| 高恺,马泽鹏,张天乐,等.能谱扫描在超重及肥胖患者腹部CT增强中的价值研究[J].中华放射医学与防护杂志,2024,44(11):971-978.Gao Kai,Ma Zepeng,Zhang Tianle,et al.The value of gemstone spectral imaging (GSI) in abdominal CT enhancement scanning of overweight and obese patients[J].Chin J Radiol Med Prot,2024,44(11):971-978 |
| 能谱扫描在超重及肥胖患者腹部CT增强中的价值研究 |
| The value of gemstone spectral imaging (GSI) in abdominal CT enhancement scanning of overweight and obese patients |
| 投稿时间：2024-01-25 |
| DOI：10.3760/cma.j.cn112271-20240125-00031 |
| 中文关键词: 腹部CT增强 能谱成像 低管电压 低对比剂浓度 辐射剂量 |
| 英文关键词:Abdominal CT enhancement scanning Spectral imaging Low tube voltage Low contrast medium concentration Radiation dose |
| 基金项目:河北省2020年度重点研发计划项目(20377765D);河北省2020年度医学科学研究课题计划项目(20200572);河北省医学适用技术跟踪项目(GZ2023093);河北大学医学学科培育项目(2021A10);保定市科技计划项目(2141ZF307);大学生创新创业项目(202310075014) |
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| 中文摘要: |
| 目的 比较不同扫描方案在超重及肥胖患者腹部CT增强的图像质量,辐射剂量和总碘量,并探讨腹部图像的最佳单能量值。方法 将90例超重[24 kg/m2 ≤ 体质量指数(BMI)< 28 kg/m2]及肥胖(BMI ≥ 28 kg/m2) 患者按随机数表法分为A、B、C 3组,每组30例。A组采用能谱模式+ 320 mg I/ml浓度对比剂,B组采用低管电压模式100 kVp+ 370 mg I/ml, C组采用常规管电压模式120 kVp+ 370 mg I/ml,并对A组的动脉期和门静脉期分别重建50~70 keV(间隔5 keV)的单能量图像。将感兴趣区域放置在腹主动脉、门静脉主干、肝脏、脾脏、胰腺、肾脏及其同层面竖脊肌上,测量上述部位的CT值和噪声值,并计算图像的对比度噪声比(CNR)。由两名放射科医师对所有图像采用双盲法评分。记录并计算3组患者的辐射剂量和总碘量。比较A组各亚组与B组和C组双期图像各器官和血管的CT值、CNR及主观评分值,以及3组患者的辐射剂量和总碘量,并选出A组的最佳keV值。结果 50~60 keV水平:A组动脉期和门静脉期各部位CT值和CNR高于(P<0.05)或等于B组和C组(P>0.05),主观评分值在50和55 keV时均低于B组和C组(H = 34.47、41.27,P<0.05),而在60 keV时与B组和C组差异无统计学意义(P>0.05);65和70 keV水平:A组除65 keV动脉期肾皮质的CT值和CNR高于B组和C组(F = 102.38、29.47,P<0.001),主观评分值与B组和C组差异无统计学意义(P>0.05)。B组与C组双期各部位CT值、CNR及主观评分值之间无统计学意义(P>0.05)。A组和B组的有效剂量较C组分别降低了24.72%和25.78%,A组的总碘量较B组和C组分别减少了12.50%和13.34%。结论 在超重及肥胖患者中采用能谱模式联合低浓度对比剂行腹部CT增强,既能满足图像质量,又能降低辐射剂量和总碘量。腹部CT增强双期图像的最佳单能量值为60 keV。 |
| 英文摘要: |
| Objective To compare the image quality, radiation dose, and total iodine content of abdominal computed tomography (CT) enhancement scanning of overweight and obese patients with different scanning protocols, and to explore the optimal keV image serial for abdominal CT. Methods A total of 90 overweight or obese patients [24 kg/m2 ≤ body mass index (BMI) < 28 kg/m2 or BMI ≥ 28 kg/m2] were divied into groups A, B and C, with 30 patients in each group. Group A used Gemstone spectral imaging (GSI) mode and contrast medium with 320 mg I/ml, group B used low tube voltage mode (100 kVp) and contrast medium with 370 mg I/ml, and group C used conventional tube voltage mode (120 kVp) and contrast medium with 370 mg I/ml. Monochromatic energy images at 50-70 keV (5 keV interval) were reconstructed for the arterial and portal vein phases of group A. Radiation dose and total iodine content were recorded and calculated for the 3 groups. The region of interest was placed on the organ, blood vessel, and erector spinae muscle at same level. The CT values and image noise values were measured, and the contrast-to-noise ratio (CNR) was calculated. All images were scored subjectively in double-blinded by two radiologists. One-way analysis of variance or Kruskal-Wallis H test were used to compare The CT values, CNRs, and subjective scores of each subgroup image in group A, group B and group C, and the radiation doses and total iodine contents in 3 groups were compared. The optimal keV value for group A was selected. Results At 50-60 keV, the CT values and CNRs of arterial and portal vein phases in group A were higher (P < 0.05) than or similar to those in groups B and C (P > 0.05), and the subjective scores were lower than those of groups B and C at 50 and 55 keV (H = 34.47, 41.27, P < 0.05), whereas there was no statistically significant difference at 60 keV (P > 0.05). At 65 and 70 keV, only the CT value and CNR of the renal cortex in group A at the 65 keV of arterial phase were higher than those in groups B and C (F = 102.38, 29.47, P < 0.001). The subjective scores were not significantly between groups B and C (P > 0.05). There were no statistically significant difference between CT values, CNRs, or subjective scores in group B and group C (P > 0.05). The effective doses in groups A and B were 24.72% and 25.78% lower than those in group C, respectively. Compared to groups B and C, the total iodine content in group A decreased by 12.50% and 13.34%, respectively. Conclusions GSI model combined with a low-concentration contrast medium in abdominal CT for overweight and obese patients can meet the image quality requirements while reducing patient total iodine content and radiation dose. The optimal keV value of enhanced abdominal CT for double phases was 60 keV. |
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