上腹部低辐射高浓度碘对比剂CT动态容积灌注成像取代常规应用的可行性  

Feasibility of routine application of low-radiation CT dynamic volume perfusion imaging with high concentration iodine contrast agent in upper abdomen

作　　者：明兵[1] 兰茜琳 张仕勇 邹庆[1] 李洁[1] 谢冬梅 王晓玲 宋思思[1] 郭开灿 Ming Bing;Lan Xilin;Zhang Shiyong;Zou Qing;Li Jie;Xie Dongmei;Wang Xiaoling;Song Sisi;Guo Kaican(Department of Radiology,Deyang People's Hospital of Sichuan Province,Deyang 618000,China)

机构地区：[1]四川省德阳市人民医院放射科,618000

出　　处：《中华放射学杂志》2020年第5期423-429,共7页Chinese Journal of Radiology

基　　金：四川省医学科研课题计划 (S17031)。

摘　　要：目的探讨一站式上腹部低辐射动态容积灌注CT(dVPCT)取代常规上腹部三期扫描、血管成像及灌注成像的可行性。方法回顾性分析四川省德阳市人民医院2017年4月至2019年6月行上腹部dVPCT检查的患者94例,并顺序选取2019年5月至6月采用常规64层CT(28例)及双源CT(26例)行上腹部常规增强的患者54例进行分析。根据不同对比剂浓度、用量及常规增强扫描机型将上述148例患者分为6组,分别为64层CT常规增强组(28例)、双源CT常规增强组(26例)、60 ml碘海醇(含碘350 mg/ml)dVPCT组(24例)、60 ml碘普罗胺(含碘370 mg/ml)dVPCT组(20例)、60 ml碘美普尔(含碘400 mg/ml)dVPCT组(26例)和80 ml碘美普尔(含碘400 mg/ml)dVPCT组(24例)。评价动脉期及门静脉期肝脏、胰腺及腹主动脉图像的信噪比(SNR)及对比噪声比(CNR),采用方差分析进行比较;进行主观评分,并采用Kruskal-Wallis检验进行比较。记录辐射剂量。结果各灌注扫描组有效剂量均低于64层CT常规增强组,但高于双源CT常规增强组(P<0.05)。80 ml碘美普尔dVPCT组的CNR、SNR均优于64层CT常规增强组、双源CT常规增强组(P<0.05),并且优于60 ml碘海醇dVPCT组、60 ml碘普罗胺dVPCT组及60 ml碘美普尔dVPCT组(P<0.05),但主观指标较双源CT常规增强组评分低(P<0.05)。各dVPCT组在病灶发现、正常组织及血管的显示、鉴别诊断方面均优于常规增强CT。结论上腹部一站式动态容积灌注成像辐射剂量较低,图像质量好,能获得更多的诊断信息,采用高浓度常规增强CT用量(80 ml碘美普尔)能获得更佳的血管、肝脏及胰腺实质图像。Objective To evaluate the application of one-stop dynamic volume perfusion CT(dVPCT)in upper abdomen,and its feasibility of replacing conventional enhanced CT,perfusion,and angiography.Methods A total of 94 patients with upper abdominal perfusion examinations were retrospectively enrolled in Deyang People's Hospital of Sichuan Province from April 2017 to June 2019.The data of another 64 patients underwent routine upper abdominal enhancement with 64-slice CT(28 patients)and dual-source CT(26 patients)were analyzed in the same period.The radiation dose and image quality were compared.According to different contrast agent concentration and dosage,4 perfusion groups and 2 conventional enhanccement groups were divided,including 60 ml iohexol group(350 mg/ml)and 60 ml ultravist group(370 mg/ml),60 ml and 80 ml iomeprol group(400 mg/ml),64-slice routine group and dual-source CT routine group.Signal-to-noise ratio(SNR)and contrast-to-noise ratio(CNR)of the liver,pancreas and abdominal aorta images in the arterial and portal vein phases were measured by two radiologists in a blinded way.Subjective image quality was evaluated by two radiologists using a 5-point Likert Scale in a blinded method.Statistical analysis was performed using analysis of variance and kappa test.Imaging findings and typical cases of perfusion were retrospectively analyzed.Results Radiation dose:the effective dose of each perfusion group was lower than that of the 64-slice spiral CT scan,but higher than that of the dual-source CT routine scan.The SNR and CNR of the 80 ml iomeprol dVPCT group were better than that of 64-slice spiral CT and dual-source CT routine scan(P<0.05),and were better than that of 60 ml iohexol,ultravist and iomeprol dVPCT groups(P<0.05).However,the subjective index was lower than that of the dual-source CT routine scan group(P<0.05).The comprehensive information of multi-phase images,vascular images and perfusion quantitative parameters of volume perfusion data reconstruction in this group is superior to conventional enhanced C

关 键 词：体层摄影术 X线计算机 辐射剂量 造影剂 上腹部 对比研究 

分 类 号：R816[医药卫生—放射医学]