双源CT低剂量技术在冠状动脉成像中的临床应用
发布时间：2018-09-16 21:27
【摘要】：第一部分双源CT低管电压技术在冠状动脉成像中的临床应用 目的 (1)探讨双源CT (Dual-source CT, DSCT)100、80kV管电压冠状动脉CTA检查的可行性及价值。 (2)评价DSCT智能最佳kV扫描技术(CARE kV)在冠状动脉CTA检查中的应用及价值。 (3)与传统滤波反投影(FBP)重建比较,评价管电压100kV下DSCT基于原始数据的迭代重建(Sinogram Affirmed Iterative Reconstruction, SAFIRE)在超重患者冠状动脉成像的应用价值。 材料和方法 (1)90例行DSCT冠状动脉成像患者,体重指数(Body Mass Index,BMI)处于正常范围内(男性：20kg/m2≤BMI25kg/m2,女性：19kg/m2≤BMI24kg/m2),随机分成(120kV.362mAs)、(100kV、362mAs)及(80kV、362mAs)三组,每组30例。对三组的图像质量、平均CT值、图像噪声、信号噪声比(Signal-to-noise ratio, SNR)、对比噪声比(Contrast-to-noise ratio, CNR)及辐射剂量进行对比分析。 (2)150例行DSCT冠状动脉成像患者,体重指数处于正常范围内,随机分成5组。A组：管电压120kV, CARE kV设置为"Semi"及开启全自动动态实时射线剂量调控技术(CARE Dose4D)(参考电压120kV、参考电流400mAs); B组：管电压100kV, CARE kV设置为"Semi"及开启全自动动态实时射线剂量调控技术(CARE Dose4D)(参考电压120kV、参考电流400mAs);C组：管电压80kV,CARE kV设置为"Semi"及开启全自动动态实时射线剂量调控技术(CAREDose4D)(参考电压120kV、参考电流400mAs); D组：同时开启CARE kV及CARE Dose4D(参考电压120kV、参考电流400mAs), E组：同时开启CARE kV及CARE Dose4D(参考电压100kV、参考电流400mAs),每组30例。对五组的图像质量、平均CT值、图像噪声、SNR、CNR及辐射剂量进行对比分析。 (3)将80例体重指数处于超重患者(男性：25kg/m2≤BMI30kg/m2,女性：24kg/m2≤BMI29kg/m2)行双源CT冠状动脉成像患者按扫描,管电压随机分成A组(120kV)、B组(100kV),采用FBP法重建,对B组采用SAFIRE重建得到C组图像。对三组的图像质量、平均CT值、图像噪声、SNR、CNR及辐射剂量进行对比分析。 结果 (1)三组图像质量评分分别为(3.50±0.61)分、(3.43±0.53)分和(3.29±0.82)分,差异无统计学意义(P0.05)；120kV组与100kV组的冠状动脉平均CT值及图像噪声均低于80kV组,且两两比较差异均具有统计学意义(P0.05),120kV组与100kV组的冠状动脉的SNR及CNR略高于80kV组,但两两比较差异均无统计学意义(P0.05)。三组患者有效辐射剂量分别为(10.39±1.35)mSv、(7.29±1.36)mSv及(2.80±1.53)mSv,且差异有统计学意义(P0.05)。 (2)五组图像质量评分分别为(3.42±0.63)分、(3.41±0.54)分、(3.49±0.33)分、(3.45±0.43)分和(3.48±0.81)分,差异无统计学意义(P0.05)；C组冠状动脉平均CT值及图像噪声均最高,且两两比较差异均具有统计学意义(P0.05),五组冠状动脉的SNR及CNR之间比较差异无统计学意义(P0.05)。C组辐射剂量最低,且两两比较差异均具有统计学意义(P0.05)。 (3)三组图像质量分别为(3.51±0.70)分、(3.49±0.33)分和(3.55±0.47)分,差异无统计学意义(P0.05)；三组平均CT值、图像噪声、SNR及CNR比较差异均具有统计学意义(P0.05);A组与B组(或C组)两组间平均CT值比较差异有统计学意义(P0.05),且A组平均CT值最低。B组与A组(或C组)两组间图像噪声、SNR及CNR比较差异有统计学意义(P0.05),且A组较高。