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中华放射医学与防护杂志
中华放射医学与防护杂志

苏旭

双月刊

0254-5098

cjrmp@cjrmp.sina.net

010-62389620

100088

北京市德外新康街2号

中华放射医学与防护杂志/Journal Chinese Journal of Radiological Medicine and ProtectionCSCD北大核心CSTPCD
查看更多>>1981年创刊，中华医学会主办，中国疾病预防控制中心辐射防护与核安全医学所承办。本刊是中文核心期刊、中国科技论文统计源期刊。主要报道电离辐射生物效应、放射治疗剂量控制、放射病诊断与实验研究、放射卫生防护、影像技术、核事故医学应急等理论与应用方面内容。读者对象为从事放射生物学、放射医学、辐射防护、环境保护、临床医生、各级卫生监督所、医学院校有关专业师生、放射性厂矿技安人员及科技信息工作者。
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    不同剂量X射线对cGAS-STING信号通路及肿瘤免疫微环境的影响

    许明燕陈娴张华伊力亚尔·努尔如拉...
    1-6页
    查看更多>>摘要：目的 研究不同剂量X射线照射对肝癌细胞免疫微环境及cGAS-STING信号通路的影响。 方法 C57BL/C小鼠右侧腋部皮下注射Hepa 1－6肝癌细胞，建立皮下成瘤肝癌模型，按顺序随机分为0、4、8、12 Gy照射组，每组10只，监测小鼠体重和肿瘤体积。照射后28 d收集标本，采用ELISA法和流式细胞术，比较各组肿瘤组织内巨噬细胞肿瘤坏死因子α(TNF-α)、干扰素γ(IFN-γ)、白介素6(IL-6)、趋化因子配体5(CCL5)、IL-10、IL-13、转化生长因子β(TGF-β)、IL-4和巨噬细胞M1、M2表型比例(M1/M2)的变化。采用实时荧光定量聚合酶链式反应(qRT-PCR)和免疫印迹实验检测肝癌细胞cGAS-STING信号通路相关基因与蛋白表达情况。 结果 随着照射剂量的增加，肿瘤体积明显减小(F＝8.42，P<0.05)，细胞坏死比例增加(F＝3.89，P<0.05)，除IL-4之外的巨噬细胞相关细胞因子含量增加(F＝6.32～15.50，P<0.05)，肝癌肿瘤免疫微环境中的M1、M2型巨噬细胞的比例升高(F＝5.46、5.14，P<0.05)。肝癌细胞内的cGAS-STING信号通路基因表达与蛋白表达水平升高(mRNA：F＝6.35、16.10，P<0.05；蛋白：F＝71.31、37.15，P<0.05)。 结论 X射线照射可激活肝癌细胞的cGAS-STING信号通路，促使肿瘤免疫微环境重塑。 Objective To study the effects of different doses of X-ray irradiation on the immune microenvironment and cGAS-STING signaling pathway of hepatocellular carcinoma cells. Methods C57BL/C mice were subcutaneously injected with Hepa 1-6 hepatocellular carcinoma cells in the right axilla to establish a subcutaneous tumor-forming hepatocellular carcinoma model. The mice were randomly divided into 0, 4, 8, 12 Gy irradiation groups, with 10 mice in each group. The body weights and tumor volumes were monitored. Specimens were collected 28 d after irradiation. The ELLSA and Flow Cytometry method was used to compare the macrophage-associated cytokines tumor necrosis factor-α (TNF-α), interferon-γ (IFN-γ), interleukin-6 (IL-6), chemokine ligand 5 (CCL5), IL-10, IL-13, transforming growth factor-β (TGF-β), IL-4 and macrophage M1, M2 phenotype ratio (M1/M2). Real-time fluorescence quantitative polymerase chain reaction (qRT-PCR) and immunoblotting assay were used to detect the expression of genes and proteins related to the cGAS-STING signaling pathway in hepatoma cells. Results With the increase of irradiation dose, the tumor volume was significantly reduced (F=8.42, P<0.05), the proportion of cell necrosis increased (F=3.89, P<0.05), the content of macrophage-associated cytokines other than IL-4 increased (F=6.32-15.50, P<0.05), and the proportion of M1 and M2 types of macrophage in the immune microenvironment of hepatocellular carcinoma tumors was elevated (F= 5.46, 5.14, P < 0.05).The gene expression and protein expression levels of cGAS-STING signaling pathway were elevated in hepatocellular carcinoma cells (mRNA expression of cGAS and STING: F=6.35, 16.10, P<0.05 protein expression of cGAS and STING:F=71.31, 37.15, P<0.05). Conclusions X-ray irradiation activates the cGAS-STING signaling pathway in hepatocellular carcinoma cells and contributes to the remodeling of the tumor immune microenvironment.

