前瞻性心电门控大螺距联合“四低”在支气管动脉CTA中的价值  

Value of prospective electrocardiogated large pitch combined with“four-low”in bronchial arterial CTA

作　　者：蒋东 丁晨宇 秦立新 李宝学 李政旻 JIANG Dong;DING Chen-yu;QIN Li-xin;LI Bao-xue;LI Zheng-min(Department of Radiology,Wuhan Pulmonary Hospital,Wuhan 430033,Hubei,China)

机构地区：[1]武汉市肺科医院放射科,湖北武汉430033

出　　处：《生物医学工程与临床》2025年第2期191-197,共7页Biomedical Engineering and Clinical Medicine

基　　金：武汉市卫生健康科研基金资助项目(WX21C08)。

摘　　要：目的探讨前瞻性心电门控大螺距联合“四低”(超低管电压70 kV、低浓度造影剂、低注射流率、低注射总量)在支气管动脉CT血管造影(CTA)中的应用价值。方法选择2023年6月至12月在武汉市肺科医院因大咯血行支气管动脉CTA检查的患者128例,其中男性66例,女性62例;年龄41~75岁,平均年龄60.15岁;身高160~178 cm,平均身高168.00 cm;体质量指数18.20~24.76 kg/m^(2),平均体质量指数20.12 kg/m^(2)。随机平分为常规组(A组)和四低组(B组)。行支气管动脉CTA,A组采用管电压120 kV,管电流60 mAs,对比剂用量1.0 mL/kg,造影剂用碘帕醇370 mg/mL,造影剂注射流率4.5 mL/s,螺距1.5,不使用心电门控,采用螺旋扫描;B组采用超低管电压70 kV,参考管电流350 mAs,造影剂用量0.8 mL/kg,造影剂用碘海醇300 mg/mL,造影剂注射流率3.5 mL/s,使用心电门控,螺距为3.2,采用前瞻性心电门控大螺距扫描;两组CTA检查的余参数一致。检查完成后,行数字减影血管造影(DSA)手术,DSA手术由介入医师根据CTA指示寻找出血血管后,行血管造影,明确出血情况后,行出血动脉栓塞;检查完成后对两组图像进行主客观评价,并对两组辐射剂量和对支气管动脉的检出率进行对比分析。结果CTA检查A组发现支气管动脉194支,B组发现197支,DSA手术发现201支;以DSA手术为金标准,B组发现支气管动脉的数目与DSA的符合率明显高于A组;B组的主动脉在CT值和噪声方面都高于A组[457.50(419.75,544.00)HU vs 356.50(305.505,383.75)HU、6.65(5.95,7.63)dB vs 4.88(4.19,5.64)dB](P<0.05)。对比A、B组图像竖脊肌的CT值、噪声、信噪比(SNR)、对比噪声比(CNR),差异均有统计学意义[60.50(54.00,65.00)HU vs 64.50(57.00,70.00)HU、4.67(3.68,5.63)dB vs 5.51(4.59,7.54)dB、13.09(9.92,16.48)vs 11.13(8.31,14.36)、60.14(45.79,80.57)vs 75.32(56.35,94.23)];B组实际剂量(ED)较A组降低了49.87%;B组比A组碘用量减少了25.63%。CTA检查A组碘用量为(20.13±2.08)mL,B组碘用Objective To investigate the application value of prospective electrocardiogated gated large pitch combined with“four-low”(ultra-low tube voltage 70 kV,low concentration of contrast agent,low injection flow rate,low injection volume)in bronchial artery CT angiography(CTA).Methods From June to December 2023,a total of 128 patients underwent bronchial artery CTA examination due to massive hemoptysis were enrolled,which included 66 males and 62 females,aged 41-75 years old with mean age of 60.15 years old;height was 160-178 cm with mean height of 168.00 cm;body mass index was 18.20-24.76 kg/m2 with mean of 20.12 kg/m^(2).All of them were randomly divided into routine group(group A)and four-low group(group B),and the bronchial artery CTA was performed.In group A,the tube voltage was 120 kV,tube current was 60 mAs,contrast agent dosage was 1.0 mL/kg,contrast agent iopamidol was 370 mg/mL with injection flow rate was 4.5 mL/s,pitch was 1.5,spiral scanning but not electrocardiogated was used.In group B,ultra-low tube voltage was 70 kV,tube current was 350 mAs,contrast agent dosage was 0.8 mL/kg,contrast agent iohexol was 300 mg/mL with injection flow rate was 3.5 mL/s,electrocardiogated was performed,pitch was 3.2 and prospective electrocardiogated high pitch scanning were used.The remaining parameters of CTA examination in 2 groups were consistent.The digital subtraction angiography(DSA)was performed after the examination completed,the interventional physician searched for bleeding vessels according to CTA and then performed angiography,and performed the bleeding artery embolization after the bleeding was clearly defined.After completion examination,the 2 groups of images were evaluated subjectively and objectively,the radiation dosage and detection rate of bronchial arteries were compared and analyzed.Results CTA examination showed 194 bronchial arteries in group A,197 in group B,and 201 in DSA.The DSA as the gold standard,the coincidence rate of bronchial arteries number in group B was significantly higher than t

关 键 词：大螺距 前瞻性心电门控 四低 高级模拟迭代重建 支气管动脉 CT血管造影(CTA) 

分 类 号：R526[医药卫生—内科学] R816.4[医药卫生—临床医学]