A、C两组间图像噪声、SNR及CNR比较差异无统计学意义(P0.05);A、B组(或C组)辐射剂量比较差异有统计学意义(P0.05),且B组(或C组)较A组辐射剂量下降约34%。 结论 (1)对于体重指数在正常范围内的患者,采用80kV或100kV管电压行冠状动脉CTA检查,可在保证图像质量的同时显著降低辐射剂量。 (2)对于体重指数在正常范围内的患者,采用同时开启CARE kV及CARE Dose4D(参考电压100kV、参考电流400mAs)行冠状动脉CTA检查,可获得优质图像,并显著降低辐射剂量。 (3)对于超重患者,采用100kV管电压结合基于原始数据的重建(SAFIRE)行冠状动脉CTA检查,可改善图像质量,显著降低辐射剂量。 第二部分双源CT低对比剂注射方案在冠状动脉成像中的临床应用 目的 (1)通过DSCT100kV管电压下三种不同浓度对比剂在冠状动脉CTA检查中的应用,探讨270mgI/ml含碘对比剂结合100kV管电压扫描在冠状动脉CTA检查中的应用价值。 (2)评价DSCT不同管电压下三种对比剂注射方案在冠状动脉CTA检查的图像质量,探讨低用量及速率对比剂注射方案结合不同低管电压扫描在冠状动脉CTA检查中的可行性。 材料和方法 (1)120例行DSCT冠状动脉造影患者随机分为3组,体重指数处于正常范围内,分别采用370mgI/ml、320mgI/ml、270mgI/ml浓度的对比剂,以相同的注射流率(5ml/s)行增强扫描,对三组冠状动脉分支的显示率、各个感兴趣区域平均CT值、图像噪声、SNR及CNR进行对比分析。 (2)120例行DSCT冠状动脉造影患者随机分为3组,体重指数处于正常范围内,分别采用不同kV匹配三种对比剂注射方案行增强扫描。A组管电压120kV,注射对比剂70ml、生理盐水30ml,注射速率5.0ml/s;B组管电压100kV,注射对比剂60ml、生理盐水30ml,注射速率4.5ml/s；C组管电压80kV,注射对比剂55ml、生理盐水25ml,注射速率4.0ml/s。评价三组上腔静脉及右心室伪影,并对三组冠状动脉分支的显示率、各个感兴趣区域平均CT值、图像噪声、SNR及CNR进行对比分析。 结果 (1)三组冠状动脉4个主要分支的显示率均为100%,其余细小分支显示率之间的差异均无统计学意义(P0.05)。三组冠状动脉在AAO、DAO、LM、RCA、 LAD、LM及LCX的平均CT值比较差异具有统计学意义(P0.05),370组平均CT值最高,270组平均CT值最低。三组冠脉左心室壁(LVW)平均CT值、图像噪声、SNR及CNR之间比较差异无统计学意义(P0.05)。三组间辐射剂量之间差异均无统计学意义(P0.05)。 (2)A组上腔静脉及右心室伪影出现比例明显高于B、C组,且差异均有统计学意义(P0.05)：两两比较上腔静脉及右心室伪影在B组与C组之间差异无统计学意义(P0.05)。三组冠状动脉3个主要分支的显示率均为100%,其余细小分支显示率之间的差异均无统计学意义(P0.05)。三组冠脉图像噪声比较差异有统计学意义(P0.05),C组图像噪声最高。三组冠脉SNR及CNR之间比较差异无统计学意义(P0.05)。三组冠状动脉在AAO、DAO、LM、RCA、 LAD、LM及LCX的平均CT值比较差异均有统计学意义(P0.05),C组平均CT值最高,A组平均CT值最低。三组冠状动脉在LVW比较差异无统计学意义(P0.05)。三组间辐射剂量之间差异有统计学意义(P0.05)。 结论 (1)对于体重指数在正常范围内的患者,100kV管电压结合270mgI/ml含碘对比剂行冠状动脉CTA检查,在保证图像质量的同时能达到“双低剂量”的效果。 (2)对于体重指数在正常范围内的患者,采用不同管电压(80kV、100kV及120kV)扫描结合不同的比剂注射方案行冠状动脉CTA检查,既可保证图像质量又降低对比剂对患者的危害,起到了“双低剂量”的效果。
[Abstract]:Part I clinical application of dual source CT low tube voltage technology in coronary artery imaging
objective
(1) to explore the feasibility and value of dual source CT (Dual-source CT, DSCT) 100,80kV tube voltage coronary CTA examination.