    肝癌放射治疗肿瘤免疫微环境巨噬细胞

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    人工智能识别 60Co γ射线照射诱导人外周血微核的剂量-效应曲线建立

    吴梦云李炜张华东袁方...
    7-12页
    查看更多>>摘要：目的 根据扫描显微镜搭配玻片扫描软件(Metafer 4)，在松弛素B(CB)阻断微核法试验中识别和鉴定微核，建立60Co γ射线照射剂量与人外周血淋巴细胞微核率的剂量-效应曲线。 方法 采集4名健康人(2男2女)肘静脉血样品，用0、0.25、0.5、1、2、3、4和5 Gy 60Co γ射线(剂量率0.74 Gy/min)离体照射，胞质分裂阻断微核法培养、收获和制备标本玻片，人工智能彩色识别分析系统分析并记录双核细胞和微核数。应用CABAS软件拟合基于微核率的剂量-效应曲线。2份照射后的盲样进行生物剂量估算验证。 结果 在0～5 Gy剂量范围内，拟合的微核剂量-效应曲线符合二次多项式模型，回归方程为y＝0.032 1D2＋0.023 7D＋0.012 7(R2＝0.998，D为剂量)。用拟合曲线对验证样本的剂量估算结果与实际照射剂量基本接近。 结论 成功建立基于人工智能识别微核的剂量-效应曲线，为估算辐射生物剂量提供了可行方法。 Objective To identify micronuclei through the cytochalasin B blocking micronucleus method-based assay using scanning microscope, combined with the slide scanning software Metafer 4 and, accordingly, to establish a dose-response relationship between the dose of 60Co γ-rays and the frequency of micronuclei in human peripheral blood lymphocytes using artificial intelligence-based color recognition. Methods Blood samples were collected from four healthy individuals (two men and two women) and were then exposed to varying doses of 60Co γ-ray radiation (0, 0.25, 0.5, 1, 2, 3, 4, 5 Gy) at a dosage rate of 0.74 Gy/min. Micronucleus slides were prepared as per the GBZ 128-2023 standard. The numbers of binuclear cells and micronuclei were recorded using an artificial intelligence-based color recognition analysis system. The dose-response curve was determined through fitting using the CABAS software. Then, the doses to both independent samples were estimated based on the curve. Results Within a dose range of 0 to 5 Gy, the fitted micronucleus dose-response curve aligned with a quadratic polynomial model, with a regression equation of y = 0.032 1D2+ 0.023 7 D+ 0.012 7 (D denoting the dose, correlation coefficient R2=0.998). The dose estimations from the validation samples closely corresponded to the actual irradiation doses. Conclusions Establishing the micronucleus dose-response curve provides a feasible method and basis for the rapid and accurate estimation of radiation biological doses in laboratory automation.

