中华放射学杂志
中華放射學雜誌
중화방사학잡지
Chinese Journal of Radiology
2014年
10期
816-821
,共6页
林晓珠%福井利佳%沈云%町田治彦%田中功%汪禾青%上野惠子%陈克敏%严福华
林曉珠%福井利佳%瀋雲%町田治彥%田中功%汪禾青%上野惠子%陳剋敏%嚴福華
림효주%복정리가%침운%정전치언%전중공%왕화청%상야혜자%진극민%엄복화
肾功能不全%体层摄影术,X线计算机%造影剂
腎功能不全%體層攝影術,X線計算機%造影劑
신공능불전%체층섭영술,X선계산궤%조영제
Renal insufficiency%Tomography,X-ray computed%Contrast media
目的 探讨腹部增强能谱CT成像在肾功能不全患者低剂量对比剂扫描中的应用价值.方法 前瞻性收集因病情需要行腹部增强CT扫描的100例患者纳入研究.根据检查方式将患者分为能谱扫描组和常规扫描组,并根据患者肾功能和对比剂碘含量将能谱扫描组患者分成3个亚组.其中常规扫描组46例,患者肾小球滤过率(eGFR) ＞50 ml· min-1·1.73 m-2,管电压120 kVp,对比剂用量为含碘600 mg/kg.能谱扫描组54例,其中亚组1患者10例,eGFR为30～ 39 ml·min-1·1.73 m-2,对比剂用量为含碘300mg/kg;亚组2患者25例,eGFR为40～ 50 ml· min-·1.73 m-2,对比剂用量为含碘450mg/kg;亚组3患者19例,eGFR＞50 ml· min-1·1.73m-2,对比剂用量为含碘600 mg/kg.所有患者均行腹部CT双期扫描.以腹主动脉、胰腺、肝脏、脾脏作为研究对象,竖脊肌为背景.计算与常规扫描组CT增强值相当的单能量图像水平、对比噪声比(CNR)、最佳CNR单能量水平及其CT增强值和CNR.常规扫描组与能谱扫描各亚组之间不同部位CT增强值及CNR的比较采用独立样本t检验.结果 针对不同肾功能水平的患者,采用300 mg/kg对比剂方案、能谱扫描,动脉晚期选择53 keV单能量图像[腹主动脉CT增强值为(314±70) HU,CNR为20.0±5.6;胰腺CT增强值为(85±11)HU,CNR为4.0±0.8],肝实质期选择54～ 57 keV单能量图像[肝脏CT增强值为(43±6)HU,CNR为3.0±0.9;脾脏CT增强值为(68±8)HU,CNR为3.8±1.6],能够获得与常规扫描相当的增强效果和CNR.常规扫描组腹主动脉、胰腺、肝脏和脾脏的CT增强值分别为(285±60)、(86±15)、(50±11)和(66±11)HU,CNR分别为19.7±5.0、5.1±1.4、3.3±0.8和3.5±1.0,差异均无统计学意义(P均＞0.05).采用450 mg/kg对比剂方案、能谱扫描,63 ～ 65 keV单能量范围图像与常规成像CT增强值相当,腹主动脉、胰腺、肝脏和脾脏单能量图像CNR分别为29.1±7.4、6.2±2.3、4.3±1.3和4.7±1.7,常规扫描图像CNR分别为19.7±5.0、5.1±1.4、3.3±0.8和3.5±1.0,差异均有统计学意义(P均＜0.05).采用600 mg/kg对比剂方案、能谱扫描,72～73 keV单能量图像CT增强值与常规成像相当,其CNR高于常规成像组(P均＜0.05).动脉晚期和肝实质期选择最佳CNR单能量或CT增强值相当的单能量水平,可以获得更高的CT增强值和(或)CNR.结论 采用能谱CT单能量成像技术、对肾功能不全患者腹部增强CT减少50％的碘对比剂使用剂量是可行的.与常规成像方案相比,75％碘量的对比剂方案能谱成像可以根据临床需要,在获得相当增强效果的同时可以提高图像CNR,或选择最佳CNR单能量图像,同时提高图像的增强效果和CNR.