(2) to evaluate the application and value of DSCT intelligent kV scanning technology (CARE kV) in coronary artery CTA examination.
(3) Compared with the traditional filter back projection (FBP) reconstruction, the application value of DSCT based on original data iterative reconstruction (SAFIRE) in coronary artery imaging of overweight patients under 100 kV tube voltage was evaluated.
Materials and methods
(1) 90 patients underwent DSCT coronary angiography were randomly divided into three groups (120 kV.362 mAs, (100 kV, 362 mAs) and (80 kV, 362 mAs) with body mass index (BMI) within the normal range (male: 20 kg/m2 < 25 kg/m2 BMI, female: 19 kg/m2 < 24 kg/m2 BMI), 30 patients in each group. For the three groups, the image quality, average CT value, image noise, signal-to-noise ratio (S/N) Ignal-to-noise ratio (SNR), Contrast-to-noise ratio (CNR) and radiation dose were compared and analyzed.
(2) 150 patients undergoing DSCT coronary angiography were randomly divided into 5 groups with normal body mass index (BMI). Group A: tube voltage 120 kV, CARE kV set to "Semi" and CARE Dose 4D (reference voltage 120 kV, reference current 400 mAs); Group B: tube voltage 100 kV, CARE kV set to "Semi" and open. Automatic dynamic real-time radiation dose control technology (CARE Dose 4D) (reference voltage 120 kV, reference current 400 mAs); group C: tube voltage 80 kV, CARE kV set to "Semi" and turn on automatic dynamic real-time radiation dose control technology (CAREDose 4D) (reference voltage 120 kV, reference current 400 mAs); group D: simultaneously turn on CARE kV and CARE Dose 4D (reference voltage). Group E: Care kV and CARE Dose 4D (reference voltage 100 kV, reference current 400 mAs) were turned on simultaneously, 30 cases in each group.
(3) Eighty patients with body mass index in overweight (male: 25kg/m2 < BMI 30kg/m2, female: 24kg/m2 < BMI 29kg/m2) underwent dual-source CT coronary angiography. The patients were randomly divided into group A (120kV) and group B (100kV). The images of group C were reconstructed by FBP and SAFIRE. Sound, SNR, CNR and radiation dose were compared and analyzed.
Result
(1) The image quality scores of the three groups were (3.50+0.61), (3.43+0.53) and (3.29+0.82) respectively, with no significant difference (P 0.05); the average CT value and image noise of the coronary arteries of the 120 kV group and the 100 kV group were lower than those of the 80 kV group, and the difference was statistically significant (P 0.05). The SNR and CNR of the coronary arteries of the 120 kV group and the 100 kV group were slightly lower than those of the 80 kV group. There was no significant difference between the two groups (P 0.05). The effective radiation doses of the three groups were (10.39 + 1.35) mSv, (7.29 + 1.36) mSv and (2.80 + 1.53) mSv respectively, and the difference was statistically significant (P 0.05).
(2) The image quality scores of the five groups were (3.42+0.63), (3.41+0.54), (3.49+0.33), (3.45+0.43) and (3.48+0.81) respectively, with no significant difference (P 0.05). The average CT value and image noise of coronary artery in group C were the highest, and there was significant difference between the two groups (P 0.05). The SNR and CNR of coronary artery in the five groups were compared. There was no significant difference (P 0.05). The radiation dose of group C was the lowest, and the difference was statistically significant (P 0.05).
