| 张萌,雷鸣,林凤涣,叶敬志,陈妍黠,陈俊,刘金丰,肖梦强.超低剂量CT扫描对踝关节骨折的诊断及三维打印模型质量的影响[J].中华放射医学与防护杂志,2022,42(6):475-480 |
| 超低剂量CT扫描对踝关节骨折的诊断及三维打印模型质量的影响 |
| Eeffect of ultra-low dose CT scanning on the diagnosis of ankle fracture and the quality of a three-dimensional printing model |
| 投稿时间：2022-03-20 |
| DOI：10.3760/cma.j.cn112271-20220320-00114 |
| 中文关键词: 三维打印模型 踝关节骨折 低剂量CT扫描 |
| 英文关键词:Three-dimensional printing model Ankle fracture Low dose CT scanning |
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| 中文摘要: |
| 目的 探讨超低剂量(ULD)CT扫描对踝关节骨折诊断及三维打印(3DP)模型质量的影响。方法 本研究为前瞻性研究，收集2019年11月—2022年1月广东省中医院珠海医院61例临床踝关节骨折保守治疗患者，分别行标准剂量(SD)和超低剂量CT扫描，SD和ULD扫描的管电压/管电流时间乘积分别为120 kV/100 mAs、80 kV/10 mAs。比较两次扫描的辐射剂量(E)、噪声、信噪比(SNR)、对比信噪比(CNR)及骨皮质与周围脂肪CT值差值(CTc)。按照李克特5分评分法，由两名高年资影像诊断主治医师分别对骨折线的可发现、可诊断和整体图像质量进行主观评价，两名高年资骨科主治医生对3DP模型质量(模型清晰度及手术的指导价值)进行主观评价，评分≥3为诊断可接受影像图像和3DP模型质量。结果 两次扫描间隔(9.23±1.92)d，骨折94处，与SD对比、ULD扫描无漏诊、误诊。噪声、SNR、CNR SD优于ULD(F=5.92, 9.70, 8.32，P=0.00)，而CTc ULD优于SD(F=27.55，P =0.00)。SD和ULD扫描的图像评分分别为(4.97±0.18)和(4.21±0.71)分；3DP模型质量评分两者分别为(4.99±0.01)和(4.87±0.34)分；主观CT图像质量及3DP模型质量SD优于ULD(Z=-6.88, -2.91，P＜0.01)，图像质量主观评分及3DP模型质量评分均≥3分均能满足临床需求；SD和ULD扫描E分别为(34.68±4.96)和(1.04±0.10) μSv，ULD明显优于SD(F=38.77，P < 0.01)。结论 采用ULD扫描E约为SD扫描E的3.00%，能满足临床诊断踝关节骨折及3DP模型打印诊断需求。 |
| 英文摘要: |
| Objective To investigate the effect of ultra-low dose (ULD) computed tomography (CT) scanning on the diagnosis of ankle fractures and the quality of a three-dimensional printing (3DP) model.Methods This study was a prospective study. A total of 61 patients with clinical ankle fractures treated conservatively in Zhuhai Hospital of Guangdong Hospital of Traditional Chinese Medicine from November 2019 to January 2022 were included in this study. Patients underwent standard dose (SD) CT scan and ultra-low dose (ULD) CT scan, respectively. The tube voltage/tube current of SD and ULD were 120 kV/100 mAs and 80 kV/10 mAs, respectively. Two senior radiologists evaluated the presence of ankle fractures. The effective radiation dose (E), noise, signal-to-noise ratio (SNR), contrast signal-to-noise ratio (CNR), and CT value of bone cortex minus CT value of peripheral fat (CTc) were compared. The radiologists also evaluated the discoverability, diagnosability, and overall image quality of the fracture line according to Likert′s 5-point scoring method. Two senior orthopedists subjectively evaluated the quality of each 3DP model (model clarity and operation guidance). A score ≥ 3 indicated that the quality of the CT diagnostic image and 3DP model were acceptable.Results The interval between the two CT scans was (9.23 ± 1.92) d. A total of 94 fracture sites were found. There were no missed diagnosis or misdiagnosis based on the SD and ULD scans.Noise, SNR, and CNR were better on the SD CT scanning (F=5.92, 9.70, 8.32, P=0.00), however, CTc was higher on the ULD scans (F=27.55, P < 0.01). The image scores of the SD and ULD scans were (4.97 ± 0.18) and (4.21 ± 0.71), and the quality scores of the 3DP model (4.99 ± 0.01) and (4.87 ± 0.34), respectively. The SD scans were better than the ULD scans with respect to CT image quality and 3DP model quality (Z=-6.88, -2.91, P < 0.01), but both were considered suitable to meet clinical needs (all ≥ 3 points). The E associated with SD and ULD scannings were (34.68 ± 4.96) μSV and (1.04 ± 0.10) μSV, respectively. The latter was thus significantly better than the former (F=38.77, P =0.00).Conclusions The E value of ULD scanning is about 3.00% of SD scanning E, which can meet the needs of clinical diagnosis of ankle fracture and 3DP model printing diagnosis. |
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