目的 探討腹部增彊能譜CT成像在腎功能不全患者低劑量對比劑掃描中的應用價值.方法 前瞻性收集因病情需要行腹部增彊CT掃描的100例患者納入研究.根據檢查方式將患者分為能譜掃描組和常規掃描組,併根據患者腎功能和對比劑碘含量將能譜掃描組患者分成3箇亞組.其中常規掃描組46例,患者腎小毬濾過率(eGFR) ＞50 ml· min-1·1.73 m-2,管電壓120 kVp,對比劑用量為含碘600 mg/kg.能譜掃描組54例,其中亞組1患者10例,eGFR為30～ 39 ml·min-1·1.73 m-2,對比劑用量為含碘300mg/kg;亞組2患者25例,eGFR為40～ 50 ml· min-·1.73 m-2,對比劑用量為含碘450mg/kg;亞組3患者19例,eGFR＞50 ml· min-1·1.73m-2,對比劑用量為含碘600 mg/kg.所有患者均行腹部CT雙期掃描.以腹主動脈、胰腺、肝髒、脾髒作為研究對象,豎脊肌為揹景.計算與常規掃描組CT增彊值相噹的單能量圖像水平、對比譟聲比(CNR)、最佳CNR單能量水平及其CT增彊值和CNR.常規掃描組與能譜掃描各亞組之間不同部位CT增彊值及CNR的比較採用獨立樣本t檢驗.結果 針對不同腎功能水平的患者,採用300 mg/kg對比劑方案、能譜掃描,動脈晚期選擇53 keV單能量圖像[腹主動脈CT增彊值為(314±70) HU,CNR為20.0±5.6;胰腺CT增彊值為(85±11)HU,CNR為4.0±0.8],肝實質期選擇54～ 57 keV單能量圖像[肝髒CT增彊值為(43±6)HU,CNR為3.0±0.9;脾髒CT增彊值為(68±8)HU,CNR為3.8±1.6],能夠穫得與常規掃描相噹的增彊效果和CNR.常規掃描組腹主動脈、胰腺、肝髒和脾髒的CT增彊值分彆為(285±60)、(86±15)、(50±11)和(66±11)HU,CNR分彆為19.7±5.0、5.1±1.4、3.3±0.8和3.5±1.0,差異均無統計學意義(P均＞0.05).採用450 mg/kg對比劑方案、能譜掃描,63 ～ 65 keV單能量範圍圖像與常規成像CT增彊值相噹,腹主動脈、胰腺、肝髒和脾髒單能量圖像CNR分彆為29.1±7.4、6.2±2.3、4.3±1.3和4.7±1.7,常規掃描圖像CNR分彆為19.7±5.0、5.1±1.4、3.3±0.8和3.5±1.0,差異均有統計學意義(P均＜0.05).採用600 mg/kg對比劑方案、能譜掃描,72～73 keV單能量圖像CT增彊值與常規成像相噹,其CNR高于常規成像組(P均＜0.05).動脈晚期和肝實質期選擇最佳CNR單能量或CT增彊值相噹的單能量水平,可以穫得更高的CT增彊值和(或)CNR.結論 採用能譜CT單能量成像技術、對腎功能不全患者腹部增彊CT減少50％的碘對比劑使用劑量是可行的.與常規成像方案相比,75％碘量的對比劑方案能譜成像可以根據臨床需要,在穫得相噹增彊效果的同時可以提高圖像CNR,或選擇最佳CNR單能量圖像,同時提高圖像的增彊效果和CNR.
목적 탐토복부증강능보CT성상재신공능불전환자저제량대비제소묘중적응용개치.방법 전첨성수집인병정수요행복부증강CT소묘적100례환자납입연구.근거검사방식장환자분위능보소묘조화상규소묘조,병근거환자신공능화대비제전함량장능보소묘조환자분성3개아조.기중상규소묘조46례,환자신소구려과솔(eGFR) ＞50 ml· min-1·1.73 m-2,관전압120 kVp,대비제용량위함전600 mg/kg.능보소묘조54례,기중아조1환자10례,eGFR위30～ 39 ml·min-1·1.73 m-2,대비제용량위함전300mg/kg;아조2환자25례,eGFR위40～ 50 ml· min-·1.73 m-2,대비제용량위함전450mg/kg;아조3환자19례,eGFR＞50 ml· min-1·1.73m-2,대비제용량위함전600 mg/kg.소유환자균행복부CT쌍기소묘.이복주동맥、이선、간장、비장작위연구대상,수척기위배경.계산여상규소묘조CT증강치상당적단능량도상수평、대비조성비(CNR)、최가CNR단능량수평급기CT증강치화CNR.상규소묘조여능보소묘각아조지간불동부위CT증강치급CNR적비교채용독립양본t검험.결과 침대불동신공능수평적환자,채용300 mg/kg대비제방안、능보소묘,동맥만기선택53 keV단능량도상[복주동맥CT증강치위(314±70) HU,CNR위20.0±5.6;이선CT증강치위(85±11)HU,CNR위4.0±0.8],간실질기선택54～ 57 keV단능량도상[간장CT증강치위(43±6)HU,CNR위3.0±0.9;비장CT증강치위(68±8)HU,CNR위3.8±1.6],능구획득여상규소묘상당적증강효과화CNR.상규소묘조복주동맥、이선、간장화비장적CT증강치분별위(285±60)、(86±15)、(50±11)화(66±11)HU,CNR분별위19.7±5.0、5.1±1.4、3.3±0.8화3.5±1.0,차이균무통계학의의(P균＞0.05).채용450 mg/kg대비제방안、능보소묘,63 ～ 65 keV단능량범위도상여상규성상CT증강치상당,복주동맥、이선、간장화비장단능량도상CNR분별위29.1±7.4、6.2±2.3、4.3±1.3화4.7±1.7,상규소묘도상CNR분별위19.7±5.0、5.1±1.4、3.3±0.8화3.5±1.0,차이균유통계학의의(P균＜0.05).채용600 mg/kg대비제방안、능보소묘,72～73 keV단능량도상CT증강치여상규성상상당,기CNR고우상규성상조(P균＜0.05).동맥만기화간실질기선택최가CNR단능량혹CT증강치상당적단능량수평,가이획득경고적CT증강치화(혹)CNR.결론 채용능보CT단능량성상기술、대신공능불전환자복부증강CT감소50％적전대비제사용제량시가행적.여상규성상방안상비,75％전량적대비제방안능보성상가이근거림상수요,재획득상당증강효과적동시가이제고도상CNR,혹선택최가CNR단능량도상,동시제고도상적증강효과화CNR.