(3) The image quality of the three groups were (3.51+0.70), (3.49+0.33) and (3.55+0.47) respectively, with no significant difference (P 0.05); the average CT value, image noise, SNR and CNR of the three groups were statistically significant (P 0.05); the average CT value of group A and group B (or group C) were significantly different (P 0.05), and the average CT value of group A was the highest (P 0.05). The difference of image noise, SNR and CNR between group A and group B (or group C) was statistically significant (P 0.05), and the difference of image noise, SNR and CNR between group A and group C was not statistically significant (P 0.05); the difference of radiation dose between group A and group B (or group C) was statistically significant (P 0.05), and the radiation dose of group B (or group C) was about 34% lower than that of group A.
conclusion
(1) For patients with BMI in the normal range, coronary CTA with 80 kV or 100 kV tube voltage can significantly reduce radiation dose while ensuring image quality.
(2) For patients with BMI in the normal range, coronary CTA can be performed by simultaneously opening CARE kV and CARE Dose 4D (reference voltage 100 kV, reference current 400 mAs) to obtain high quality images and significantly reduce radiation dose.
(3) For overweight patients, 100 kV tube voltage combined with original data-based reconstruction (SAFIRE) for coronary CTA can improve image quality and significantly reduce radiation dose.
The second part is the clinical application of dual source CT low contrast injection in coronary artery imaging.
objective
(1) To investigate the value of 270 mg I/ml iodine-containing contrast medium combined with 100 kV tube voltage scanning in coronary CTA by using three different concentrations of contrast medium under DSCT 100 kV tube voltage.
(2) To evaluate the image quality of three contrast agent injection schemes under different tube voltages in coronary CTA, and to explore the feasibility of low dose and rate contrast agent injection schemes combined with different tube voltages in coronary CTA.
Materials and methods
(1) 120 patients undergoing DSCT coronary angiography were randomly divided into three groups. BMI was within normal range. Contrast agents of 370 mg I/ml, 320 mg I/ml and 270 mg I/ml were used to contrast the coronary artery with the same injection rate (5 ml/s). The display rate of coronary artery branches, the average CT value of each region of interest, image noise, SNR and CNR were performed. Comparative analysis.
(2) 120 patients who underwent DSCT coronary angiography were randomly divided into 3 groups. BMI was within normal range. Three different contrast medium injection schemes were used to enhance the scan. In group A, the tube voltage was 120 kV, the contrast medium was 70 ml, the saline was 30 ml, the injection rate was 5.0 ml/s; in group B, the tube voltage was 100 kV, the contrast medium was 60 ml, and the saline was 30 ml. The artifacts of superior vena cava (SVC) and right ventricle (RV) were evaluated in three groups, and the display rate of coronary artery branches, mean CT value of each region of interest, image noise, SNR and CNR were compared and analyzed.
Result
(1) The displaying rate of four main branches of coronary artery in three groups was 100%. There was no significant difference in the displaying rate of other small branches (P 0.05). The mean CT values of AAO, DAO, LM, RCA, LAD, LM and LCX in three groups were significantly different (P 0.05). The mean CT values of 370 groups were the highest, and the mean CT values of 270 groups were the lowest. There was no significant difference in mean CT value, image noise, SNR and CNR of ventricular wall (LVW). There was no significant difference in radiation dose among the three groups (P 0.05).
(2) The ratio of superior vena cava and right ventricular artifacts in group A was significantly higher than that in group B and group C, and the difference was statistically significant (P 0.05). There was no significant difference between the two groups in the ratio of superior vena cava and right ventricular artifacts between group B and group C (P 0.05). There was no significant difference among the three groups (P 0.05). The difference of coronary image noise among the three groups was statistically significant (P 0.05). The highest noise was found in group C. There was no significant difference between the three groups in coronary SNR and CNR (P 0.05). There was no significant difference in LVW among the three groups (P 0.05). There was significant difference in radiation dose among the three groups (P 0.05).
conclusion
(1) For patients with BMI in the normal range, 100 kV catheter voltage combined with 270 mg I/ml iodine-containing contrast medium for coronary CTA can ensure the image quality and achieve "double low dose" effect.
(2) For patients with BMI in the normal range, different tube voltages (80kV, 100kV and 120kV) scanning combined with different dosage regimens for coronary CTA examination can not only ensure the image quality but also reduce the harm of contrast medium to the patients, thus playing a "double low dose" effect.
