| 杜长谕,刘义军,魏巍,等.自动预置技术联合迭代重建算法在低剂量肺动脉CT血管成像中的应用价值[J].中华放射医学与防护杂志,2025,45(7):685-691.Du Changyu,Liu Yijun,Wei Wei,et al.Application value of auto-prescription technique combined with iterative reconstruction algorithm in low-dose CT pulmonary angiography[J].Chin J Radiol Med Prot,2025,45(7):685-691 |
| 自动预置技术联合迭代重建算法在低剂量肺动脉CT血管成像中的应用价值 |
| Application value of auto-prescription technique combined with iterative reconstruction algorithm in low-dose CT pulmonary angiography |
| 投稿时间：2024-07-25 |
| DOI：10.3760/cma.j.cn112271-20240725-00280 |
| 中文关键词: 肺动脉CT血管成像 肺动脉栓塞 低剂量 自动预置 |
| 英文关键词:Pulmonary CT angiography Pulmonary embolism Low dose Auto-prescription |
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| 中文摘要: |
| 目的 探究自动预置技术联合迭代重建算法"双低"技术在肺动脉CT血管成像(CTPA)中的应用价值。方法 前瞻性收集大连医科大学附属第一医院临床怀疑肺栓塞行CTPA检查的患者86例,按随机数表法分为对照组(45例):管电压120 kVp,常规60 ml碘对比剂,重建后置40%自适应统计迭代重建算法(ASIR-V)图像;观察组(41例):管电压采用自动预置技术,0.4 ml/kg个体化低碘对比剂,分别重建后置40%、60%和80% ASIR-V图像,记为观察1、观察2和观察3组。记录并比较4组容积CT剂量指数(CTDIvol)、剂量长度乘积(DLP),并计算有效辐射剂量(E)。测量肺动脉干、左右肺动脉和左右肺叶动脉的CT值及标准差(SD),计算上述动脉的信噪比(SNR)和对比噪声比(CNR);测量上腔静脉对比剂浓聚处SD值并计算伪影指数(AI)。由两名观察者采用盲法独立对各组肺动脉显示情况、图像噪声和上腔静脉硬化伪影进行评估。结果 观察组有效辐射剂量3.28(2.08,3.93) mSv低于对照组5.03(4.86,5.20) mSv,差异有统计学意义(Z=174.00,P＜0.05);观察组对比剂用量28(25,30) ml低于对照组60 ml,差异有统计学意义(Z=0,P＜0.05)。观察组肺动脉干、左右肺叶动脉CT值高于对照组,差异均有统计学意义(t=-3.65~-3.89,P＜0.05),观察2和观察3组的SNR、CNR高于对照组(t=-9.20~-2.98,P＜0.05)。两名观察者间主观评价一致性较好(Kappa=0.729~0.879,P＜0.05)。对照组与观察组图像肺动脉显示主观评分差异无统计学意义(P＞0.05),观察2和观察3组图像噪声主观评分高于对照组(U=598.50、654.00,P＜0.05);观察组上腔静脉硬化伪影显著少于对照组(χ2=46.09,P＜0.001)。结论 自动预置技术结合ASIR-V重建算法及低对比剂成像方案可在不影响图像质量的前提下降低辐射剂量和对比剂用量,实现个体化"双低"CTPA成像。临床试验注册 中国临床试验注册中心,YJ-KY-2022-57 |
| 英文摘要: |
| Objective To explore the application value of the double-low technique of auto-prescription technique combined with iterative reconstruction algorithm in CT pulmonary angiography (CTPA). Methods A total of 86 patients who were clinically suspected of having pulmonary embolism and underwent CTPA examination in the First Affiliated Hospital of Dalian Medical University were prospectively collected and randomly assigned to a control group (n = 45) and an observation group (n = 41) according to the random number table method. In the control group, a tube voltage of 120 kVp was used with a standard iodine contrast agent dose of 60 ml, and images were reconstructed using the 40% adaptive statistical iterative reconstruction algorithm (ASIR-V). In the observation group, the tube voltage was set by auto-prescription technique, and 0.4 ml/kg of personalized low iodine contrast agent was used. Images were reconstructed with 40%, 60%, and 80% ASIR-V, respectively, and designated as observation 1, observation 2, and observation 3 respectively. The volume CT dose index (CTDIvol), dose-length product (DLP), and effective dose (E) were recorded and compared among the four groups. The CT values and standard deviation (SD) of the main pulmonary artery, left and right pulmonary arteries, as well as the left and right pulmonary lobe arteries were measured, and the signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) of these arteries were calculated. Additionally, the SD value at the contrast medium concentration in the superior vena cava was measured, and the artifact index (AI) was subsequently calculated. Two observers independently assessed the visibility of the pulmonary arteries, image noise, and sclerosis artifacts in the superior vena cava using a blinded method. Results The E in the observation group was 3.28 (2.08, 3.93) mSv, which was significantly lower than that in the control group [5.03 (4.86, 5.20)] mSv, and the difference was statistically significant (Z = 174.00, P < 0.05). The contrast agent dosage in the observation group was 28 (25, 30) ml, which was lower than that in the control group (60 ml), and the difference was statistically significant (Z = 0, P < 0.05). The CT values for the main pulmonary artery and the left and right pulmonary lobe arteries in the observation group were higher than those in the control group, and the differences were all statistically significant (t = -3.65 to -3.89, P < 0.05). The SNR and CNR of the observation groups 2 and 3 were greater than those of the control group (t = -9.20 to -2.98, P < 0.05). The consistency of subjective evaluations between the two observers was good (Kappa = 0.729 - 0.879, P < 0.05). There was no statistically significant difference in the subjective score of pulmonary artery visibility between the control and observation group (P > 0.05). The subjective scores for image noise in observation group 2 and group 3 were higher than those in the control group (U =598.50, 654.00, P < 0.05). The presence of artifacts due to sclerosis in the superior vena cava was significantly lower in the observation group compared to the control group (χ2 = 46.09, P < 0.001). Conclusions The combination of auto-prescription technique with ASIR-V reconstruction algorithm and low contrast agent imaging protocol can reduce the radiation dose and contrast agent dose without compromising image quality, and enable personalized double low CTPA imaging.Clinical trial registration Chinese Clinical Trial Registry, YJ-KY-2022-57 |
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