本文選題：冠狀動(dòng)脈　切入點(diǎn)：體層攝影術(shù)　出處：《放射學(xué)實(shí)踐》2017年09期 　論文類型：期刊論文

【摘要】：目的:探討體質(zhì)指數(shù)(BMI)、窄R-R間期結(jié)合前瞻性心電門控和迭代重建技術(shù)在CTCA三低(低管電壓、低對(duì)比劑濃度、低對(duì)比劑用量)成像中的應(yīng)用價(jià)值。方法:選取300例臨床疑有冠狀動(dòng)脈疾病的患者行CTCA檢查,分為常規(guī)組和實(shí)驗(yàn)組;常規(guī)組100例,對(duì)比劑濃度和管電壓分別為350mg I/mL和120kV(350mg I/mL-120kV),BMI≤30kg/m~2;實(shí)驗(yàn)組200例,其中100例BMI23kg/m~2的患者按隨機(jī)數(shù)字法分成320mg I/mL-80kV組(A組)和350mg I/mL-120kV組(B組),另100例BMI為23~30kg/m~2的患者按同樣方法分成320mg I/mL-100kV組(C組)和350mg I/mL-120kV組(D組),A、B、C、D每組各50例。常規(guī)組采用迭代重建技術(shù)及350mg I/mL的碘海醇,實(shí)驗(yàn)組中A、C兩組采用迭代重建技術(shù)及320mg I/mL的碘克沙醇,B、D兩組采用非迭代重建技術(shù)及350mg I/mL的碘海醇;對(duì)每位患者的CTCA圖像進(jìn)行主觀評(píng)分,測(cè)量容積劑量指數(shù)(CTDIvol)、劑量長(zhǎng)度乘積(DLP)、有效輻射劑量(ED)、圖像噪聲、冠狀動(dòng)脈CT值、信噪比(SNR)和對(duì)比噪聲比(CNR),并進(jìn)行統(tǒng)計(jì)學(xué)分析。結(jié)果:常規(guī)組與實(shí)驗(yàn)組的CTCA圖像質(zhì)量評(píng)分差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05),而碘對(duì)比劑用量及輻射劑量?jī)山M差異均有統(tǒng)計(jì)學(xué)意義(P值均0.05);實(shí)驗(yàn)組內(nèi)A組與B組、C組與D組間圖像質(zhì)量主觀評(píng)分差異均無(wú)統(tǒng)計(jì)學(xué)意義(P值均0.05),而CTDIvol、DLP、ED差異均有統(tǒng)計(jì)學(xué)意義(P值均0.05)。A組與B組、C組與D組的噪聲及CT值差異均有統(tǒng)計(jì)學(xué)意義(P值均0.05),A組與B組、C組與D組的平均SNR及平均CNR差異均無(wú)統(tǒng)計(jì)學(xué)意義(P值均0.05)。結(jié)論:與常規(guī)雙源CT冠狀動(dòng)脈成像方案相比,基于體質(zhì)數(shù)、窄R-R間期結(jié)合前瞻性心電門控與迭代重建技術(shù)的CTCA,不僅可大幅降低輻射劑量,同時(shí)可以降低碘對(duì)比劑濃度和用量,所獲得的冠狀動(dòng)脈圖像質(zhì)量均能滿足臨床診斷要求。
[Abstract]:Objective: to investigate the effects of BMI, narrow R-R interval combined with prospective ECG gating and iterative reconstruction techniques on three low (low tube voltages, low contrast medium concentrations) in CTCA. Methods: 300 patients with suspected coronary artery disease were selected for CTCA examination and divided into routine group and experimental group, 100 cases in routine group, 100 cases in routine group, 100 cases in routine group, 100 cases in routine group, 100 cases in routine group, 100 cases in routine group, The concentration of contrast agent and the tube voltage were 350 mg / mL and 120 kV / mL respectively. One hundred patients with BMI23kg/m~2 were randomly divided into two groups: group A (320mg I / mL-80kV) and group B (350mg / mL-120kV). The other 100 patients with BMI of 2330kg / m-2 were divided into group C (320mg I / mL-100kV) and group D (350mg ImL-120kV). Generation reconstruction technique and 350 mg I / mL iodohexanol, In the experimental group, the two groups were treated by iterative reconstruction technique and 320 mg I / mL iodoxanol / butene D group with non-iterative reconstruction technique and 350 mg I / mL iodosea alcohol respectively. The CTCA images of each patient were evaluated subjectively. Measurement of volumetric dose index CTDIvoll, dose length product (DLPX), effective radiation dose (EDV), image noise, coronary CT value, SNR) and contrast noise ratio were analyzed statistically. Results: there was no significant difference in CTCA image quality score between the routine group and the experimental group (P 0.05), but there were significant differences in the dosage of iodine contrast agent and radiation dose between the two groups. There was no significant difference in subjective score of image quality between group A and group B (P = 0.05), but there were significant differences in DLPnD between group A and group B (P = 0.05) and the noise and CT value of group C and group D in group A and group B (P = 0.05), respectively, in group A and group B (P = 0.05), and in group A and group B (n = 0.05), there was no significant difference in the subjective score of image quality between group A and group B (P = 0.05). There was no significant difference in average SNR and CNR between group A and group B (P = 0.05). Conclusion: compared with conventional dual-source CT coronary angiography, there was no significant difference in average SNR and CNR between group A and group B. Based on body size, narrow R-R interval combined with prospective ECG gating and iterative reconstruction techniques can not only significantly reduce the radiation dose, but also reduce the concentration and dosage of iodine contrast agent. The quality of coronary artery images obtained can meet the requirements of clinical diagnosis.
【作者單位】： 西南醫(yī)科大學(xué)附屬中醫(yī)醫(yī)院放射科;
【基金】：四川省教育廳科研課題(17ZB0483)
【分類號(hào)】：R816.2

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