个体化碘对比剂注射方案在头颈心多部位大范围联合CT血管成像中的应用  

Study of individualized iodine contrast injection protocolin comprehensive multi-region CTA of head-neckcoronary

作　　者：程晓奕 张贺 刘忠啸 孟闫凯 张恒伟 董超 张畅 孙存杰 CHENG Xiaoyi;ZHANG He;LIU Zhongxiao;MENG Yankai;ZHANG Hengwei;DONG Chao;ZHANG Chang;SUN Cunjie(School of Medical Imaging,Xuzhou Medical University,Xuzhou 221004,Jiangsu,China;Department of Imag-ing,Affiliated Hospital of Xuzhou Medical University,Xuzhou 221006,Jiangsu,China)

机构地区：[1]徐州医科大学医学影像学院,徐州221004 [2]徐州医科大学附属医院医学影像科,徐州221006

出　　处：《医学研究与战创伤救治》2024年第6期604-609,共6页Journal of Medical Research & Combat Trauma Care

摘　　要：目的探讨个体化碘对比剂注射方案在第3代双源CT头颈心多部位大范围联合CTA中的可行性与应用价值,并比较该个体化方案在不同血管分支之间的异质性。方法回顾性分析2022年9月至2023年6月于徐州医科大学附属医院医学影像科行头颈心CTA检查的90例患者。入组BMI≤22 kg/m^(2)(低体重组)、22 kg/m^(2)<BMI≤26 kg/m^(2)(中体重组)、26 kg/m^(2)<BMI≤30 kg/m^(2)(高体重组),每组30例,并将3组患者再次分为亚组:个体化方案(45例)和对照方案(常规方案进行检查,45例),即每个BMI亚组15例。采用主观评分、CT值、强化变异系数(CV)对头颈和冠状动脉CTA的图像质量进行评估。获取各组CT容积剂量指数(CTDIvol)、剂量长度乘积(DLP)和有效辐射剂量(ED)。广义加性模型进一步分析影响各分支血管图像质量的关联因素。结果个体化各动脉强化CT值均低于对照(P<0.001)。个体化动脉强化CV均小于对照,个体化的动脉强化均一性更好。个体化的主观评分高于对照(P<0.001),且2名医师主观评分一致性较好(Kappa=0.769)。低体重组中,个体化、对照的所有目标血管的CT值差异均有统计学意义(P<0.05),个体化的动脉强化CT值低于对照(P<0.05);中体重组中,个体化、对照的所有目标血管的CT值差异均有统计学意义(P<0.05),个体化的动脉强化CT值低于对照(P<0.05)。个体化的理想最佳强化(300~450 HU)血管节段数明显多于对照(P<0.05)。低体重组、中体重组中个体化的CTDIvol、ED、对比剂以及流速低于对照(P<0.05)。BMI是影响血管CT值的重要因素,经协变量校正后,BMI仍与CT值存在非线性关系。结论在第三代双源CT中,根据BMI结合个体化碘对比剂注射方案行头颈心多部位大范围联合CTA,图像质量能满足临床诊断要求,且辐射剂量和对比剂用量更低。Objective This study is aimed to explore the feasibility and clinical value of an individualized iodine contrast agent injection protocolin multi body parts CTA of head-neck-coronary by using the third-generation dual-source CT and to compare the heterogeneity of the individualized scheme among different vascular branches.Methods A total of 90 patients who underwent head-neck-coronary CTA were assigned to three groups based on BMI:light weight(BMI≤22 kg/m^(2),n=30),medium weight(22 kg/m^(2)<BMI≤26 kg/m^(2),n=30),and high weight(26 kg/m^(2)<BMI≤30 kg/m^(2),n=30).These groups were further equally divided into the individualized group(n=45)and the control group(n=45),with each BMI subgroup containing 15 patients.The individualized group received the individualized protocol,while the control group received 80ml agent at a flow rate of 4.5 ml/s.Subjective assessment,CT val-ue and the reinforcement CV were used to assess the image quality.The CTDIvol,DLP and the ED were obtained.GAM was used to ana-lyze the related factors affecting the image quality of each vascular branch.Results In individualized group,the CT value of all vessels reinforcement were lower than that in the control group(P<0.001).The arterial enhancement CV of individualized group was smaller than that of the control group.The homogenization of arterial en-hancement in the individualized group is better.The subjective image quality scores were higher than the control group(P<0.001),and the subjective scores of the two physicians showed good consistency(Kappa=0.769).In light weight group,the differences in CT values of all target vessels between the individualized group and the control group were statistically significant(P<0.05),the CT val-ues of the individualized group were lower than those of the control group(P<0.05).In medium weight group,the differences in CT values of all target vessels between the individualized group and the control group were statistically significant(P<0.05),the CT val-ues of the individualized group were lower than th

关 键 词：计算机体层成像 血管造影术 冠状动脉 头颈动脉 体质量指数 

分 类 号：R445[医药卫生—影像医学与核医学]