조)화소제량단주측시기술(T조)학정,2명영상의사측량병통계비교각목표혈관(쇄골하정맥、상강정맥、좌심방、폐동맥주간、폐동맥S1단급S10단)적CT치、폐조직증강폭도、CT폐동맥성상(CTPA)도상질량주관평분급폐관주도상위영주관평분.채용Student t검험、방차분석、사격표잡방검험、비삼수질화검험、Kappa일치성검험진행통계학분석.결과 B조여T조비교,쇄골하정맥[(1042 ±639)、(2200±724) HU,F=43.196,P=0.001]、상강정맥[(529±237)、(904±329) HU,F=25.654,P=0.001]、폐동맥주간[(325±112)、(383±69) HU,F=5.94,P=0.018]、폐동맥S1단[(320±118)、(385±73) HU,F=6.549,P=0.013]급폐동맥S10단[(307±78)、(360±82) HU,F=6.658,P=0.012]CT치균저우T조；좌심방적CT치B조고우T조[(270±53)、(219±57) HU,F=12.823,P=0.001].폐동맥주간CT치고우진단수구CT치(＞250 HU)적비례B조저우T조[21례(70.0％)화29례(96.7％),x2=5.88,P＜0.05].B조폐조직증강폭도균저우T조[우폐(29±8)화(34±8) HU,t=-2.401,P=0.020;좌폐(30±7)화(36±9)HU,t=-2.493,P=0.016;전폐(30±7)화(35±8) HU,t=-2.495,P=0.016].B조적폐동맥성상질량평분4.4분,저우T조적4.9분(U=619.5,P＜0.05),재2명관찰자간취득료교호적일치성(kappa=0.708).B조폐관주도상위영평분위3.9분,고우T조적2.6분(U=162.5,P＜0.05),재2명관찰자간취득료교호적일치성(Kappa=0.796).결론 재사용60 ml대비제적정황하,소제량단주측시기술비단주대비제근종기술능획득경호적폐동맥성상질량,경충분적대비제관주,동시제시존재진일보감소대비제적가능성,치득림상추천.
Objective To compare the test bolus technique with the bolus tracking technique for dual-energy CT pulmonary angiography in patients suspected of pulmonary embolism (PE).Methods A total of 60 patients were randomized into 2 groups:bolus tracking technique group (group B,n =30) and test bolus technique group (group T,n =30).A standard dual-energy CT pulmonary angiography (CTPA)was performed after injection of 60 ml contrast medium followed by 35ml saline chaser at a speed of 4 mL/s.Attenuation profiles of different vascular segments (the subclavian vein,superior vena cava,left atrium,pulmonary trunk,S1 and S10 pulmonary artery) and enhancement value of lung parenchyma were measured to evaluate the timing techniques.The overall image quality of CTPA and pulmonary perfusion were analyzed by two radiologists.SPSS 19.0,Student t test,ANOVA test,Chi-Square test,Mann-Whitney U test and Kappa test were used for the statistic analysis.Results The attenuation of the subclavian vein [(1042 ± 639),(2200 ± 724) HU,F =43.196,P =0.001],superior vena cava [(529 ± 237),(904 ± 329)HU,F=25.654,P=0.001],pulmonary trunk [(325 ±112),(383±69)HU,F=5.94,P=0.018],S1 pulmonary artery [(320 ± 118),(385 ±73) HU,F =6.549,P =0.013],S10 pulmonary artery [(307 ± 78),(360 ± 82) HU,F =6.658,P =0.012] in group B were lower than those in group T,while the attenuation of the left atrium in group B was higher than that in group T [(270 ± 53),(219 ± 57)HU,F=12.823,P =0.001].The percentage of pulmonary arteries exceeding optimal attenuation (＞ 250 HU) in groups B was lower than that in group T [n =21 (70.0％),n =29 (96.7％),x2 =5.88,P ＜ 0.05].The enhancement value of pulmonary parenchyma in group B was lower than that in group T (the right lung (29±8)vs(34±8) HU,t=-2.401,P=0.020; the left lung (30±7)vs(36±9)HU,t=-2.493,P=0.016; total (30 ±7)vs(35 ±8) HU,t =-2.495,P =0.016).The image quality of CTPA in group B was poorer than that in group T (U =619.5,P ＜ 0.05,Kappa =0.708),while the artifacts of lung perfusion image in group B was less than that in group T (U =162.5,P ＜ 0.05,Kappa =0.796).Conclusion The test bolus technique has a better image quality of CT pulmonary angiography and a higher lung perfusion blood volume compared with the bolus tracking technique by using 60 ml contrast medium and 35ml saline.
