中华临床医师杂志(电子版) 2017年2月,11卷4期

临床论著

双低剂量联合低流速注射在双源CT冠状动脉血管成像中的应用

汤振华

271200 山东新泰,泰山医学院附属新泰医院CT室
汤振华,Email: xttzh1974@163.com

摘要:目的 探讨低管电压和低剂量对比剂、低流速注射在双源CT前瞻性心电触发大螺距扫描进行冠状动脉成像的可行性。方法 选取120例体质量指数(BMI)18.6~24.9 kg/m2和心率<65次/min的患者,A组60例采用120 kV管电压、对比剂剂量0.9 ml/kg、注射流速5.0 ml/s进行前瞻性心电触发门控扫描;B组60例采用80 kV管电压、对比剂剂量0.7 ml/kg、注射流速3.5 ml/s进行前瞻性心电触发大螺距扫描。对比剂均采用碘海醇350 mgI/ml,图像重建均采用迭代重建技术(SAFIRE)。测量2组的CT强化值和噪声,计算信噪比(SNR)、对比噪声比(CNR)。采用双盲法对冠状动脉以4分法进行评价,其中1分为不可诊断图像。结果 A组管腔内的平均强化CT值略高于B组,B组的图像噪声较A组略高,A组的SNR、CNR高于B组,差异均无统计学意义(P>0.05)。B组有效辐射剂量[(0.39±0.02)mSv]较A组显著降低[(4.99±1.36)mSv],差异有统计学意义(P<0.01)。结论 在BMI 18.6~24.9 kg/m2、心率<65次/min的患者中,应用双源CT前瞻性心电触发大螺距、低管电压、低对比剂剂量、低流速注射扫描,图像重建采用迭代重建,能够在保证冠状动脉图像质量的情况下,大幅度降低辐射剂量。

关键词:冠状血管; 体层摄影术,X线计算机; 辐射剂量; 对比剂

Double low dose combined with low velocity of flow injection in the application of the dual-source CT coronary angiography 

Tang Zhenhua.

Department of CT, Xintai Hospital Affiliated to Taishan Medical College, Xintai 271200, China
Tang Zhenhua, Email: xttzh1974@163.com

Abstract: Objective To discuss the feasibility of lower tube voltage and low dose of iodine- concentration contrast material, low velocity of flow injection in dual-source CT prospective ECG-trigger high pitch to scan for coronary artery imaging. Methods Selected 120 cases patients of body mass index (BMI) of 18.6 to 24.9 kg/m2, and heart rate<65 bpm. A group of 60 patients used 120 kV tube voltages, contrast media dosage 0.9 ml/kg, and injection rate of 5.0 ml/s to carry out prospective ECG-trigger scanning. B group of 60 cases used 80 kV tube voltage, contrast media dosage 0.7 ml/kg, injection rate of 3.5 ml/s to carry out prospective ECG-trigger high-pitch scan. Adopt iodine contrast media (Iohexol 350 mgI/ml) and iterative reconstruction technique (SAFIRE) was used in image reconstruction. Measured the values of CT enhanced images and noise of two groups, calculated the signal-to-noise ratio (SNR) and contrasted to noise ratio (CNR). The method of double blind was used to evaluate coronary artery in 4-point scale (1=non-diagnostic, 4=excellent) . Results The average enhanced CT attenuation of coronary artery in group A was slightly higher than group B; The image noise of group B was slightly higher than group A; SNR, CNR of group A was higher than group B, the difference was not statistically significant (P>0.05). Group B effective radiation dose (0.39±0.02)mSv was significantly lower in group A (4.99±1.36)mSv and had statistically significant difference (P<0.01). Conclusion In the patients of BMI 18.6 to 24.9 kg/m2, HR<65 bpm, the application of dual-source CT prospective ECG-trigger and high pitch, low voltage, low dose contrast media, low velocity of flow injection, image reconstruction using iterative reconstruction, can guarantee the quality of coronary artery image, and radiation dosage significantly reduces 91.8%.

Keywords:Coronary, vessels; Tomography, X-ray computed; Radiation dosage; Contrast media

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参考文献

  [1] Levsky J, Km CW, Spevack DM, et al. Efficacy of coronary CT angiography: where we are, where we are going, and where we want to be[J]. Cardiovasc Comput Tomogr, 2009, 3(suppl 2): S99-S108.

