医学研究与教育
醫學研究與教育
의학연구여교육
MEDICAL RESEARCH AND EDUCATION
2014年
5期
22-28
,共7页
赵永霞%常津%左紫薇%张畅达%张天乐
趙永霞%常津%左紫薇%張暢達%張天樂
조영하%상진%좌자미%장창체%장천악
低浓度对比剂%CT门静脉成像%影像质量%比较研究
低濃度對比劑%CT門靜脈成像%影像質量%比較研究
저농도대비제%CT문정맥성상%영상질량%비교연구
low concentration of contrast media%CT portal venography%image quality%comparative studies
目的：探讨低浓度对比剂门静脉成像在能谱CT中的临床应用。方法50例患者分为5组行肝脏门静脉期能谱CT扫描，患者注射对比剂总量为1 mL/kg，5组患者注射对比剂浓度分别为320 mgI/mL，288 mgI/mL，256 mgI/mL，224 mgI/mL，192 mgI/mL，扫描结束获得门静脉期0.625 mm层厚的门静脉最佳对比度噪声比（CNR）单能量图像，用此单能量图像对门静脉行VR和MIP重组。测量5组图像中门静脉和相同层面背部肌肉竖脊肌及腹壁脂肪的CT值及其标准差，计算信噪比（SNR）及CNR并取平均值，由2名高年资医师在盲法下对5组图像进行主观图像质量评分并取平均值，5组间比较采用单因素方差分析（ANOVA）。2名医师对重建图像质量一致性评估采用Kappa检验。结果门静脉最佳CNR单能量图像能量为50~55 keV。5组注射不同浓度对比剂患者的SRN、CNR分别为15.83±3.02、14.78±2.13、13.87±1.91、9.37±2.13、7.72±2.82和14.95±3.82、15.01±3.79、13.93±3.52、10.35±4.22、9.65±3.56。2位医师评分值均值为4.50±0.81、4.45±0.76、4.41±0.73、4.38±0.79、3.5±0.57。浓度为320 mgI/mL、288 mgI/mL、256 mgI/mL之间SNR、CNR及2位医师评分值之间差异无统计学意义（F=36.221，P<0.05）；320 mgI/mL、288 mgI/mL、256 mgI/mL与224 mgI/mL、192 mgI/mL之间SNR、CNR及3位医师评分值之间差异有统计学意义（F=7.221，P>0.05）。2名医师对320 mgI/mL、288 mgI/mL、256 mgI/mL对比剂浓度产生图像质量评价的一致性（Kappa值为0.86）高于224 mgI/mL、192 mgI/mL对比剂浓度产生图像（Kappa值为0.63）。结论应用能谱CT最佳单能量门静脉成像能显著降低对比剂使用浓度，推荐使用对比剂浓度为256 mgI/mL，注射总量为1 mL/kg。推荐能谱CT显示门静脉的最佳单能量为50～55 keV。
目的：探討低濃度對比劑門靜脈成像在能譜CT中的臨床應用。方法50例患者分為5組行肝髒門靜脈期能譜CT掃描，患者註射對比劑總量為1 mL/kg，5組患者註射對比劑濃度分彆為320 mgI/mL，288 mgI/mL，256 mgI/mL，224 mgI/mL，192 mgI/mL，掃描結束穫得門靜脈期0.625 mm層厚的門靜脈最佳對比度譟聲比（CNR）單能量圖像，用此單能量圖像對門靜脈行VR和MIP重組。測量5組圖像中門靜脈和相同層麵揹部肌肉豎脊肌及腹壁脂肪的CT值及其標準差，計算信譟比（SNR）及CNR併取平均值，由2名高年資醫師在盲法下對5組圖像進行主觀圖像質量評分併取平均值，5組間比較採用單因素方差分析（ANOVA）。2名醫師對重建圖像質量一緻性評估採用Kappa檢驗。結果門靜脈最佳CNR單能量圖像能量為50~55 keV。5組註射不同濃度對比劑患者的SRN、CNR分彆為15.83±3.02、14.78±2.13、13.87±1.91、9.37±2.13、7.72±2.82和14.95±3.82、15.01±3.79、13.93±3.52、10.35±4.22、9.65±3.56。2位醫師評分值均值為4.50±0.81、4.45±0.76、4.41±0.73、4.38±0.79、3.5±0.57。濃度為320 mgI/mL、288 mgI/mL、256 mgI/mL之間SNR、CNR及2位醫師評分值之間差異無統計學意義（F=36.221，P<0.05）；320 mgI/mL、288 mgI/mL、256 mgI/mL與224 mgI/mL、192 mgI/mL之間SNR、CNR及3位醫師評分值之間差異有統計學意義（F=7.221，P>0.05）。2名醫師對320 mgI/mL、288 mgI/mL、256 mgI/mL對比劑濃度產生圖像質量評價的一緻性（Kappa值為0.86）高于224 mgI/mL、192 mgI/mL對比劑濃度產生圖像（Kappa值為0.63）。結論應用能譜CT最佳單能量門靜脈成像能顯著降低對比劑使用濃度，推薦使用對比劑濃度為256 mgI/mL，註射總量為1 mL/kg。推薦能譜CT顯示門靜脈的最佳單能量為50～55 keV。
목적：탐토저농도대비제문정맥성상재능보CT중적림상응용。방법50례환자분위5조행간장문정맥기능보CT소묘，환자주사대비제총량위1 mL/kg，5조환자주사대비제농도분별위320 mgI/mL，288 mgI/mL，256 mgI/mL，224 mgI/mL，192 mgI/mL，소묘결속획득문정맥기0.625 mm층후적문정맥최가대비도조성비（CNR）단능량도상，용차단능량도상대문정맥행VR화MIP중조。측량5조도상중문정맥화상동층면배부기육수척기급복벽지방적CT치급기표준차，계산신조비（SNR）급CNR병취평균치，유2명고년자의사재맹법하대5조도상진행주관도상질량평분병취평균치，5조간비교채용단인소방차분석（ANOVA）。2명의사대중건도상질량일치성평고채용Kappa검험。결과문정맥최가CNR단능량도상능량위50~55 keV。5조주사불동농도대비제환자적SRN、CNR분별위15.83±3.02、14.78±2.13、13.87±1.91、9.37±2.13、7.72±2.82화14.95±3.82、15.01±3.79、13.93±3.52、10.35±4.22、9.65±3.56。2위의사평분치균치위4.50±0.81、4.45±0.76、4.41±0.73、4.38±0.79、3.5±0.57。농도위320 mgI/mL、288 mgI/mL、256 mgI/mL지간SNR、CNR급2위의사평분치지간차이무통계학의의（F=36.221，P<0.05）；320 mgI/mL、288 mgI/mL、256 mgI/mL여224 mgI/mL、192 mgI/mL지간SNR、CNR급3위의사평분치지간차이유통계학의의（F=7.221，P>0.05）。2명의사대320 mgI/mL、288 mgI/mL、256 mgI/mL대비제농도산생도상질량평개적일치성（Kappa치위0.86）고우224 mgI/mL、192 mgI/mL대비제농도산생도상（Kappa치위0.63）。결론응용능보CT최가단능량문정맥성상능현저강저대비제사용농도，추천사용대비제농도위256 mgI/mL，주사총량위1 mL/kg。추천능보CT현시문정맥적최가단능량위50～55 keV。
