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中华诊断学电子杂志

中华诊断学电子杂志 ›› 2017, Vol. 05 ›› Issue (01) : 1 -7. doi: 10.3877/cma.j.issn.2095-655X.2017.01.001

所属专题： 文献；

影像学诊断研究

Flash双源CT迭代重建80kV低剂量冠状动脉CT成像的临床应用
韩洋1, 韩瑞娟2, 陈国强1, 赵瑞平2, 孙凯1,†()   
  1. 1. 014040　包头市中心医院CT室；014040　包头市中心医院医学影像研究所
    2. 014040　包头市中心医院CT室；014040　包头市中心医院心内科
  • 收稿日期:2016-06-07 出版日期:2017-02-26
  • 通信作者: 孙凯
  • 基金资助:
    国家自然科学基金(81560286); 内蒙古自治区自然科学基金(2013ms1172); 内蒙古自治区卫生和计划委员会医疗卫生科研计划项目(201302124)

Clinical application of electrocardiogram-triggered high-pitch dual-source coronary CT angiography at 80 kV low radiation dose integrated iterative reconstruction technology

Yang Han1, Ruijuan Han2, Guoqiang Chen1, Ruiping Zhao2, Kai Sun1,†()   

  1. 1. Department of Radiology, Baotou Central Hospital, Baotou 014040, China;Department of Medical Imaging Research Institute, Baotou Central Hospital, Baotou 014040, China
    2. Department of Radiology, Baotou Central Hospital, Baotou 014040, China; Department of Cardiology, Baotou Central Hospital, Baotou 014040, China
  • Received:2016-06-07 Published:2017-02-26
  • Corresponding author: Kai Sun
  • About author:
    Corresponding author: Sun Kai, Email:
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引用本文：

韩洋, 韩瑞娟, 陈国强, 赵瑞平, 孙凯. Flash双源CT迭代重建80kV低剂量冠状动脉CT成像的临床应用[J]. 中华诊断学电子杂志, 2017, 05(01): 1-7.

Yang Han, Ruijuan Han, Guoqiang Chen, Ruiping Zhao, Kai Sun. Clinical application of electrocardiogram-triggered high-pitch dual-source coronary CT angiography at 80 kV low radiation dose integrated iterative reconstruction technology[J]. Chinese Journal of Diagnostics(Electronic Edition), 2017, 05(01): 1-7.

目的

探讨第二代炫速双源CT大螺距前瞻性心电门控触发扫描模式在低管电压下评估图像质量和辐射剂量。

方法

研究对象为包头市中心医院影像科2013年8月至2014年7月，接受第二代双源CT冠状动脉CT血管造影(CCTA)检查体检或者住院患者，共120例，其中男性68例，女性52例。采用西门子第二代炫速双源CT进行前瞻性研究，本研究经包头市中心医院伦理委员会批准，且每个病人签署知情同意书。动态随机分组将其分为80 kV和100 kV两组，每组60例，扫描完成后将80 kV组分别采用迭代重建算法(SAFIRE)和滤波反投影算法(FBP)重建，最终为80 kV＋SAFIRE组、80 kV＋FBP组、100 kV＋FBP组。2名高年资的放射科医生进行双盲主观图像质量的评价，不同的感兴趣区描述客观图像的质量。

结果

80 kV＋SAFIRE组主动脉根部、右冠状动脉(RCA)、左冠状动脉主干(LAM)噪声值(23.66±5.57、18.89±8.80、17.42±5.94)低于80 kV＋FBP组(31.62±8.41、24.15±15.84、22.45±5.62)和100 kV＋FBP组(27.38±8.01、22.76±4.41、22.09±4.51)，差异有统计学意义(F＝19.09，4.36，22.15；P<0.05)；80 kV＋SAFIRE组主动脉根部、RCA、LAM信噪比(SNR)(24.89±8.37、32.33±12.80、34.46±11.73)高于80 kV±FBP组(18.84±6.43、24.89±9.08、25.70±7.90)和100 kV＋FBP组(19.66±4.43，24.12±7.35，24.93±7.86)，差异有统计学意义(F＝21.08，16.69，26.55；P<0.01)。80 kV＋SAFIRE组和80 kV＋FBP组与100 kV＋FBP组的平均图像质量评分分别为(1.05±0.33)分、(1.05±0.33)分、(1.07±0.27)分，3组比较差异无统计学意义(F＝16.54，P＝0.14)；80 kV＋SAFIRE组，80 kV＋FBP组与100 kV＋FBP组的有效辐射剂量分别为(0.47±0.03)mSv、(0.47±0.05)mSv、(1.00±0.04)mSv，100 kV＋FBP组的有效辐射剂量高于80 kV＋SAFIRE组和80 kV＋FBP组差异有统计学意义(F＝38.14，P<0.01)，80 kV＋SAFIRE组降低了53%的辐射剂量。