    人工智能剂量-效应曲线松弛素B阻断微核法人外周血

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    125I粒子治疗恶性肺肿瘤所致放射性肺炎剂量学因素分析

    徐克赵金鑫刘泽洲梁岩松...
    13-17页
    查看更多>>摘要：目的 观察125I粒子植入治疗恶性肺肿瘤导致放射性肺炎发生率，对其相关剂量学参数进行分析。 方法 回顾分析2017年1月至2022年12月河北省肿瘤放射性粒子植入诊疗中心收治的31例接受125I粒子植入治疗的恶性肺肿瘤患者，其中鳞癌8例，腺癌10例，其他部位转移癌13例，术后1～6个月复查胸部CT，采用实体瘤疗效评价标准(RECIST 1.1)对所有患者行疗效评价，观察客观缓解率(ORR)及疾病控制率(DCR)，放射性肺炎(RP)采用美国肿瘤放射治疗协作组(RTOG)放射性肺炎评价标准评价，统计术后D90(90%靶体积所接受的最小周边剂量)、患侧肺V8(8 Gy包绕肺体积占患侧肺体积的百分比)、V32(32 Gy包绕肺体积占患侧肺体积的百分比)、患侧肺Dmean(平均照射剂量)。分析术后D90、V8、V32、Dmean等剂量学参数与发生RP的关系，将术后各剂量学参数与外放疗相关数据进行比较，寻找与RP发生相关性较高的参数。 结果 所有患者均顺利手术，术后6个月疗效评价完全缓解(CR)11例，部分缓解(PR)11例，疾病稳定(SD)8例，疾病进展(PD)1例，ORR为71.0%，DCR为96.8%，RP患者3例，RP发生率为9.7%，粒子术后V8、V32、Dmean等不能作为预测放射性肺炎指标，经随访观察术后D90超过170 Gy发生放射性肺炎患者3例(3/5)，<170 Gy患者发生放射性肺炎患者0例(0/26)。 结论 粒子植入治疗恶性肺肿瘤，术后D90与RP发生有一定相关性，V8、V32、Dmean与RP发生无相关性。 Objective To investigate the incidence of radiation pneumonitis (RP) induced by 125I seed implantation for the treatment of malignant lung tumors and analyze related dosimetric parameters. Methods A retrospective analysis was conducted on 31 cases of malignant lung tumors treated with 125I seed implantation from January 2017 to December 2022 at Hebei Provincial Tumor Radioactive Seeds Implantation Diagnosis and Treatment Center. These cases consisted of eight patients with squamous cell carcinoma, 10 patients with adenocarcinoma, and 13 patients with metastatic cancer in other sites. At 1-6 months after treatment, these patients received postoperative chest CT scans, with the efficacy evaluated based on the Response Evaluation Criteria in Solid Tumors version 1.1 (RECIST 1.1), including the objective response rate (ORR) and the disease control rate (DCR). The efficacy of RP was evaluated using the Radiation Therapy Oncology Group (RTOG) criteria. Postoperative dosimetric parameters, including D90 (minimum peripheral dose received by 90% of the target volume), V8 (percentage of lung volume receiving 8 Gy), V32 (percentage of lung volume receiving 32 Gy), and Dmean (mean radiation dose) of the affected lung, were statistically analyzed. The relationships of the RP occurrence with postoperative D90, V8, V32, and Dmean were analyzed by comparison with relevant external radiotherapy data, to identify the parameters that are correlated closely with RP occurrence. Results All the patients underwent successful surgeries. The postoperative efficacy evaluation after six months showed complete response (CR) in 11 cases, partial response (PR) in 11 cases, stable disease (SD) in eight cases, and progressive disease (PD) in one case, with an overall response rate (ORR) of 71.0%, and a disease control rate (DCR) of 96.8%. Three patients suffered RP, with an incidence rate of 9.7%. Postoperative V8, V32, and Dmean could not serve as predictive indicators for RP. Follow-up observation revealed that three RP cases (3/5) exhibited postoperative D90 exceeding 170 Gy and no RP cases (0/26) showed postoperative D90 below 170 Gy. Conclusions In the treatment of malignant lung tumors with 125I seed implantation, there is a certain correlation between RP and postoperative D90, while there is no correlation between it and V8, V32, and Dmean.

