本文選題：計算機體層攝影 + 低管電壓��； 參考：《瀘州醫(yī)學院》2013年碩士論文

【摘要】：目的：通過對比分析低管電壓（80kV、100kV）與常規(guī)管電壓（120kV）掃描在頭部減影CT血管成像（DS-CTA）中對輻射劑量及圖像質量的影響，評價低管電壓、低輻射劑量掃描在頭部DS-CTA中的臨床應用可行性及價值。 方法：將2012年10月-2013年3月期間在我院就診臨床需要做頭部DS-CTA的所有成年人患者納入本次研究，共57例（男31例,女26例,年齡37-85歲,平均年齡62.4歲），按隨機分配原則分別編入不同管電壓組，即A（80kV）、B（100kV）、C（120kV）三組，，其中A組共19例、B組共20例、C組共18例，在其他掃描參數基本一致的情況下，記錄三組不同管電壓掃描條件下所產生的輻射劑量（CT劑量指數（CTDIvol）、劑量長度乘積（DLP）、有效劑量（ED）），并從主觀、客觀兩方面評價三組圖像質量的差異，其中客觀評價包括頭部各段血管平均強化CT值（SI）、噪聲、信噪比(SNR)及對比噪聲比（CNR）,主觀評價則由2名有經驗的影像科醫(yī)師采用5分評價法分別對原始圖像、二維、三維圖像質量進行盲法獨立評價。采用單因素方差分析比較三組間輻射劑量及血管CT值、圖像噪聲、CNR、SNR的差異；采用非參數秩和檢驗比較三組圖像間的主觀評分差異；采用Kappa檢驗評價2名觀察者間的一致性。統(tǒng)計學結果P0.05認為差異有統(tǒng)計學意義,K0.60認為一致性較好。 結果：1.輻射劑量結果：低管電壓A、B組（80kV、100kV）的輻射劑量指標（CTDIvol、DLP、ED）較常規(guī)常規(guī)管電壓C組（120kV）均明顯降低，其中尤以80kV組輻射劑量指標降低顯著，三組間差異具有統(tǒng)計學意義。2、圖像質量的客觀評價結果：隨著管電壓逐步降低，血管強化CT值及圖像噪聲值均逐漸增高，三組間差異具有統(tǒng)計學意義，但三組間血管的CNR、SNR值差異無統(tǒng)計學意義。3、圖像質量的主觀評價結果：隨著管電壓降低,血管邊緣的銳利程度降低，細小血管分支顯示增多，靜脈干擾加大，但三組間的MIP、MPR、VR圖像質量的評分及圖像整體質量的評分差異均無統(tǒng)計學意義,且圖像質量差異不會影響到腦血管疾病的診斷。4、兩位觀察者評分的一致性較好。 結論：128層螺旋CT低管電壓掃描技術在頭部DS-CTA中可以明顯降低其輻射劑量、增加血管強化CT值，而對圖像質量及臨床診斷沒有明顯影響，具有臨床應用可行性。
[Abstract]:Objective: to evaluate the effects of low-tube voltage (80kV) and conventional tube voltage (120kV) on radiation dose and image quality in head subtraction CT angiography (DS-CTAA). Feasibility and value of low radiation dose scanning in head DS-CTA. Methods: from October 2012 to March 2013, 57 adult patients (31 males, 26 females, aged 37-85 years) with head DS-CTA were enrolled in this study. The average age was 62.4 years old. According to the principle of random distribution, they were divided into three groups, namely, AH80kV BX 100kVV (120kV) group. There were 19 cases in group A, 20 cases in group B, 20 cases in group C, 18 cases in group C, and 18 cases in group A, and 18 cases in group C, with the same scanning parameters. Three groups of radiation doses produced under different tube voltage scanning conditions were recorded. The CT dose index (CTDIvoll), the dose length product (DLPX) and the effective dose (EDV) were recorded. The difference of image quality between the three groups was evaluated from subjective and objective aspects. Objective evaluation included the mean enhancement CT value of each segment of the head, noise, SNR) and contrast noise ratio CNR.The subjective evaluation was used by two experienced imaging physicians to evaluate the original image, 2-D, 2-D, respectively. Three-dimensional image quality was evaluated by blind method. Single factor analysis of variance (ANOVA) was used to compare the difference of radiative dose and vascular CT value, image noise and SNR, nonparametric rank sum test was used to compare the subjective score differences among the three groups, and Kappa test was used to evaluate the consistency between two observers. Statistical results P0.05 that the difference was statistically significant (K 0.60) that the consistency was better. The result is 1: 1. The results of radiation dose showed that the radiation dose index (CTD) of low tube voltage ANAB group (80 kV / 100kV) was significantly lower than that of conventional tube voltage group C (120kV), especially the radiation dose index of 80kV group was significantly lower than that of conventional tube voltage group C (P < 0.05), and the radiation dose index was significantly lower than that of conventional tube voltage group C (P < 0.05), especially in the 80kV group. The difference among the three groups was statistically significant. The objective evaluation results of image quality showed that the CT value and image noise value of vascular enhancement increased gradually with the decrease of tube voltage, and the difference among the three groups was statistically significant. However, there was no significant difference in CNRN SNR between the three groups. The subjective evaluation results of image quality were as follows: with the decrease of tube voltage, the sharp degree of vessel edge was decreased, the number of small vessel branches was increased, and the venous interference was increased. However, there was no significant difference in the image quality and the overall image quality between the three groups, and the difference in image quality did not affect the diagnosis of cerebrovascular diseases. Conclusion the low tube voltage scan technique of 128-slice spiral CT can significantly reduce the radiation dose and increase the CT value of vascular enhancement in head DS-CTA, but it has no obvious influence on image quality and clinical diagnosis, so it is feasible in clinical application.
【學位授予單位】：瀘州醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2013
【分類號】：R816.1

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