双源Flash 100kV低对比剂方案在冠状动脉成像中的初步应用  

Application of 100 kVp combining with low contrast medium scanning scheme in SOMATOM definition Flash coronary CT angiography

作　　者：康瑞[1] 王锡明[2] 程召平[2] 段艳华[2] 纪晓鹏[2] 陈宝锦[1] 

机构地区：[1]山东大学医学院,山东济南250061 [2]山东省医学影像学研究所CT室

出　　处：《实用放射学杂志》2015年第12期2041-2045,共5页Journal of Practical Radiology

基　　金：国家自然科学基金项目（81371547）;山东省自然科学基金（ZR2012HM006）;泰山学者工程专项经费资助.

摘　　要：目的 探讨双源Flash CT 100 kV低对比剂扫描方案在冠状动脉CT血管造影（CCTA）中应用的可行性。方法 200例行CCTA检查患者随机分为2组：A组（100例）采用100 kV低对比剂方案扫描。B组（100例）作为对照组，常规行CCTA扫描。记录有效辐射剂量（ED）并分别测量升主动脉根部、右冠状动脉近段及左冠状动脉主干近段的CT值。最后对图像进行主、客观评价并与DSA结果进行对比。结果 患者平均年龄51岁，A组男女比例14-11，66例行DSA检查，B组男女比例13-12。2组间年龄、心率等一般资料无统计学差异（P〉0.05）。A组较B组的ED下降约50%，对比剂用量下降约20%，组间有统计学差异（P〈0.05）。所有冠状动脉主干节段CT值均＞ 250 HU，A、B 2组升主动脉根部、右冠状动脉近段及左冠状动脉主干近段的CT值分别为（430.92±38.62） HU、（426.42±38.29） HU；（412.78±64.91） HU、（413.29±46.33） HU；（402.41±57.78） HU、（403.46±59.68） HU，组间无统计学差异（P〉0.05）。A组噪声值高于B组，但组间主观评分无统计学差异（P〉0.05），Kappa系数为0.874，2位评价者一致性较好。A组CCTA与DSA比较，诊断中度以上冠状动脉狭窄病变的特异度、敏感度、阳性预测值、阴性预测值分别为96.2％、98.1%、93.9%、98.7%。CCTA与DSA冠状动脉成像检验值χ^2=0.528，P＝0.467（＞0.05）。结论 双源CT 100 kV低对比剂扫描方案不仅可以降低辐射剂量，进一步减少对比剂用量，而且具有良好的冠状动脉评价的准确性。Objective To investigate the feasibility of the dual-source Flash CT scanning scheme with 100 kV and low contrast medium in coronary CT angiography （CCTA）. Methods Prospectively, 200 patients with routine CCTA examination were randomly divided into two groups： Group A （100 cases） with 100 kV and low contrast agent injection scheme scanning. Group B （100 cases） with regular CCTA scanning as control group. Record effective doses of radiation（ED）and CT values were measured in the proximal of ascending aorta, right coronary artery, and left coronary artery. Finally, subjective and objective evaluation on the image was acquired and compared with DSA results. Results Patients were with an average age of 51 years. Group A was 56 males and 44 females, among whom 66 patients performed DSA examination. Group B was 52 males and 48 females. General data, such as the age, heart rate and so on, between the two groups had no statistical difference （P〉0.05）. The average El） decreased by 50 % and iodine dosage decreased by 20 % in Group A compared with Group B （P〈0. 05）. All segmental CCTA values were more than 250 HU. The mean CT value of proximal of ascending aorta, right coronary artery,and left coronary artery were （430.92±38.62） HU, （412.78± 64.91） HU, （402.41 ± 57. 78} HU in Group A and （426.42±38.29） HU,（413.29±46.33） HU,（403.46±59.68） HU in Group B, respectively. There was no statistical difference of these CT values between the two groups Call P〉0.05）. The noise value in Group A was higher than in Group B, but subjective scoring had no statistical difference between these two groups （P〉0. 05）. The Kappa coefficient was 0. 874, so two radiologists＇ consistency was good. Compared with DSA in Group A, the sensitivity, specificity, positive predictive value, negative predictive value of CCTA to diagnose stenosis degree of above moderate coronary artery were 96.2 %, 98.1%, 93.9 % and 98.7 %, respectively. Between CCTA and DSA, the Х^2 = 0. 528, P= 0. 467

关 键 词：计算机体层成像 冠状动脉 血管造影术 对比剂 低辐射剂量 

分 类 号：R814.42[医药卫生—影像医学与核医学] R816.2[医药卫生—放射医学]