  [2] Becker J, Babb J, Serrano M. Glomerular filtration rate in evaluation of the effect of iodinated contrast media on renal function[J]. AJR, 2013, 200(4): 824-826.

  [3] 姜原, 刘建新, 王霄英, 等. 冠脉CT检查个体化对比剂注射方案的优化研究[J], 放射学实践, 2013, 28(3): 303-306.

  [4] 苟文静, 刘士远, 萧毅, 等. 降低管电压及对比剂剂量在前瞻性冠状动脉成像中的应用: 高级迭代重建算法的应用价值[J]. 实用放射学杂志, 2013, 29(8): 1324-1329.

  [5] 中华放射学杂志心脏冠状动脉多排CT临床应用协作组. 心脏冠状动脉多排CT临床应用专家共识[S]. 中华放射学杂志, 2011, 45(1): 9-17.

  [6] Klass O, Walker M, Siebach A, et al. Prospectively gated axial CT coronary angiography: comparison of image quality and effective radiation dose between 64-and 256-slice CT[J]. Eur Radiol, 2010, 20(5): 1124-1131.

  [7] Pflederer T, Jakstat J, Marwan M, et al. Radiation exposure and Image quality in staged low-dose protocols for coronary dual-source CT angiography: a randomized comparion[J]. Eur Radiol, 2010, 20(5): 1197-1206.

  [8] Einstein AJ, Henzlova MJ, Rajagopalan S. Estimating risk of cancer associated with radiation exposure from 64-slice computed tomography coronary angiography[J]. JAMA, 2007, 298(3): 317-323.

  [9] Achenbach S, Marwan M, Ropers D, et al. Coronary computed tomography angiography with a consistent dose below 1 mSv using prospectively electrocardiogram-triggered high-pitch spiral acquisition[J]. Eur Heart J, 2010, 31(3): 340-346.

  [10] Zhao Y, Tao Z, Xu Z, et al. Toxic effects of a high dose of non-ionic iodinated contrast media on renal glomerular and aortic endothelial cells in aged rats in vivo[J]. Toxicol Lett, 2011, 202(3): 253-260.

  [11] Layritz C, Schmid J, Achenbach S, et al. Accuracy of prospectively ECG-triggered very low-dose coronary dual-source CT angiography using iterative reconstruction for the detection of coronary artery stenosis: comparison with invasive catheterization[J]. Eur Heart J Cardiovasc Imaging, 2014, 15(11): 1238-1245.

  [12] Cademartiri F, Maffei E, Palumbo AA, et al. Influence of intra-coronary enhancement on diagnostic accuracy with 64-slice CT coronary angiography[J]. Eur Radiol, 2008, 18(3): 576-583.

  [13] Nakaura T, Kidoh M, Sakaino N, et al. Low contrast- and low radiation dose protocol for cardiac CT of thin adults at 256-row CT: usefulness of low tube voltage scans and the hybrid iterative reconstruction algorithm[J]. Int J Cardiovasc Imaging, 2013, 29(4): 913-923.

  [14] Lembcke A, Schwenke C, Hein PA, et al. High-pitch dual-source CT coronary angiography with low volumes of contrast medium[J]. Eur Radiol, 2014, 24(1): 120-127.

  [15] Kawaguchi N, Kurata A, Kido T, et al. Optimization of coronary attenuation in coronary computed tomography angiography using diluted contrast material[J]. Circ J, 2014, 78(3): 662-670.

  [16] 胡莹莹, 孙宏亮, 王玉丽, 等. 采用低管电压技术和低剂量对比剂行256层螺旋CT头颈部动脉成像的可行性[J]. 中国医学影像技术, 2012, 28(7): 1396-1400.

  [17] Martinsen AC, Saether HK, HoI PK, et al. Iterative reconstruction reduces abdominal CT dose[J]. Eur J Radiol, 2012, 81(7): 1483-1487.

  [18] Wang R, Schoepf UJ, Wu R, et al. Image quality and radiation dose of low dose coronary CT angiography in obese patients: sinogram affirmed iterative reconstruction versus filtered projection[J]. Eur J Radiol, 2012, 81(11): 3141-3145.

(编辑:吴莹 收稿日期:2016-10-25)