Objective To investigate the feasibility and value of low iodine load at abdominal dynamic enhancement using CT with gemstone spectral imaging (GSI) in patients with renal insufficiency.Methods One hundred patients underwent abdominal dynamic enhancement CT (dual phase) were enrolled in this study.Ten patients with 30 ml· min-1· 1.73 m-2≤estimated glomerular filtration rate(eGFR)＜ 40 ml · min-1 · 1.73 m-2were administrated the contrast medium (CM) with a dosage of 300 mg/kg and scanned with GSI.Twenty-five patients with 40 ml· min-1 · 1.73 m-2≤eGFR≤50 ml· min-1 · 1.73 m-2 were administrated the CM with a dosage of 450 mg/kg and scanned with GSI.Sixty-five patients with eGFR＞ 50 ml · min-1 · 1.73 m-2 were administrated the CM with a standard dosage of 600 mg/kg.Among them 19 patients were scanned with GSI and 46 patients were scanned with conventional protocol (120 kVp).ROIs were manually placed in abdominal aorta,pancreas,liver,spleen and sacrospinalis muscle (as background).The CT value of pre-contrast and post-contrast were calculated for each region.For abdominal aorta and pancreas,CT values of plain scan and late arterial phase(40 s) were measured.For hepatic and splenic parenchyma,CT values of plain scan and hepatic parenchymal phase (100 s) were measured.The keV of monochromatic image of different CM dosage GSI groups with equivalent CT value were calculated according to the conventional group(120 kVp,600 mg/kg).KeV level of optimal contrast-to-noise ratio(CNR) monochromatic image were calculated for each region.The difference of CT value and CNR were compared between conventional group and GSI groups.Two sample independent t test was employed and P＜0.05 was significant.Results In 300 mg/kg group,53 keV in 40 s[abdominal aorta (314±70) HU,CNR 20.0±5.6;pancreas(85±1 1) HU,CNR 4.0±0.8] and 54 to 57 keV in 100 s[liver (43±6) HU,CNR 3.0±0.9; spleen (68± 8) HU,CNR 3.8± 1.6] had equivalent CT value with conventional group[abdominal aorta (285±60) HU,CNR (19.7±5.0); pancreas (86± 15) HU,CNR 5.1± 1.4; liver (50± 11)HU,CNR 3.3±0.8; spleen (66± 11) HU,CNR 3.5±1.0] and no significant difference of the CNR was found between the two groups(P＞0.05).In 450 mg/kg group,63 to 65 keV had equivalent CT value compared with conventional group and higher CNR[abdominal aorta (29.1 ±7.4) vs.(19.7±5.0),pancreas (6.2±2.3) vs.(5.1 ± 1.4),liver (4.3± 1.3) vs.(3.3±0.8),spleen (4.7± 1.7) vs.(3.5± 1.0) than conventional group(all P＜0.05).In 600 mg/kg group,72 to 73 keV had equivalent CT value compared with conventional group and higher CNR than conventional group (all P＜0.05).Optimal monochromatic images of 450 mg/kg group (40 s) and 600 mg/kg GSI group had higher CT value and CNR than conventional group(all P＜0.05).Conclusions Iodine load can be reduced to 50％ for the patients with renal insufficiency in abdominal dynamic CT with GSI.GSI with 75％ dosage of CM can provide equivalent enhancement quality and higher CNR in abdominal dynamic enhancement CT.