    放射性肺炎肺肿瘤近距离治疗剂量学参数

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    局部晚期宫颈癌同步放化疗中尿道受照剂量与泌尿系统并发症相关性研究

    李凤虎梅烦杜燕军田雪...
    18-23页
    查看更多>>摘要：目的 探讨局部晚期宫颈癌患者盆腔外照射时泌尿系统不良反应与膀胱及尿道剂量的相关性。 方法 回顾性收集贵州医科大学附属医院肿瘤科诊治的局部晚期宫颈癌患者行盆腔外照射计划中膀胱及尿道最大剂量点(Dmax)、最小剂量(Dmin)、平均剂量(Dmean)、计划靶区周围0.1、1、2 cm3接受的平均剂量(D0.1 cm 3、D1 cm 3、D2 cm 3)及接受5、10、15、20、25、30、35、40、45、50 Gy受照体积占整个器官体积百分比(V5 Gy、V10 Gy、V15 Gy、V20 Gy、V25 Gy、V30 Gy、V35 Gy、V40 Gy、V45 Gy、V50 Gy)等相关剂量学参数及患者出现的尿频、尿急、尿痛等泌尿系症状。采用独立样本t检验及Logistic回归模型分析泌尿系症状与剂量学参数相关性。 结果 膀胱及尿道的中位体积分别为294.8、4.71 cm3，以尿道各个参数的中位值为界分成两组，行单因素分析发现尿道Dmax、Dmin、Dmean、V5 Gy、V10 Gy、V15 Gy、V20 Gy、V25 Gy、V30 Gy、V35 Gy、V40 Gy、V45 Gy、V50 Gy与发生泌尿系并发症相关(t＝14.30、21.65、32.19、33.36、16.62、17.91、21.52、20.11、12.27、37.25、30.18、36.24、21.98，P<0.05)，进一步行多因素分析显示，尿道D2 cm 3、V20、V40及膀胱V40、D1 cm 3、D2 cm 3是预测泌尿系发生2级不良反应的独立因素(P<0.05)。 结论 建议限制尿道的D2 cm 3、V20、V40以尽量减少2级泌尿系统并发症的风险。 Objective To investigate the correlations of urinary adverse reactions with dose to the bladder and urethra during external pelvic irradiation for locally advanced cervical cancer. Methods This study retrospectively collected relevant dosimetric parameters and urinary symptoms, such as frequent, urgent, and painful urination, from locally advanced cervical cancer patients treated with external pelvic irradiation in the Department of Oncology, Affiliated Hospital of Guizhou Medical University. The dosimetric parameters examined in this study included the maximum, minimum, and mean doses to bladder and urethra (i.e., Dmax, Dmin and Dmean), mean doses received in an area of 0.1, 1, and 2 cm3 around the planning target volume, D0.1 cm 3, D1 cm 3, D2 cm 3, and percentages of irradiated volumes in the whole organ volume under doses of 5, 10, 15, 20, 25, 30, 35, 40, 45, 50 Gy, V5 Gy, V10 Gy, V15 Gy, V20 Gy, V25 Gy, V30 Gy, V35 Gy, V40 Gy, V45 Gy, V50 Gy. Then the correlations between urinary symptoms and these dosimetric parameters were analyzed using the independent-sample t-test and the Logistic regression model. Results The median volumes of bladder and urethra were 294.8 and 4.71 cm3, respectively. Patients were divided into two groups based on the median division. The univariate analysis showed that urethral Dmax, Dmin, Dmean, V5 Gy, V10 Gy, V15Gy, V20 Gy, V25 Gy, V30 Gy, V35 Gy, V40 Gy, V45 Gy and V50 Gy correlated with urinary complications (t = 14.30, 21.65, 32.19, 33.36, 16.62, 17.91, 21.52, 20.11, 12.27, 37.25, 30.18, 36.24 and 21.98, P<0.05). The multivariate analysis further indicates that urethralD2 cm 3, V20 Gy, V40 Gy and Bladder V40 Gy, D1 cm 3, D2 cm 3 were independent predictors of grade 2 urinary adverse reactions (P<0.05). Conclusions This study reported the correlations of relevant dosimetric parameters of urethra with urinary toxicity during external pelvic irradiation. It holds that urethral D2 cm 3, V20 Gy and V40 Gy should be restricted to minimize the risks of grade 2 urinary complications.

