【摘要】：目的評(píng)估第3代雙源CT大螺距70 kV管電壓15 ml對(duì)比劑用量模式在CT肺動(dòng)脈成像(CTPA)中的應(yīng)用價(jià)值。方法將70例臨床擬診肺栓塞行CTPA檢查的患者隨機(jī)分為2組:(1)A組(n=35)行常規(guī)CTPA掃描模式(120 kV,80 ml對(duì)比劑);(2)B組(n=35)行大螺距70 kV管電壓15 ml對(duì)比劑用量模式。測(cè)量所有患者的肺動(dòng)脈主干、右肺上葉尖段肺動(dòng)脈、右肺下葉后基底段肺動(dòng)脈、胸前空氣及背部肌肉的CT值及標(biāo)準(zhǔn)差,計(jì)算圖像信噪比(SNR)、對(duì)比噪聲比(CNR)和每例患者的有效劑量(ED)。由2名醫(yī)師共同對(duì)肺動(dòng)脈圖像進(jìn)行主觀評(píng)分,兩組圖像質(zhì)量的比較采用獨(dú)立樣本的非參數(shù)等級(jí)檢驗(yàn),并計(jì)算Kappa(κ)值評(píng)價(jià)2名醫(yī)師對(duì)兩組間圖像質(zhì)量評(píng)分的一致性。采用獨(dú)立樣本t檢驗(yàn)分析兩組間CT值、SNR、CNR和ED值的差異是否具有統(tǒng)計(jì)學(xué)意義。結(jié)果 A、B兩組患者在肺動(dòng)脈主干[(300.62±77.54)HU比(332.80±102.80)HU;t=-1.53,P=0.13]、右肺上葉尖段肺動(dòng)脈[(361.72±84.92)HU比(325.37±87.86)HU;t=1.81,P=0.08]和右肺下葉后基底段肺動(dòng)脈CT值[(359.54±89.61)HU比(318.26±87.19)HU;t=2.00,P=0.05]方面差異均無統(tǒng)計(jì)學(xué)意義。A組圖像右肺上葉尖段(22.81±6.05比19.80±6.60;t=2.05,P=0.04)及右肺下葉后基底段肺動(dòng)脈(22.65±6.37比19.28±6.63;t=2.23,P=0.03)CNR均明顯高于B組。A、B兩組圖像主觀質(zhì)量評(píng)分分別為1(1,1)、1(1,1),差異無統(tǒng)計(jì)學(xué)意義(Z=-0.08,P=0.93)。兩位醫(yī)師分析圖像質(zhì)量的一致性非常好(κ=0.87,P=0.01)。A組的ED為(4.33±1.80)m Sv,明顯高于B組的(0.92±0.23)m Sv(t=11.72,P=0.00),B組的ED值較A組降低了約79%。結(jié)論第3代雙源CT在大螺距70 kV管電壓15 ml對(duì)比劑模式下行CTPA檢查,可獲得滿足診斷需求的圖像并大幅度降低輻射劑量。
[Abstract]:Objective to evaluate the application value of the third generation dual-source CT with large pitch 70 kV tube voltage of 15 ml contrast medium in CT pulmonary artery imaging (CTPA). Methods 70 patients with pulmonary embolism were randomly divided into two groups: (1) A group (n = 35) underwent routine CTPA scan (120 kV,80 ml contrast agent); (2) Group B (NM35) was given a large pitch 70 kV tube voltage of 15 ml. The CT values and standard deviations of pulmonary trunk, apical segment of right lung, pulmonary artery of posterior basal segment of right lower lobe, chest air and back muscle of all patients were measured. The signal-to-noise ratio (SNR) (SNR), was calculated. Contrast noise ratio (CNR) and effective dose (ED). For each patient The pulmonary artery images were evaluated by two physicians. The image quality of the two groups was compared with the non-parametric grade test of independent samples, and the Kappa (魏) value was calculated to evaluate the consistency of the image quality scores between the two groups. The difference of CT, SNR,CNR and ED between the two groups was analyzed by t test. Results the pulmonary artery trunk [(300.62 鹵77.54) HU vs (332.80 鹵102.80) HU;t=-1.53,P=0.13] and the right superior lobar segment pulmonary artery [(361.72 鹵84.92) HU vs (325.37 鹵87.86) HU;] in group A and B were found in the main pulmonary artery [(300.62 鹵77.54) HU vs (332.80 鹵102.80) HU;t=-1.53,P=0.13]. CT value of pulmonary artery of posterior basal segment of right lower lobe [(359.54 鹵89.61) HU vs (318.26 鹵87.19) HU;] There was no significant difference between the two groups (22.81 鹵6.05 vs 19.80 鹵6.60) and pulmonary artery (22.65 鹵6.37 vs 19.28 鹵6.63) in the posterior basal segment of the right lower lobe. The subjective quality scores of the two groups were 1 (1 / 1) and 1 (1 / 1), respectively, and there was no significant difference between the two groups (ZP0. 08) (P < 0. 93), the CNR was significantly higher than that of group B (P < 0. 03), and the subjective quality scores of group A and B were 1 (1 / 1) and 1 (1 / 1), respectively. The consistency of image quality between the two physicians was very good (魏 = 0.87P0. 01). A ED was (4. 33 鹵1. 80) m Sv,) significantly higher than that of B group (0. 92 鹵0. 23) m Sv (t0. 72P0. 00). The ED value of group B was about 79% lower than that of group A. Conclusion the third generation dual-source CT can be used to detect the high pitch 70 kV tube voltage 15 ml contrast medium mode, and the image can be obtained to meet the diagnostic needs and the radiation dose can be greatly reduced.
【作者單位】： 中國(guó)醫(yī)學(xué)科學(xué)院北京協(xié)和醫(yī)學(xué)院北京協(xié)和醫(yī)院放射科;
【基金】：衛(wèi)生公益性行業(yè)科研專項(xiàng)項(xiàng)目(201402013)~~
【分類號(hào)】：R563.5;R816.4

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