| 施优波,孙玲麟,李强,王涛.慢性肾病患者低辐射低碘量冠状动脉CT成像可行性分析[J].中华放射医学与防护杂志,2020,40(5):402-407 |
| 慢性肾病患者低辐射低碘量冠状动脉CT成像可行性分析 |
| Feasibility analysis of low-radiation and low-iodine coronary artery CT imaging in patients with chronic kidney disease |
| 投稿时间：2020-01-22 |
| DOI：10.3760/cma.j.issn.0254-5098.2020.05.013 |
| 中文关键词: 慢性肾病 冠状动脉成像 碘对比剂 辐射剂量 |
| 英文关键词:Chronic kidney disease Coronary artery imaging Iodine contrast agent Radiation dose |
| 基金项目:浙江省医药卫生科技计划（2019RC273） |
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| 中文摘要: |
| 目的 评估低电压、等渗低浓度和低容量碘对比剂检查方案用于慢性肾病患者冠状动脉CT成像的可行性。方法 前瞻性选取2016年7月至2018年1月南京医科大学附属常州二院共36例临床怀疑冠状动脉疾病而准备行冠状动脉成像（CTA）检查的慢性肾病患者，采用随机数表法分为对照组和观察组。对照组13例，使用常规管电压120 kV，步进-发射（step-and-shot，SAS）扫描方案，注射高浓度碘对比剂（碘普罗胺，370 mgI/ml），63~85 ml，采用传统滤波反投影法（FBP）重建。观察组23例，使用低电压SAS扫描方案，依据体质量指数（BMI）选择不同的管电压，即管电压100 kV（BMI≥25 kg/m2）或80 kV（BMI<25 kg/m2），等渗低浓度碘对比剂（碘克沙醇，270 mg I/ml），低容量注射45 ml，采用迭代重建算法。两组患者扫描时均开启自动管电流调制（4D CareDose）。两组的冠状动脉图像质量分别采用主观和客观法评价；辐射剂量以剂量长度乘积（DLP）与胸部系数k的乘积为依据计算；两组摄入的总碘量以碘浓度与注射容量的乘积计算；肾功能变化以检查前和检查后第3天的血清肌酐清除率下降百分比计算。结果 32例患者顺利完成冠状动脉CT检查，对照组和观察组的冠状动脉图像质量主观评分为（3.789±0.598）和（3.708±0.717）分，差异无统计学意义（P>0.05）；对照组和观察组左前降支（LAD）、右冠状动脉（RCA）和回旋支（LCX）平均信噪比分别为（12.88±4.53）和（13.67±2.08）、（11.9±5.0）和（12.6±5.1）、（12.78±3.15）和（13.22±3.10），两组比较差异均无统计学意义（P> 0.05）；平均对比噪声比分别为LAD（10.94±1.31）和（11.27±1.81）、RCA（10.38±1.90）和（11.01±2.26）、LCX（11.71±3.15）和（12.49±3.62），两组比较差异亦均无统计学意义（P> 0.05）。平均辐射剂量观察组比对照组降低了61.75%，分别为（1.09±0.19）和（2.85±0.59）mSv，观察组两组指标比较差异有统计学意义（t=20.260，P<0.05）。对照组与观察组的平均碘摄入量分别为（2.71±0.37）和（1.22±0.00）g，观察组降低了54.70%，两组比较差异有统计学意义（t=18.162，P<0.05）。碘对比剂注射后72 h内血清肌酐清除率观察组比对照组有所下降分别为（11.89±4.98）%和（28.75±5.24）%，差异有统计学意义（χ2=9.004，P<0.05）。结论 "三低"扫描方案可降低患者总用碘量和辐射剂量，对肾功能影响小，图像质量可满足诊断，可用于慢性肾病患者的冠状动脉成像检查。 |
| 英文摘要: |
| Objective To evaluate the feasibility of low-voltage, low-concentration, and low-volume iodine contrast agent for coronary artery CT imaging in patients with chronic kidney disease (CKD). Methods A total of 36 patients from July 2016 to January 2018 with CKD who were suspected of having coronary artery disease (CAD) were selected prospectively and were performed with coronary artery CT angiography (CCTA) by randomly divided into control group and observation group. In the control group, 13 patients were scanned with a conventional tube voltage of 120 kV, a step-and-shot (SAS) scanning protocol, 63-85 ml injection of a high-concentration iodine contrast agent (iopromide, 370 mg I/ml), and traditional filtered back projection (FBP) reconstruction algorithm. In the observation group, 23 patients were scanned with a low-voltage SAS scanning scheme based on body mass index (BMI) (100 kV for BMI ≥ 25 kg/m2 or 80 kV for BMI<25 kg/m2), isotonic low-concentration iodine agent(iodixanol, 270 mgI/ml), low volume injection (45 ml) and iterative algorithm reconstruction algorithm. The scans for both groups of patients were turned on automatic tube current modulation (4D CareDose). The coronary artery image quality of the two groups was evaluated with subjective and objective method. The radiation dose was calculated based on the product of the dose length product (DLP) and the chest coefficient k. The total iodine intake of the two groups was calculated by the product of the iodine concentration and the injection volume. Changes in renal function were calculated as a percentage decrease in serum creatinine clearance before and on day 3 after examination. Results Totally 32 patients were performed CCTA successfully. Subjective scores of coronary artery image quality in the control and observation groups were 3.789±0.598 and 3.708±0.717, respectively, with no significant statistically difference(P>0.05). The signal noise ratios were 12.88±4.53 and 13.67±2.08(LAD), 11.9±5.0 and 12.6±5.1(RCA), 12.78±3.15 and 13.22±3.10(LCX), with no significant statistically difference (P>0.05). The average contrast noise ratios were 10.94±1.31 and 11.27±1.81 (LAD), 10.38±1.90 and 11.01±2.26 (RCA), 11.71±3.15 and 12.49±3.62 (LCX), with no significant statistically difference (P> 0.05). The average radiation doses in observation and control group were (1.09±0.19) and (2.85±0.59) mSv, respectively, with statistically significant difference between the two groups (t=20.260, P<0.05). The average iodine intakes of the control and observation group were (2.71±0.37) and (1.22±0.00) g, respectively, with statistically significant difference (t=18.162, P<0.05). The decreases of serum creatinine clearance within 72 hours after injection of iodine contrast agent in the control group and observation group were (28.75±5.24)% and (11.89±4.98)%, respectively, with significant statistically difference (χ2=9.004, P<0.05). Conclusions Triple-low scanning scheme can reduce the total iodine consumption and radiation dose of patients with little effect on renal function and meeting the diagnostic requirements of image quality. It is suitable for CCTA of patients with CKD. |
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