    宫颈癌盆腔放疗不良反应泌尿系统

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    自适应多叶光栅在脑肿瘤质子放疗中的应用

    吴韦清袁响林胡广原郑仁超...
    24-28页
    查看更多>>摘要：目的 通过比较使用和不使用自适应多叶光栅的脑肿瘤质子调强治疗计划，评估自适应多叶光栅的临床应用价值。 方法 选取20例脑肿瘤术后行放射治疗的患者，在同样优化条件下为每位患者分别设计使用和不使用自适应多叶光栅的质子调强治疗计划，通过比较靶区适形指数(CI)、靶区均匀性指数(HI)和正常组织受量对两组方案进行评价。 结果 使用自适应多叶光栅设计质子调强治疗计划，靶区CI均值从0.58提高到0.66，50%处方剂量体积均值从797.70 cm3降低到638.15 cm3，耳蜗、脑干、视交叉、视神经、眼晶状体的辐射受量均显著减少(t＝2.06、3.02、2.11、2.58、2.67，P < 0.05)。另外，两组方案间靶区的HI值以及计划的机器跳数差异没有统计学意义( P > 0.05)。 结论 自适应多叶光栅能显著降低靶区周围正常组织的照射剂量，对保护靶区外危及器官具有积极作用，具有良好的临床应用前景。 Objective To evaluate the clinical application value of the adaptive aperture by comparing intensity-modulated proton radiotherapy(IMPT) plans using and not using the aperture for brain tumors. Methods A total of twenty patients treated with postoperative radiotherapy for brain tumors were enrolled in this study. IMPT plans were developed for each patient using and not using the adaptive aperture under the same optimization conditions. The target conformal index (CI) value, target homogeneity index (HI) value, and the dose to normal tissues of the two sets of plans were compared. Results The IMPT plans designed using the adaptive aperture significantly increased the mean CI value from 0.58 to 0.66, while decreasing the mean 50% prescription dose volume from 797.70 cm3 to 638.15 cm3. These plans also reduced the irradiation doses to the cochlea, brainstem, optic chiasm, optic nerve, and lens (t = 2.06, 3.02, 2.11, 2.58, 2.67, P < 0.05). Additionally, there was no significant difference in the HI value of the target volumes and the machine jumps (MU) between the two sets of plans ( P > 0.05). Conclusions The adaptive aperture can significantly reduce the irradiation dose to normal tissues outside the target volumes, positively impacting the protection of organs at risk (OARs) around the target values. This demonstrates its great potential for clinical application.

