128层螺旋CT多期低剂量CT尿路造影在输尿管梗阻病变中的应用  

Study of Multi-Phase Low Dose CTU by 128-slice spiral CT in Urinary Tract Obstruction Patients

作　　者：孙静[1] 丁景峰[1] 耿和[2] 敖炜群[3] 胡金文[1] 徐良根[1] 

机构地区：[1]上海市普陀区人民医院放射科 [2]上海市普陀区人民医院泌尿外科 [3]浙江省立同德医院放射科

出　　处：《中国医学计算机成像杂志》2017年第1期58-63,共6页Chinese Computed Medical Imaging

基　　金：上海市普陀区卫生系统科研自主创新重点项目(普KW15103)~~

摘　　要：目的:探讨128层螺旋CT多期低剂量CT尿路造影扫描模式在输尿管梗阻病变诊断中的应用。方法:收集2011年9月至2015年12月临床怀疑有输尿管梗阻病变行CTU检查的患者427例。病人随机分为常规组和低剂量组,其中低剂量组分3组,每组患者按体重指数(BMI)分组,其中BMI值<18.5(A组),18.5≤BMI<24(B组),BMI值≥24(C组)。低剂量组平扫、皮质期、髓质期开启CARE Dose 4D低剂量自动管电流扫描模式扫描;分泌期分别给予瘦型、标准、肥胖病人不同程度低剂量管电流模式扫描(105m As、126m As、147m As);常规剂量组4期扫描管电流为210 m As。扫描完成后记录有效m As值、剂量长度乘积(DLP),计算出有效剂量(ED)及剂量减低比值(DR),并比较两组的剂量及图像质量。结果:低剂量A、B、C三组,分别较常规组(D组)扫描期总辐射剂量平均下降约35.9%、29.8%、4.4%,差异有统计学意义(P<0.01)。两名放射科医师在对图像质量综合评分结果有很好一致性(Kappa值分别为0.74和0.61)。低剂量组和对照组得分相近,低剂量组中未发现影响诊断和有大量噪声的图像。结论:多期低剂量CTU扫描模式在不同体型患者中均取得了良好的效果,在不影响诊断质量的同时能较大幅度减低辐射剂量。扫描更加个体化、人性化,是一项有价值的检查方法。Purpose： To evaluate the value of multi-phase low dose CT urography （CTU） in diagnosis of urinary tract obstruction. Methods： Four hundred and twenty-seven patients, who were suspected with urinary tract obstruction, were enrolled in our study. All the cases were randomly divided into routine group and low-dose group. And low-dose group was divided into three groups, group A, group B and group C, which were stratified by body mass index （BMI）. BMI of group A was less than 18.5, that of group B was between 18.5 and 24, and that of group C was larger than 24. CARE Dose 4D technique was used for the low-dose group in plain scan, cortical phase and medulla phase scans. Different low tube current （147mAs, 126mAs, 105mAs） was used for the three low-dose group in secretory phase. Routine group （group D） was scanned with tube current of 210mAs. After scanning, the effective mAs, dose length product（DLP） were recorded, and the effective dose（ED） and the dose reduction （DR） were calculated, the radiation dose and image quality were compared between groups. Results： Compared with group D, the effective dose were significantly reduced in group A, B and C. Dose reduction（DR） were reduced about 35.9%, 29.8%, 4.4%. There was statistical significant difference between routine group and low-dose group （P〈0.01）. Two radiologists had good consistency in the image quality assessment（Kappa value was 0.74 and 0.61）. Routine group and low-dose groups achieved the similar score. Heavy image noise was not found in low-dose groups. Conclusion： The application of multi-phase low dose CTU had achieved good effect in patients with different body size. It may not only reduce the radiation dose, but also not affect the diagnosis results. It was a valuable diagnostic method.

关 键 词：低剂量CT CT尿路造影 输尿管梗阻 

分 类 号：R693[医药卫生—泌尿科学] R816.7[医药卫生—外科学]