CAJ | 학술논문

目的：探讨第二代双源 CT 低管电压（100 kV）扫描联合基于原始数据的迭代重建（SAFIRE）在冠状动脉支架成像中的可行性。资料与方法156例患者冠状动脉支架植入术后行 CT 冠状动脉成像，其中86例采用100 kV 结合 SAFIRE 重建，70例采用120 kV 结合滤波反投影重建，比较两组图像主动脉根部、支架内、支架近端冠状动脉的平均 CT 值、图像噪声、信噪比（SNR）、支架内 CT 值净增比（SAIR）、图像质量主观评分、支架显示情况、辐射剂量等。结果100 kV组主动脉根部、支架内、支架近端冠状动脉平均 CT 值高于120 kV 组（t=2.75、11.77、3.19，P<0.05），图像噪声及 SAIR 低于120 kV 组（t=－2.53、－9.51，P<0.05）；100 kV 组与120 kV 组主动脉根部、支架内、支架近端冠状动脉 SNR 差异无统计学意义（t=－1.34、－0.95、－1.67，P>0.05)。100 kV、SAFIRE 重建图像质量主观评分与120 kV、滤波反投影重建差异无统计学意义（t=－0.203，P>0.05）；两组共显示243个支架，其中右冠状动脉67个，左前降支123个，回旋支36个，其他分支17个；支架长度3.8~98.7 mm，平均（27.5±16.4）mm。100 kV 组容积 CT 剂量指数、剂量长度乘积、有效剂量均低于120 kV 组（t=－11.03、－9.41、－9.41，P<0.05），采用100 kV 扫描时有效剂量降低约51.5%。结论第二代双源 CT 低管电压（100 kV）联合 SAFIRE 重建技术评价冠状动脉支架不会增加图像噪声及支架射束硬化伪影，能满足诊断要求，并显著降低辐射剂量。
목적：탐토제이대쌍원 CT 저관전압（100 kV）소묘연합기우원시수거적질대중건（SAFIRE）재관상동맥지가성상중적가행성。자료여방법156례환자관상동맥지가식입술후행 CT 관상동맥성상，기중86례채용100 kV 결합 SAFIRE 중건，70례채용120 kV 결합려파반투영중건，비교량조도상주동맥근부、지가내、지가근단관상동맥적평균 CT 치、도상조성、신조비（SNR）、지가내 CT 치정증비（SAIR）、도상질량주관평분、지가현시정황、복사제량등。결과100 kV조주동맥근부、지가내、지가근단관상동맥평균 CT 치고우120 kV 조（t=2.75、11.77、3.19，P<0.05），도상조성급 SAIR 저우120 kV 조（t=－2.53、－9.51，P<0.05）；100 kV 조여120 kV 조주동맥근부、지가내、지가근단관상동맥 SNR 차이무통계학의의（t=－1.34、－0.95、－1.67，P>0.05)。100 kV、SAFIRE 중건도상질량주관평분여120 kV、려파반투영중건차이무통계학의의（t=－0.203，P>0.05）；량조공현시243개지가，기중우관상동맥67개，좌전강지123개，회선지36개，기타분지17개；지가장도3.8~98.7 mm，평균（27.5±16.4）mm。100 kV 조용적 CT 제량지수、제량장도승적、유효제량균저우120 kV 조（t=－11.03、－9.41、－9.41，P<0.05），채용100 kV 소묘시유효제량강저약51.5%。결론제이대쌍원 CT 저관전압（100 kV）연합 SAFIRE 중건기술평개관상동맥지가불회증가도상조성급지가사속경화위영，능만족진단요구，병현저강저복사제량。
Purpose To investigate the second generation dual source CT low tube voltage (100 kV) combined with sonogram-affirmed iterative reconstruction (SAFIRE) in assessing coronary artery stents. Materials and Methods One hundred and fifty-six patients underwent CT coronary angiography after implanted coronary artery stents. Among all the patients, 86 cases were performed with 100 kV combined with SAFIRE, and 70 cases with 120 kV combined with filtered back projection reconstruction (FBP). Mean CT values, image noise, SNR, SAIR, image quality scores, stents detecting and radiation dose of aortic root, inner-stent, and the coronary artery proximal to the stent were compared. Results The mean CT value of aortic root, inner-stent, and the coronary artery proximal to the stent of 100 kV group was higher than that of 120 kV group (t=2.75, 11.77 and 3.19, P<0.05), while image noise and SAIR of 100 kV group were lower than those of 120 kV group (t=-2.53 and -9.51, P<0.05). SNR of aortic root, inner-stent, and the coronary artery proximal to the stent was not statistically different between the two groups (t= -1.34, -0.95 and 1.67, P>0.05). There was no statistic difference of image quality score between the two groups (t= -0.203, P>0.05). Totally there were 243 stents detected, including 67 of right coronary artery, 123 of left anterior descending, 36 of left circumflex, and 17 of other branches. Stent length ranged 3.8 to 98.7 mm and averaged (27.5±16.4) mm. The CTDIvol, DLP and ED of 100 kV group were lower than those of 120 kV group (t= -11.03, -9.41 and -9.41, P<0.05). The effective dosage reduced about 51.5% in 100 kV group when compared with that of 120 kV group. Conclusion The second generation dual source CT low tube voltage (100 kV) combined with SAFIRE in assessing coronary artery stent could meet the diagnostic requirement and reduce the radiation dosage, without increasing image noise and beam hardening artifacts.