    脑肿瘤自适应多叶光栅质子放射治疗

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    放射诊断检查频次变化趋势及其影响因素分析

    张永县牛延涛康天良刘云福...
    29-35页
    查看更多>>摘要：目的 探讨某综合医院近四年放射诊断检查频次的变化趋势及其相关影响因素。 方法 利用医院信息系统和放射信息系统收集2019—2022年门急诊、住院人数和放射诊断检查信息。使用数据透视表对各种影像设备的检查频次和占比进行统计，并计算各检查项目频次及其占比。统计放射诊断检查的阳性率、患者性别和年龄分布情况；对放射检查人次数与门急诊、住院人数的关系采用Spearman相关分析。 结果 2019—2022年放射诊断检查每年的频次分别为307 306、245 418、317 250、325 625人次，累计1 195 599人次；其中CT、X射线摄影、床旁X射线摄影、骨密度、消化道造影、乳腺X射线摄影的占比分别为59.74%、38.04%、1.39%、0.42%、0.21%、0.19%。各年度中，CT在所有放射诊断检查中的占比依次为49.58%、63.40%、60.40%、65.20%。急诊CT和急诊胸部CT检查频次与急诊就诊人次数具有相关性(r＝0.63、0.61，P<0.05)，非急诊CT检查频次与门诊、住院人次数有相关性(r＝0.61、0.66，P<0.05)。CT检查阳性率除2021年最低为79.95%外均高于80%。 结论 放射检查尤其是CT检查显著增加，在疾病诊断中发挥着重要的作用，但应重视CT检查正当性的判断。及时统计分析放射检查信息，可为放射检查科学管理提供数据支持和参考。 Objective To investigate the trend of radiological diagnostic examination frequency and the related influencing factors in a general hospital in recent four years. Methods The hospital information system and the radiology information system were used to collect the information on the numbers of the outpatients, the emergency patients, and the inpatients and the radiology examination information from 2019 to 2022. The examination frequency and proportion of various imaging equipment were counted by using the perspective table of data, and the examination items and the proportion of the radiological diagnostic examinations were calculated. The positive rates of the radiological examinations were measured from 2019 to 2022. The gender and age distribution of the patients were analyzed. Spearman correlation analysis was used to analyze the relationships between the numbers of the patients undergoing radiological examinations and the numbers of the outpatients, emergency patients and the inpatients. Results The annual frequency of radiological diagnostic examinations from 2019 to 2022 were 307 306, 245 418, 317 250 and 325 625, respectively, with a total of 1 195 599. Among them, the proportions of CT, X-rays, bedside X-rays, bone density, gastrointestinal imaging and mammography were 59.74%, 38.04%, 1.39%, 0.42%, 0.21% and 0.19%, respectively. In each year, the proportion of CT in all radiological diagnostic examinations was 49.58%, 63.40%, 60.40% and 65.20%, respectively. The frequency of emergency CT and emergency chest CT was correlated with the number of emergency patients(r =0.63, 0.61, P<0.05), and the frequency of non-emergency CT was correlated with the number of outpatients and inpatients (r =0.61, 0.66, P<0.05). The positive rates of the CT examinations were higher than 80% except the lowest of 79.95% in 2021. Conclusions Radiological examinations especially CT examinations have increased significantly, and played an important role in the diagnosis of diseases. However, attention should be paid to the Justification of the CT examinations. Timely statistical analysis of radiological examination information can provide data supports and references for scientific management of radiological examinations.

