640层螺旋CT低剂量扫描技术结合低浓度对比剂在冠状动脉支架CTA中的应用
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摘要
目的探讨640层螺旋CT低剂量扫描技术结合低浓度对比剂在冠状动脉支架CTA中的应用价值。方法前瞻性连续入选2014年10月至2015年10月冠脉支架CTA随访门诊患者60例,随机分为A、B 2组,每组30例。A组应用等渗低浓度对比剂威视派克(270 mgI/ml)低剂量(100 Kvp)扫描;B组用高浓度对比剂欧乃派克(350 mgI/ml),常规剂量(120 kVp)扫描。患者在冠状动脉支架CTA(coronary stent CTA,CSCTA)检查后1～2周内均行冠状动脉造影检查(coronary angiography,CAG)。比较2组主动脉根部CT值、噪声值(SD)、图像信噪比(SNR)、对比噪声比(CNR)、图像质量评分、CT容积剂量指数(CTDIvoI)、剂量长度乘积(DLP)、有效辐射剂量(ED)及碘摄入量;以CAG检查结果为金标准,比较2组CSCTA与支架CAG检查结果,评价冠脉支架狭窄的检出率差异。结果共检出81枚冠脉支架,其中78枚支架可评价(A组43枚,B组35枚)。2组的SD、SNR、CNR和图像质量评分差异无统计学意义(P>0.05);2组的CTDIvol、DLP、ED以及碘摄入量差异均有统计学意义(P<0.05),A组均明显低于B组,其中A组的有效辐射剂量(ED)较B组下降约61.72%。2组均有较高的冠脉支架再狭窄检出率,2组检出率之间差异无统计学意义(P>0.05)。结论在冠状动脉支架术后CTA随访中,在保证图像质量和冠脉支架再狭窄检出率的前提下,低管电压结合低浓度对比剂扫描能明显降低辐射剂量,并减少对比剂有效碘用量,因此低剂量低浓度对比剂扫描将成为今后冠状动脉支架CTA随访的必然趋势。
Objective To investigate the application value of 640-slice spiral CT with low radiation dose scanning technique and low dose contrast agent in coronary stent CTA(CSCTA).Methods A total of 60 patients who underwent coronary stent CTA in our hospital from October 2014 to October 2015 were randomly divided into group A(n=30) and group B(n=30).The patients in goup A were underwent low radiation dose scanning with isoosmia low dose contrast agent-visipaque(270 mgI/ml,100 kVp),and the patients in group B underwent conventional dose scanning with high dose contrast agent-omnipaque(350 mgI/ml,120 kVp).The patients in both groups were examined by the coronary angiography(CAG) within 1～2 weeks after CSCTA.The aorta root's CT value,noise value(SD),image signal-to-noise ratio(SNR),comparison noise ratio(CNR),image quality score,volume CT dose index(CTDIvol),product of dose length(DLP),the effective radiation dose(ED),and the iodine intaking dose as well as the examination results of CSCTA and CAG were observed and compared between the two grousp.Results A total of 81 coronary stents were detected,in which 78 pieces were evaluable(43 pieces in group A,35 pieces in group B).There were no significant differences in aorta root's CT value,noise,SNR,CNR and scores of the image quality between group A and group B(P>0.05).However there were significant differences in CTDIvol,DLP,ED and iodine intaking dose between group A and group B,which in group A were significantly lower than those in group B(P<0.05),and the ED in group A was decreased by 61.72%,as compared with that in group B.The detection rate of in-stent restenosis(ISR) was higher in both groups,but there was no significant difference in the detction rate(ISR) between the two groups(P>0.05).Conclusion In follow up after CSCTA,on the premise of guaranteeing the quality of image and the detection rate of ISR,to use lower tube voltage scanning combined with low-dose contrast agent can significantly decrease the radiation dose,and reduce the effective iodine contrast agent dosage.Therefore 640-slice spiral CT scanning with low radiation dose and low-dose contrast agent will be the future trend of CSCTA follow up.