结论

采用第二代双源CT大螺距前瞻性心电门控触发扫描模式，应用迭代重建算法80 kV管电压心脏成像可行有效。在保证图像质量的同时80 kV组显著低于100 kV组，降低了53%的辐射剂量。

关键词: 冠状血管, 体层摄影术，X线计算机, 图像处理，计算机辅助
Objective

To assess the impact of image quality and radiation dose levels of low tube potential with electrocardiogram (ECG)-triggered high-pitch coronary computed tomography angiography (CCTA) of 2nd generation dual-source computed tomography.

Methods

One hundred and twenty patients with suspected coronary arteries underwent high-pitch prospectively ECG-triggering CCTA.All subjects had registered for this research and hospitalized.Prospective study was conducted with dual-source coronary computed tomography using iodine contrast agents.All patients signed informed consent of the Ethical Committee of Baotou Central Hospital and the ethics committees approved the consent procedure.Sixty patients were examined with high-pitch mode by a 2nd-generation dual-source CT system at 80 kV and SAFIRE iterative reconstruction (80 kV+ SAFIRE) or with 80 or 100 kV and FBP reconstruction (80 kV+ FBP, 100 kV+ FBP) respectively.Subjective image quality was evaluated double-blindly by two experienced radiologists.Objective image quality was measured by means of various regions of interest.

Results

The noise values of aortic root, right coronary artery(RCA), left coronary artery(LAM) in 80 kV+ SAFIRE group (23.62±5.57, 18.89±8.80, 17.42±5.94) were lower than those of 80 kV+ FBP group(31.66±8.41, 24.15±15.84, 22.45±5.62) as well as 100 kV+ FBP group(27.38±8.01, 22.76±4.41, 22.09±4.51), the differences were significant (F=19.09, 4.36, 22.15; P<0.05). The signal to noise ratios (SNR) of aortic root, RCA, LAM in 80 kV+ SAFIRE group (24.89±8.37, 32.33±12.80, 34.46±11.73) were higher than those of 80 kV+ FBP group (18.84±6.43, 24.89±9.08, 25.70±7.90) and 100 kV+ FBP group (19.66±4.43, 24.12±7.35, 24.93±7.86) , the differences were also significant (F=21.08, 16.69, 26.55; P<0.01). The effective dose (ED) of 80 kV+ SAFIRE , 80 kV+ FBP groups decreased significantly compared with 100 kV+ FBP group (F=38.14; P<0.01). The ED of three group were (0.47±0.03)mSv, (0.47±0.05)mSv, (1.00±0.04)mSv respectively.

Conclusions

High-pitch prospectively ECG-triggered CCTA at 80 kV enables to obtain diagnostic image quality with 2nd-generation CT using iterative reconstruction technique in patients.This methodology can reduce radiation dose levels obviously compared with the 100 kV group.The radiation dose of the 80 kV group is reduced by 53%.