【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R816.2
本文编号：2244853
[Abstract]:Part I clinical application of dual source CT low tube voltage technology in coronary artery imaging
objective
(1) to explore the feasibility and value of dual source CT (Dual-source CT, DSCT) 100,80kV tube voltage coronary CTA examination.
(2) to evaluate the application and value of DSCT intelligent kV scanning technology (CARE kV) in coronary artery CTA examination.
(3) Compared with the traditional filter back projection (FBP) reconstruction, the application value of DSCT based on original data iterative reconstruction (SAFIRE) in coronary artery imaging of overweight patients under 100 kV tube voltage was evaluated.
Materials and methods
(1) 90 patients underwent DSCT coronary angiography were randomly divided into three groups (120 kV.362 mAs, (100 kV, 362 mAs) and (80 kV, 362 mAs) with body mass index (BMI) within the normal range (male: 20 kg/m2 < 25 kg/m2 BMI, female: 19 kg/m2 < 24 kg/m2 BMI), 30 patients in each group. For the three groups, the image quality, average CT value, image noise, signal-to-noise ratio (S/N) Ignal-to-noise ratio (SNR), Contrast-to-noise ratio (CNR) and radiation dose were compared and analyzed.
(2) 150 patients undergoing DSCT coronary angiography were randomly divided into 5 groups with normal body mass index (BMI). Group A: tube voltage 120 kV, CARE kV set to "Semi" and CARE Dose 4D (reference voltage 120 kV, reference current 400 mAs); Group B: tube voltage 100 kV, CARE kV set to "Semi" and open. Automatic dynamic real-time radiation dose control technology (CARE Dose 4D) (reference voltage 120 kV, reference current 400 mAs); group C: tube voltage 80 kV, CARE kV set to "Semi" and turn on automatic dynamic real-time radiation dose control technology (CAREDose 4D) (reference voltage 120 kV, reference current 400 mAs); group D: simultaneously turn on CARE kV and CARE Dose 4D (reference voltage). Group E: Care kV and CARE Dose 4D (reference voltage 100 kV, reference current 400 mAs) were turned on simultaneously, 30 cases in each group.
(3) Eighty patients with body mass index in overweight (male: 25kg/m2 < BMI 30kg/m2, female: 24kg/m2 < BMI 29kg/m2) underwent dual-source CT coronary angiography. The patients were randomly divided into group A (120kV) and group B (100kV). The images of group C were reconstructed by FBP and SAFIRE. Sound, SNR, CNR and radiation dose were compared and analyzed.
Result
(1) The image quality scores of the three groups were (3.50+0.61), (3.43+0.53) and (3.29+0.82) respectively, with no significant difference (P 0.05); the average CT value and image noise of the coronary arteries of the 120 kV group and the 100 kV group were lower than those of the 80 kV group, and the difference was statistically significant (P 0.05). The SNR and CNR of the coronary arteries of the 120 kV group and the 100 kV group were slightly lower than those of the 80 kV group. There was no significant difference between the two groups (P 0.05). The effective radiation doses of the three groups were (10.39 + 1.35) mSv, (7.29 + 1.36) mSv and (2.80 + 1.53) mSv respectively, and the difference was statistically significant (P 0.05).
(2) The image quality scores of the five groups were (3.42+0.63), (3.41+0.54), (3.49+0.33), (3.45+0.43) and (3.48+0.81) respectively, with no significant difference (P 0.05). The average CT value and image noise of coronary artery in group C were the highest, and there was significant difference between the two groups (P 0.05). The SNR and CNR of coronary artery in the five groups were compared. There was no significant difference (P 0.05). The radiation dose of group C was the lowest, and the difference was statistically significant (P 0.05).
(3) The image quality of the three groups were (3.51+0.70), (3.49+0.33) and (3.55+0.47) respectively, with no significant difference (P 0.05); the average CT value, image noise, SNR and CNR of the three groups were statistically significant (P 0.05); the average CT value of group A and group B (or group C) were significantly different (P 0.05), and the average CT value of group A was the highest (P 0.05). The difference of image noise, SNR and CNR between group A and group B (or group C) was statistically significant (P 0.05), and the difference of image noise, SNR and CNR between group A and group C was not statistically significant (P 0.05); the difference of radiation dose between group A and group B (or group C) was statistically significant (P 0.05), and the radiation dose of group B (or group C) was about 34% lower than that of group A.
conclusion
(1) For patients with BMI in the normal range, coronary CTA with 80 kV or 100 kV tube voltage can significantly reduce radiation dose while ensuring image quality.