Objective To investigate the effect of low concentration of contrast media with energy spectral CT on the image quality of CT portal venography. Methods 50 patients were divided into 5 groups underwent spectral CT examination on a GE Discovery CT 750 HD scanner, the total contrast media were offered at 1 mL/kg to 50 patients, the contrast media concentration of 320 mgI/mL, 288 mgI/mL, 256 mgI/mL, 224 mgI/mL, 192 mgI/mL were offered for the 5 groups patients. During portal phase, 0.625 mm slice thickness polychromatie images and optimal monochromatic images were obtained, and volume rendering and maximum intensity projection were created to show the portal venography respectively, the CT unit and standard deviation were measured at the port venography and the erector muscle of spine, calculated the signal-noise ratio and the contrast-noise ratio, calculated the singal-noise ratio and contrast-noise ratio with the CT volue of port venography and the erector muscle of spine. The overall imaging quality was evaluated on a ifve-point scale by 3 radiologists, Comparisons between 5 groups were tested by One-Way ANOVA analysis. Results The monochromatic images at 50-55 keV were found to demonstrate the best CNR for both the portal vein and erector muscle of spine. The SNR with the different concentrations of contrast media was 15.83±3.02, 14.78±2.13, 13.87±1.91, 9.37±2.13, 7.72±2.82 and the CNR was 14.95±3.82, 15.01±3.79, 13.93±3.52, 10.35±4.22, 9.65±3.56. The values by three independent radiologists were 4.50±0.81, 4.45±0.76, 4.41±0.73, 4.38±0.79, 3.5±0.57. The dates of SNR , CNR and values were not statistically signiifcant at the contrast media concentration of 320 mgI/mL, 288 mgI/mL, 256 mgI/mL, 224 mgI/mL(F=36.221, P<0.05). The dates of SNR, CNR and values were statistically signiifcant at the contrast media concentration of 320 mgI/mL, 288 mgI/mL, 256 mgI/mL and 224 mgI/mL, 192 mgI/mL(F=7.221, P>0.05). In the comparison of image quality, Kappa value was 0.86 with the contrast media concentration of 320 mgI/mL, 288 mgI/mL, 256 mgI/mL and 0.63 with 224 mgI/mL, 192 mgI/mL. conclusion The best monochromatic images of spectral CT could reduce the contrast media concentration, Recommend concentration of the contrast media was 256 mgI/mL at portal venography by spectral CT imaging. The best monochromatic X-ray keV was 50-55 keV.