Key words: Coronary vessels, Tomography, x-ray computed, Image processing, computer-assisted
表1 各组Flash Spiral模式冠状动脉成像扫描及重建参数
项目 80 kV＋ SAFIRE组 80 kV＋ FBP组 100 kV＋ FBP组
管电压(kV) 80 kV 80 kV 100 kV
管电流(mAs) 370 mAs 370 mAs 370 mAs
CTA采集模式 Flash模式 Flash模式 Flash模式
扫描长度(Z轴) 气管分叉下2 cm至膈面 气管分叉下2 cm至膈面 气管分叉下2 cm至膈面
RR%间期 55% 55% 55%
层厚(mm) 0.75 0.75 0.75
层间距(mm) 0.50 0.50 0.50
准直器(mm) 2×64×0.6 2×64×0.6 2×64×0.6
重建方法 SAFIRE FBP FBP
重建核 B26f B26f B26f
表2 80 kV组和100 kV组患者临床基本特征比较(±s)
组别 例数 年龄(岁) 心率(次/min) BMI(kg/m2) 扫描时间(ms)
80 kV组 60 60.00±10.00 60.00±5.00 23.99±3.92 248.00±21.00
100 kV组 60 60.00±12.00 62.00±4.00 24.89±3.65 252.00±22.00
t值 ? －0.01 1.87 －1.29 －13.40
P值 ? 0.99 0.42 0.21 0.14
图1 典型病例1冠脉CT图像。为80 kV＋SAFIRE组病例；a图示左冠状动脉主干根部画感兴趣区，显示左冠状动脉主干噪声14.6；b图示右冠状动脉根部画感兴趣区，显示右冠脉主干噪声34.3；c图示主动脉根画感兴趣区，大小为1 mm2，显示主动脉根部噪声17.3
图2 典型病例2冠脉CT图像。为80 kV＋FBP组病例；a图示左冠状动脉主干根部画感兴趣区，显示左主干噪声36.7；b图示右冠状动脉根部画感兴趣区，显示右冠状动脉噪声41.4；c图示主动脉根画感兴趣区，大小为1 mm2，显示主动脉根部噪声28.6
图3 典型病例3冠脉CT图像。为80 kV＋FBP组病例曲面重建图像；a图示右冠状动脉；b图示左前降支；c图示左回旋支。左主干及左前降支、左回旋支，右冠状动脉各段血管显示清晰，与周围组织对比度高，边界清晰，周边锐利
图4 典型病例4冠脉CT图像。为80 kV＋SAFIRE组病例曲面重建图像；a图示右冠状动脉；b图示左前降支；c图示左回旋支。左主干及左前降支，回旋支，右冠状动脉各段血管显示清晰，与周围组织对比度高，边界清晰，周边柔滑锐利
图5 典型病例5冠脉CT图像。a图SAFIRE　重建算法重建图像；b图FBP　重建算法重建图像；显示冠状动脉，血管边缘光滑锐利，边界清晰
表3 各组患者CT成像客观图像质量的比较(±s)
项目 80 kV＋SAFIRE组(n＝60) 80 kV＋FBP组(n＝60) 100 kV＋FBP组(n＝60) F值 P值 P值(两两比较)
P1值 P2值 P3值
主动脉根部CT值 556.00±112.38 558.30±116.20 516.60±92.01 5.53 <0.01 >0.05 <0.05 <0.05
RCA CT值 540.60±138.19 532.80±123.30 526.00±101.20 0.47 >0.05 >0.05 >0.05 >0.05
LAM CT值 557.00±132.82 546.50±114.82 524.96±92.88 1.84 >0.05 >0.05 >0.05 >0.05
周围脂肪组织CT值 －107.30±26.53 －110.50±52.16 －95.11±28.72 2.78 >0.05 >0.05 >0.01 >0.01
主动脉根部噪声值 23.66± 5.57 31.62± 8.41 27.38± 8.01 19.09 <0.05 <0.01 <0.01 <0.01
RCA噪声值 18.89± 8.80 24.15±15.84 22.76± 4.41 4.36 <0.05 >0.01 <0.01 >0.05
LAM噪声值 17.42± 5.94 22.45± 5.62 22.09± 4.51 22.15 <0.01 <0.01 <0.01 >0.05
主动脉根部信噪比值 24.89± 8.37 18.84± 6.43 19.66± 4.43 21.08 <0.01 <0.01 <0.01 >0.05
RCA信噪比值 32.33±12.80 24.89± 9.08 24.12± 7.35 16.69 <0.01 <0.01 <0.01 >0.05
LAM信噪比值 34.46±11.73 25.70± 7.90 24.93± 7.86 26.55 <0.01 <0.01 <0.01 >0.05
主动脉根部对比信噪比值 29.64± 9.05 22.53± 7.17 23.37± 5.19 22.58 <0.01 <0.01 <0.01 >0.05
RCA对比信噪比值 38.67±14.11 30.13±10.47 32.42±12.00 18.43 <0.01 <0.01 <0.01 >0.05
LAM对比信噪比值 41.07±13.04 29.46± 9.10 33.82±11.74 28.76 <0.01 <0.01 <0.01 >0.05
射线剂量DLP(mGy/cm) 33.63± 2.20 33.83± 3.33 71.81± 2.98 38.14 <0.01 >0.05 <0.01 <0.01
有效辐射剂量(mSv) 0.47± 0.03 0.47± 0.05 1.00± 0.04 38.14 <0.01 >0.05 <0.01 <0.01
平均图像质量的评分(分) 1.05± 0.33 1.05± 0.33 1.07± 0.27 16.54 <0.14 — >0.05 >0.05
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