(2) For patients with BMI in the normal range, coronary CTA can be performed by simultaneously opening CARE kV and CARE Dose 4D (reference voltage 100 kV, reference current 400 mAs) to obtain high quality images and significantly reduce radiation dose.
(3) For overweight patients, 100 kV tube voltage combined with original data-based reconstruction (SAFIRE) for coronary CTA can improve image quality and significantly reduce radiation dose.
The second part is the clinical application of dual source CT low contrast injection in coronary artery imaging.
objective
(1) To investigate the value of 270 mg I/ml iodine-containing contrast medium combined with 100 kV tube voltage scanning in coronary CTA by using three different concentrations of contrast medium under DSCT 100 kV tube voltage.
(2) To evaluate the image quality of three contrast agent injection schemes under different tube voltages in coronary CTA, and to explore the feasibility of low dose and rate contrast agent injection schemes combined with different tube voltages in coronary CTA.
Materials and methods
(1) 120 patients undergoing DSCT coronary angiography were randomly divided into three groups. BMI was within normal range. Contrast agents of 370 mg I/ml, 320 mg I/ml and 270 mg I/ml were used to contrast the coronary artery with the same injection rate (5 ml/s). The display rate of coronary artery branches, the average CT value of each region of interest, image noise, SNR and CNR were performed. Comparative analysis.
(2) 120 patients who underwent DSCT coronary angiography were randomly divided into 3 groups. BMI was within normal range. Three different contrast medium injection schemes were used to enhance the scan. In group A, the tube voltage was 120 kV, the contrast medium was 70 ml, the saline was 30 ml, the injection rate was 5.0 ml/s; in group B, the tube voltage was 100 kV, the contrast medium was 60 ml, and the saline was 30 ml. The artifacts of superior vena cava (SVC) and right ventricle (RV) were evaluated in three groups, and the display rate of coronary artery branches, mean CT value of each region of interest, image noise, SNR and CNR were compared and analyzed.
Result
(1) The displaying rate of four main branches of coronary artery in three groups was 100%. There was no significant difference in the displaying rate of other small branches (P 0.05). The mean CT values of AAO, DAO, LM, RCA, LAD, LM and LCX in three groups were significantly different (P 0.05). The mean CT values of 370 groups were the highest, and the mean CT values of 270 groups were the lowest. There was no significant difference in mean CT value, image noise, SNR and CNR of ventricular wall (LVW). There was no significant difference in radiation dose among the three groups (P 0.05).
(2) The ratio of superior vena cava and right ventricular artifacts in group A was significantly higher than that in group B and group C, and the difference was statistically significant (P 0.05). There was no significant difference between the two groups in the ratio of superior vena cava and right ventricular artifacts between group B and group C (P 0.05). There was no significant difference among the three groups (P 0.05). The difference of coronary image noise among the three groups was statistically significant (P 0.05). The highest noise was found in group C. There was no significant difference between the three groups in coronary SNR and CNR (P 0.05). There was no significant difference in LVW among the three groups (P 0.05). There was significant difference in radiation dose among the three groups (P 0.05).
conclusion
(1) For patients with BMI in the normal range, 100 kV catheter voltage combined with 270 mg I/ml iodine-containing contrast medium for coronary CTA can ensure the image quality and achieve "double low dose" effect.
(2) For patients with BMI in the normal range, different tube voltages (80kV, 100kV and 120kV) scanning combined with different dosage regimens for coronary CTA examination can not only ensure the image quality but also reduce the harm of contrast medium to the patients, thus playing a "double low dose" effect.
【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R816.2
【参考文献】
相关期刊论文 前1条
1 吴爱琴;郑文龙;许崇永;;MSCT CARE Dose 4D功能与螺距对图像噪声和辐射剂量的影响[J];放射学实践;2010年09期
，本文编号：2244853
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