Objective To investigate the application value of 640-slice spiral CT with low radiation dose scanning technique and low dose contrast agent in coronary stent CTA(CSCTA).Methods A total of 60 patients who underwent coronary stent CTA in our hospital from October 2014 to October 2015 were randomly divided into group A(n=30) and group B(n=30).The patients in goup A were underwent low radiation dose scanning with isoosmia low dose contrast agent-visipaque(270 mgI/ml,100 kVp),and the patients in group B underwent conventional dose scanning with high dose contrast agent-omnipaque(350 mgI/ml,120 kVp).The patients in both groups were examined by the coronary angiography(CAG) within 1～2 weeks after CSCTA.The aorta root's CT value,noise value(SD),image signal-to-noise ratio(SNR),comparison noise ratio(CNR),image quality score,volume CT dose index(CTDIvol),product of dose length(DLP),the effective radiation dose(ED),and the iodine intaking dose as well as the examination results of CSCTA and CAG were observed and compared between the two grousp.Results A total of 81 coronary stents were detected,in which 78 pieces were evaluable(43 pieces in group A,35 pieces in group B).There were no significant differences in aorta root's CT value,noise,SNR,CNR and scores of the image quality between group A and group B(P>0.05).However there were significant differences in CTDIvol,DLP,ED and iodine intaking dose between group A and group B,which in group A were significantly lower than those in group B(P<0.05),and the ED in group A was decreased by 61.72%,as compared with that in group B.The detection rate of in-stent restenosis(ISR) was higher in both groups,but there was no significant difference in the detction rate(ISR) between the two groups(P>0.05).Conclusion In follow up after CSCTA,on the premise of guaranteeing the quality of image and the detection rate of ISR,to use lower tube voltage scanning combined with low-dose contrast agent can significantly decrease the radiation dose,and reduce the effective iodine contrast agent dosage.Therefore 640-slice spiral CT scanning with low radiation dose and low-dose contrast agent will be the future trend of CSCTA follow up.
引文
1 Andreini D,Pontone G,Mushtaq S,et al.Coronary stent evaluation with coronary computed tomographic angiography:Comparison between low-osmolar,high-iodine concentration iomeprol-400 and iso-osmolar,lower-iodine concentration iodixanol-320.Cardiovascular Computed Tomography,2014,8:44-51.
2 中华放射学杂志心脏冠状动脉多排CT临床应用协作组.心脏冠状动脉多排CT临床应用专家共识.中华放射学杂志,2011,45:9-17.
3 中国医师协会心血管内科医师分会,中国老年学会心血管病专业委员会,中国医师协会循证医学专业委员会.心血管疾病防治指南和共识2014.北京,人民卫生出版社,2014.159-162.
4 龚健,乔风雷,鲍雷,等.128层螺旋CT冠状动脉造影在评估冠脉支架置入后随访中的临床应用价值.中国实用医药,2011,6:15-17.
5 Smith-Bindman R,Lipson J,Marcus R,et al.Radiation dose associated with common computed tomography examinations and the associated lifetime attributable risk of cancer.Arch Intern Med,2009,169:2078-2086.
6 Ghafourian K,Younes D,Simprini LA,et al.Scout view X-ray attenuation versus weight-based selection of reduced peak tube voltage in cardiac CT angiography.JACC Cardiovasc Imaging,2012,5:585-595.
7 Funama Y,Awai K,Nakayama Y,et al.Radiation dose reduction without degradation of low-contrast detectability at abdominal multisection CT with a low-tube voltage technique:phantom study.Radiology,2005,237:905-910.
8 曹建新,王鹏,王一民,杨诚,王帅.低体质量指数患者双源CT低管电压冠状动脉成像的应用研究.中华放射学杂志,2013,47:452-457.
9 Jared D,Christensen L,Laura T,et al.Hurwitz Effects of lopamidol-370 Versus Iodixanol-320 on Coronary Contrast,Branch Depiction,and Heart Rate Variability in Dual-Source Coronary MDCT Angiography.AJR,2011,197:445-451.
10 Ludwig U,Connemann J,Keller F.Effect of low-osmolar contrast medium iopromide and iso-osmolar odixanol on DNA fragmentation in renal tubular cell culture.Clin Exp Nephrol,2013,17:779-782.
11 Zhang C,Zhang Z,Yan Z,et al.320-row CT coronary angiography:effect of 100 kV tube voltages on image quality,contrast volume,and radiation dose.Int J Cardiovasc Imaging,2011,27:1059-1068.
12 中华医学会放射学分会.对比剂安全使用工作组.碘对比剂使用指南.第2版.中华放射学杂志,2013,47:869-872.
13 Darwish T.An evidence-based approach to minimise contrast-induced nephropathy.N Z Med J,2009,122:39-41.
14 Haussler MD.Safety and patient comfort with iodixanol:a postmarketing surveillance study in 9515 patients undergoing diagnostic CT examinations.Acta Radiol,2010,51:924-933.
