低浓度等渗对比剂联合低管电压在肥胖患者冠状动脉成像中的应用  

Coronary computed tomographic angiography at low concentration of contrast media and low tube voltage in obese patients

作　　者：潘宇宁[1] 李爱静[2] 陈晓敏[3] 任大卫[4] 王健[3] 陈兆乾[4] 黄求理[4] 

机构地区：[1]浙江省宁波大学医学院,宁波315211 [2]浙江省宁波市第二医院影像科,宁波315010 [3]浙江省宁波市第一医院心内科,宁波315010 [4]浙江省宁波市第一医院影像科,宁波315010

出　　处：《中华放射医学与防护杂志》2016年第1期67-73,共7页Chinese Journal of Radiological Medicine and Protection

基　　金：本研究接受宁波市社会发展科研项目(2011C50075)资助,进行"低剂量冠状动脉CTA"相关研究,本人与本人家属、其他研究者,未因进行该研究而接受任何不正当的职务或财务津贴,并对研究的独立性和科学性予以保证

摘　　要：目的探讨100kV管电压、270mgI／ml等渗低浓度对比剂联合迭代重建算法在肥胖人群中进行冠状动脉成像（CCTA）应用的可行性。方法将48例接受CCTA检查、体质量指数（BMI）〉30kg／m2的患者，按随机数字表法分为对照组和试验组，每组24例。对照组使用370mgI／ml对比剂，以常规120kV扫描，采用传统滤过反投影法（FBP）重建图像；试验组使用270mgI／ml对比剂，以100kV扫描，采用第三代适应性迭代降噪算法（AIDR-3D）重建图像。两名医师对两组图像质量进行双盲法评分，比较观察者评分的一致性。比较两组患者的有效剂量（E）、平均CT值、图像噪声（N）、信噪比（SNR）、对比信噪比（CNR）、图像优良指数（FOM）和图像质量评分，以及两组患者的总碘量、碘注入率和对比剂相关不适感。结果两组冠状动脉罔像质量主观评分差异无统计学意义（P〉0．05）。两名医师评分的一致性较高（Kappa：0．88，P〈0．05）。两组图像平均CT值、SNR和CNR差异无统计学意义（P〉0．05）。试验组的FOM明显高于对照组（t=-9．250、-8．604、-9．158、-5．341．P〈0．05）。试验组E为（1．61±0．41）mSv，较对照组（3．64±1．09）mSv明显降低（江8．373，P〈0．01）。试验组总碘量以及碘注入率均低于对照组（t=7．628、8．480，P〈0．01）。试验组注射对比剂热感和疼痛感的发生率低于对照组（x2=18．70、6．25，P〈0．05）。结论在肥胖人群中，使用等渗低浓度对比剂结合低管电压冠状动脉检查可以在不降低图像质量的前提下．大幅度减低辐射剂量和碘摄入量。临床试验注册中国临床试验注册中心．ChiCTR—DPD-15007510．Objective To explore the feasibility of coronary computed tomographic angiograpby （CCTA） for obese patients with lower tube voltage （100 kV） and lower contrast media concentration （270 mgL/ml） using iterative reconstruction. Methods A total of 48 patients with body mass index greater than 30 kg/m2 were included and randomly divided into 2 groups according to random number table method. The images of the control group were obtained using iodine 370 mgI/ml, a tube voltage of 120 kV, and traditional filtered back projection （FBP） image reconstruction. Patients in the test group were injected with isotonic low concentration contrast media （270 mgI/ml ）, scanned with a lower tube voltage （100 kV）, and adaptive iterative noise reduction image reconstruction algorithm （AIDR-3D） was used. Two experienced physicians scored the image quality in a double-blind way. Independent sample t-test was used to compare the effective dose （E） , average CT values, signal to noise ratio （SNR）, contrast to noise ratio （CNR） , the figure of merit （FOM） , image quality scores and the total iodine intake. Side effect was also evaluated. Results The subjective scores for control group and test group were not significantly different （P 〉 0. 05 ）. The scores of two physicians were consistency （Kappa = 0. 88, P 〈 0. 05 ）. The average CT values, SNR and CNR for the two groups were not significantly different （ P 〉 0.05 ） , but the FOM of the test group was significantly higher than that of the control group （ t = - 9. 250, - 8. 604, - 9. 158, - 5. 341, P 〈 0. 05 ）. Effective dose in the test group was （ 1.61 ＋- 0. 41 ） mSv, lower than that of the control group （ t = 8. 373, P 〈 0. 01 ）. The total iodine and iodine injection rate in the test group were both lower than in the control group （ t = 7. 628, 8. 480, P 〈0. 01 ）. The incidence of contrast media- related discomfort in the test group was lower than control group （X2 = 18.70, 6.25, P 〈 0.05 ）. Concl

关 键 词：肥胖 冠状动脉 体层摄影术 X射线计算机 辐射剂量 对比剂 

分 类 号：R816.2[医药卫生—放射医学]