| 陈博,戴婷婷,程建敏,徐雷,贺辉,孔秋雁,吴爱琴.双低技术联合迭代重建技术在小儿复杂性先天性心脏病CT血管成像中的应用[J].中华放射医学与防护杂志,2018,38(7):547-551 |
| 双低技术联合迭代重建技术在小儿复杂性先天性心脏病CT血管成像中的应用 |
| Application research of double low scanning technology combined with iterative reconstruction technique in CT angiography of pediatric complex congenital heart disease |
| 投稿时间：2017-12-31 |
| DOI：10.3760/cma.j.issn.0254-5098.2018.07.012 |
| 中文关键词: 低剂量 先天性心脏病 体层摄影术,X射线计算机 迭代重建 对比剂 |
| 英文关键词:Low dose Congenital heart disease Tomography, X-ray computed Iterative reconstruction Contrast agent |
| 基金项目:卫生部国家临床重点专科开放课题（20130204） |
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| 中文摘要: |
| 目的 探讨低辐射及低碘等渗对比剂联合iDose4迭代重建技术行新生儿、婴幼儿复杂性先天性心脏病CT血管成像（CTA）检查的可行性。方法 前瞻性连续收集2016年3月至2017年1月本院≤2岁拟诊先天性心脏病而需心脏CTA检查的57例患儿，依据检查号分为双低组和常规组，分别采用不同的CT扫描方案，双低组32例，采用80 kVp、80 mAs、碘克沙醇（270 mg I/ml）及iDose4-4迭代算法；常规组25例，采用100 kVp、100 mAs、碘普罗胺（370 mg I/ml）及滤波反投影（FBP）算法。依据患儿体重采取个体化注射方案并计算碘摄入量。测量左心房、左心室、右心房、右心室、气管分叉水平升主动脉及降主动脉、主动脉弓中点、肺动脉干以及左右肺动脉、主动脉弓层面两侧胸大肌和竖脊肌CT值以及背景噪声并计算信噪比（SNR）和对比噪声比（CNR），并对图像质量进行主观评价。记录扫描长度（L）、容积CT剂量指数（CTDIvol）和剂量长度乘积（DLP），并计算有效剂量（E）和体型特异性剂量评估（SSDE）。以手术或心导管造影检查为"金标准"计算并比较两组CTA检查的诊断符合率。结果 双低组、常规组对比剂碘摄入量分别为（2.53±1.09）、（3.46±1.27）g，差异有统计学意义（t=2.976，P<0.05）。两组间心腔、大血管CT值、主动脉弓层面肌肉CT值、背景噪声、SNR及CNR、图像质量主观评价差异均无统计学意义（P>0.05）。两组图像质量主观评价的一致性良好（Kappa=0.55、0.76）。双低组CTDIvol、SSDE、DLP、E较常规组分别降低了57.19%、56.71%、58.74%、56.33%（t=54.107、40.217、20.824、14.063，P<0.05）。双低组、常规组诊断符合率分别为96.6%、97.1%（P>0.05）。结论 80 kVp、80 mAs、碘克沙醇（270 mg I/ ml）联合iDose4迭代重建技术行小儿复杂性先天性心脏病CTA检查，图像质量能够满足临床诊断需要，同时能降低患儿的辐射剂量和对比剂碘剂量。 |
| 英文摘要: |
| Objective To evaluate the feasibility of CT angiography of pediatric complex congenital heart disease by using low radiation dose and low isotonic contrast agent dose combined with iDose4 iterative reconstruction technique. Methods Prospectively, a total of 57 continuous patients with suspected congenital heart disease under or equal to 2 years old in our hospital between Mar 2016 and Jan 2017 were divided into 2 groups according to the reservation number. "double low" group included 32 patients using 80 kVp, 80 mAs, Iodixanol (270 mg I/ml) and iDose4-4iterative reconstruction algorithm; routine group included 25 patients using 100 kVp, 100 mAs, Iopromide (370 mg I/ml) and filtered back projection algorithm. Individualized injections were taken on the weight of children and the iodine intake was calculated. CT values of left atrium, left ventricle, right atrium, right ventricle, ascending and descending aorta at the level of tracheal bifurcation, midpoint of aortic arch, pulmonary trunk, left and right pulmonary artery, pectoralis major and erector spinae on both sides as well as background noise at the level of aortic arch were measured, and signal to noise ratios (SNR) and contrast to noise ratios (CNR) were calculated. The quality of all images was evaluated subjectively. Scan length (L), volume CT dose index (CTDIvol) and dose-length-product (DLP) were recorded, and the effective dose (E) and size-specific dose estimate (SSDE) were calculated. The diagnostic coincidence rates for CTA examinations of these two groups were calculated and compared with the surgery or cardiac catheterization examination called the "gold standard". Results The iodine intake of "double low" group and routine group was (2.53±1.09) and (3.46±1.29)g, respectively, with statistically significant difference (t=2.976, P<0.05). No statistically significant difference existed in CT value of heart cavities, large blood vessels or CT value of muscles, background noise, SNR, CNR at the level of aortic arch or subjective evaluation for image quality between the two groups (P>0.05). The consistency of subjective evaluation for image quality of the two groups was good(Kappa=0.55, 0.76). Compared with routine group, CTDIvol, SSDE, DLP, E of double low group descended by 57.19%, 56.71%, 56.74%, 53.33% respectively (t=54.107, 28.269, 15.338, 11.441,P<0.05). The diagnostic coincidence rates of the two groups were 96.6% and 97.1% respectively (P>0.05). Conclusions Using 80 kVp, 80 mAs and Iodixanol (270 mg I/ml) combined with iDose4 iterative reconstruction technique for CT angiography of pediatric complex congenital heart disease, the image quality could meet the requirements for clinical diagnosis, and the radiation dose and the iodine dose of contrast agent could be lowered. |
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