15 Carrigan TP,Nair D,Schoenhagen P,et al.Prognostic utility of 64-slice computed tomography in patients with suspected but no ducumented coronary artery disease.Eur Heart J,2009,30:362-371.
16 覃杰,刘凌云,孟晓春,等.320排动态容积CT冠状动脉成像的临床应用.中国医学影像技术,2009,25:1598-1600.
17 Hou Y ,Liu X,Xv S,et al.Comparrisons of image quality and radiation dose between iterative reconstruction algorithms in 256-MDCT coronary angiography.AJR Am J Roentgeno,2012,199:588-594.
18 李运健,姚立正,李艳,等.双低冠状动脉CTA在经皮冠状动脉介入治疗(PCI)术后随访中的初步研究.中国CT和MRI杂志,2015,13:33-36.
2 中华放射学杂志心脏冠状动脉多排CT临床应用协作组.心脏冠状动脉多排CT临床应用专家共识.中华放射学杂志,2011,45:9-17.
3 中国医师协会心血管内科医师分会,中国老年学会心血管病专业委员会,中国医师协会循证医学专业委员会.心血管疾病防治指南和共识2014.北京,人民卫生出版社,2014.159-162.
4 龚健,乔风雷,鲍雷,等.128层螺旋CT冠状动脉造影在评估冠脉支架置入后随访中的临床应用价值.中国实用医药,2011,6:15-17.
5 Smith-Bindman R,Lipson J,Marcus R,et al.Radiation dose associated with common computed tomography examinations and the associated lifetime attributable risk of cancer.Arch Intern Med,2009,169:2078-2086.
6 Ghafourian K,Younes D,Simprini LA,et al.Scout view X-ray attenuation versus weight-based selection of reduced peak tube voltage in cardiac CT angiography.JACC Cardiovasc Imaging,2012,5:585-595.
7 Funama Y,Awai K,Nakayama Y,et al.Radiation dose reduction without degradation of low-contrast detectability at abdominal multisection CT with a low-tube voltage technique:phantom study.Radiology,2005,237:905-910.
8 曹建新,王鹏,王一民,杨诚,王帅.低体质量指数患者双源CT低管电压冠状动脉成像的应用研究.中华放射学杂志,2013,47:452-457.
9 Jared D,Christensen L,Laura T,et al.Hurwitz Effects of lopamidol-370 Versus Iodixanol-320 on Coronary Contrast,Branch Depiction,and Heart Rate Variability in Dual-Source Coronary MDCT Angiography.AJR,2011,197:445-451.
10 Ludwig U,Connemann J,Keller F.Effect of low-osmolar contrast medium iopromide and iso-osmolar odixanol on DNA fragmentation in renal tubular cell culture.Clin Exp Nephrol,2013,17:779-782.
11 Zhang C,Zhang Z,Yan Z,et al.320-row CT coronary angiography:effect of 100 kV tube voltages on image quality,contrast volume,and radiation dose.Int J Cardiovasc Imaging,2011,27:1059-1068.
12 中华医学会放射学分会.对比剂安全使用工作组.碘对比剂使用指南.第2版.中华放射学杂志,2013,47:869-872.
13 Darwish T.An evidence-based approach to minimise contrast-induced nephropathy.N Z Med J,2009,122:39-41.
14 Haussler MD.Safety and patient comfort with iodixanol:a postmarketing surveillance study in 9515 patients undergoing diagnostic CT examinations.Acta Radiol,2010,51:924-933.
15 Carrigan TP,Nair D,Schoenhagen P,et al.Prognostic utility of 64-slice computed tomography in patients with suspected but no ducumented coronary artery disease.Eur Heart J,2009,30:362-371.
16 覃杰,刘凌云,孟晓春,等.320排动态容积CT冠状动脉成像的临床应用.中国医学影像技术,2009,25:1598-1600.
17 Hou Y ,Liu X,Xv S,et al.Comparrisons of image quality and radiation dose between iterative reconstruction algorithms in 256-MDCT coronary angiography.AJR Am J Roentgeno,2012,199:588-594.
18 李运健,姚立正,李艳,等.双低冠状动脉CTA在经皮冠状动脉介入治疗(PCI)术后随访中的初步研究.中国CT和MRI杂志,2015,13:33-36.