CAJ | 학술논문

目的评价心率对急性胸痛患者行320排640层动态容积CT胸痛三联检查图像质量及辐射剂量的影响.方法回顾性分析2011年3月15日至9月15日河北沧州市中心医院38例急性胸痛患者的临床及影像资料.全部患者均接受了320排640层动态容积CT检查.扫描方案为心电门控下全胸部螺旋扫描(160 ×0.5 mm).按心率不同将患者分为A、B两组(A组18例,心率≤65次/min；B组20例,心率＞65次/min),分别评价A、B组间肺动脉、主动脉及冠状动脉图像质量及辐射剂量,冠状动脉主观质量评价分优、良、可、差4级.结果 (1)总体质量评价:升主动脉根部、主肺动脉、右冠状动脉及左冠状动脉平均CT值分别为(412 ±79) HU、(381±107) HU、(408±79) HU、(406 ±79) HU;升主动脉根部对比噪声比(CNR)为12±7；冠状动脉主观评价质量优的阶段占66.13％,良+可占32.79％,差占1.08％.平均辐射剂量为(22 ±3) mSv.(2)A、B两组间升主动脉根部、主肺动脉、右冠状动脉及左冠状动脉平均CT值、升主动脉根部CNR分别为(421±62) HU比(404 ±93) HU、(402±103) HU比(362±110) HU、(417±62) HU比(400±92) HU、(417±63)HU比(397±92) HU、10±3比13±8,差异均无统计学意义(均P＞0.05).A、B两组间冠状动脉主观评价质量优的节段数和可评价节段数(优+良+可节段数)均有统计学差异(P=0.001,0.019),A组优于B组,但B组可诊断节段数仍达97.9％.A、B两组间辐射剂量分别为(18±6) mSv比(26±5) mSv,差异有统计学意义(P =0.000),B组明显高于A组.结论 320排640层动态容积CT胸痛三联检查,无论高低心率组,均可获得高质量的主动脉、肺动脉和冠状动脉图像,对比剂用量和患者辐射剂量较低.适用于急性胸痛病因诊断.降低心率可进一步提高冠状动脉图像质量并减少辐射剂量.
목적 평개심솔대급성흉통환자행320배640층동태용적CT흉통삼련검사도상질량급복사제량적영향.방법 회고성분석2011년3월15일지9월15일하북창주시중심의원38례급성흉통환자적림상급영상자료.전부환자균접수료320배640층동태용적CT검사.소묘방안위심전문공하전흉부라선소묘(160 ×0.5 mm).안심솔불동장환자분위A、B량조(A조18례,심솔≤65차/min；B조20례,심솔＞65차/min),분별평개A、B조간폐동맥、주동맥급관상동맥도상질량급복사제량,관상동맥주관질량평개분우、량、가、차4급.결과 (1)총체질량평개:승주동맥근부、주폐동맥、우관상동맥급좌관상동맥평균CT치분별위(412 ±79) HU、(381±107) HU、(408±79) HU、(406 ±79) HU;승주동맥근부대비조성비(CNR)위12±7；관상동맥주관평개질량우적계단점66.13％,량+가점32.79％,차점1.08％.평균복사제량위(22 ±3) mSv.(2)A、B량조간승주동맥근부、주폐동맥、우관상동맥급좌관상동맥평균CT치、승주동맥근부CNR분별위(421±62) HU비(404 ±93) HU、(402±103) HU비(362±110) HU、(417±62) HU비(400±92) HU、(417±63)HU비(397±92) HU、10±3비13±8,차이균무통계학의의(균P＞0.05).A、B량조간관상동맥주관평개질량우적절단수화가평개절단수(우+량+가절단수)균유통계학차이(P=0.001,0.019),A조우우B조,단B조가진단절단수잉체97.9％.A、B량조간복사제량분별위(18±6) mSv비(26±5) mSv,차이유통계학의의(P =0.000),B조명현고우A조.결론 320배640층동태용적CT흉통삼련검사,무론고저심솔조,균가획득고질량적주동맥、폐동맥화관상동맥도상,대비제용량화환자복사제량교저.괄용우급성흉통병인진단.강저심솔가진일보제고관상동맥도상질량병감소복사제량.
Objective To evaluate the effects of heart rate (HR) on image quality and radiation dose of "triple rule-out" 320-row-640-slice multidetector computed tomography (MDCT) scan in patients with acute chest pain.Methods Retrospective analyses were performed for the clinical and imaging data of 38 cases with acute chest pain.All patients received 320-row-640-slice MDCT.Scanning program was electrocardiography-gated helical scan of full chest (160 × 0.5 mm).Based upon different heart rates,they were divided into A and B groups (A:n =18,HR ≤65 bpm; B:n =20,HR ＞65 bpm).The results of image quality and radiation dose of pulmonary artery,aorta and coronary artery between A and B group were evaluated respectively.The subjective quality indicators of coronary artery were excellent,good,qualified and poor.Results (1) Overall quality assessment:the mean CT values of ascending aortic root,main pulmonary artery,right coronary artery and left coronary artery were (412 ± 79) HU、(381 ± 107) HU,(408 ±79) HU,(406 ±79) HU respectively; the contrast-noise ratio (CNR) of ascending aorta root was 12 ± 7; excellent stage of subjective quality assessment of coronary artery accounted for 66.13％,good and qualified stage 32.79％ and poor stage 1.08％.The mean radiation dose was 22 ± 3 mSv.(2)The mean CT value between A and B groups of ascending aortic root,main pulmonary artery,right coronary artery and left coronary artery,and CNR of ascending aortic root [(421 ±62) HU vs (404 ±93) HU,(402 ± 103) HU vs (362 ± 110) HU,(417 ±62) HU vs (400 ±92) HU,(417 ±63) HU vs (397 ±92) HU,10 ±3 vs 13 ±8 respectively] were not statistically different (P ＞ 0.05) ; the number of segments of excellent subjective quality assessment and evaluable (excellent,good and qualified) of coronary artery between A and B groups were statistically significant (P =0.001,P =0.019).Group A was better than Group B.But the number of diagnosed segments of Group B still accounted for 97.9％.The radiation doses of two groups were 18 ±6 and 26 ± 5 mSv respectively.Group B was significantly higher than Group A and significant difference existed between two values (P =0.000).Conclusion The "triple rule-out" 320-row-640-slice MDCT scan may acquire high quality images of aorta,pulmonary arteries and coronary arteries for both high and low HR groups.With a low contrast-medium dosage and patient radiation dose,it is ideal for an etiological diagnosis of acute chest pain.Reducing HR further improves image quality and lowers radiation dose.