    放射信息系统放射诊疗医疗照射正当性阳性率

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    90Y树脂微球治疗在临床应用中的放射防护研究

    冯加武孙敬智王韶佳张力...
    36-40页
    查看更多>>摘要：目的 探讨90Y树脂微球治疗在临床应用中的放射防护措施。 方法 模拟90Y树脂微球治疗手术流程，通过监测术前药物分装准备、药物转运、术中药物操作和输注、术后患者住院观察各个阶段周围剂量当量率水平，分析临床应用中所应采取的放射防护措施。 结果 活性室周围剂量当量率水平为0.12～0.42 μSv/h，通风橱周围剂量当量率为1.04～3.32 μSv/h。数字减影血管造影(DSA)室在90Y＋DSA扫描时最高为0.78 μSv/h，在99Tcm＋DSA时最高为0.36 μSv/h 透视防护区在90Y药物时在第一术者位155 cm高度为13.19 μSv/h，而在90Y＋DSA扫描时最高为80 cm高度处315.01 μSv/h。第二术者位在90Y药物时最高为155 cm高度为6.28 μSv/h，90Y＋DSA扫描时最高为155 cm高度处291.03 μSv/h。患者病房周围剂量当量率为0.11～0.58 μSv/h。 结论 核医学科及介入室等原有屏蔽措施能够满足90Y树脂微球治疗的放射防护要求，但仍需根据实际情况进行科学评估，同时应加强药物操作中的放射防护及表面污染处理措施。 Objective To explore the radiological protection measures for yttrium-90 (90Y)-loaded resin microsphere therapy in clinical application. Methods The surgical operation process for 90Y-loaded resin microsphere therapy was simulated, involving measurement of ambient dose equivalent rates at various stages: preoperative preparation (dominated by drug package), drug transfer, intraoperative procedures (drug operation and injection), and postoperative care and observation within the hospital. Based on the simulation, the protection measures in clinical application were analyzed. Results The dose equivalent rate ranged from 0.12 to 0.42 μSv/h around the active chamber and from 1.04 to 3.32 μSv/h in the fume hood. Around the digital subtraction angiography (DSA) room, the maximum dose equivalent rate was 0.78 μSv/h when 90Y and DSA were applied simultaneously and 0.36 μSv/h when 99Tcm and DSA were applied. For the first operating position in the fluoroscopy protection area, the maximum dose equivalent rate was 13.19 μSv/h at 155 cm height when only 90Y was applied, and 315.01 μSv/h at 80 cm height when 90Y and DSA were applied. For the second operating position, the maximum dose equivalent rate was 6.28 μSv/h at 155 cm height when only 90Y was applied and 291.03 μSv/h at the same height when 90Y and DSA were applied. The dose-equivalent rates ranged from 0.11 to 0.58 μSv/h around the dedicated ward for postoperative patients. Conclusions The existing shielding measures, such as those in the nuclear medicine department and interventional room, meet the radiation protection requirements for 90Y-loaded resin microsphere therapy. However, it is still necessary to conduct a scientific assessment based on the actual situation. Additionally, radiation protection measures and surface contamination treatment should be enhanced during drug operation.

    90Y树脂微球放射防护周围剂量当量率

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    低辐射剂量与低对比剂剂量在肥胖患者冠状动脉CT血管成像中的应用研究

    狄爱辉宁春芳王莹李静...
    41-46页
    查看更多>>摘要：目的 探讨降低辐射剂量和对比剂用量的双低技术在I级肥胖患者冠状动脉CT血管成像(CCTA)中的可行性。 方法 前瞻性收集2022年8月至2023年3月于北京大学第三医院放射科行冠状动脉CTA检查的57例肥胖受检者(体重：85～119 kg且体质量指数BMI: 30～38 kg/m2),分为对照组20例和试验组37例，分别采用常规剂量和低剂量方案。对照组和试验组CCTA的管电压、碘对比剂的碘流率(IDR)分别为：120 kVp、2.2 g I/s与100 kVp、1.5 g I/s。对照组与试验组使用原始数据分别重建为混合迭代4级与8级的图像，其余扫描和重建参数均一致。测量并比较主动脉根部、左前降支(LAD)近段及右冠状动脉(RCA)远段管腔的CT值及噪声，计算左前降支及右冠状动脉的信噪比(SNR)和对比噪声比(CNR)，并采用4分法对冠状动脉18节段的图像质量进行主观评价。记录并比较两组受检者的有效辐射剂量E和碘对比剂用量。采用独立样本t检验、Mann-Whitney U检验或χ2检验分析以上指标组间差异的统计学意义。 结果 对照组和试验组受检者BMI分别为31.89 (30.77, 33.81)和31.22 (30.46, 32.83) kg/m2，差异无统计学意义(P>0.05)。两组CCTA图像在主动脉根部、左前降支近段及右冠状动脉远段管腔的CT值及噪声值，左前降支近段及右冠状动脉远段管腔的SNR和CNR值，差异均无统计学意义(均P>0.05)。两组图像冠状动脉各节段主观评分值均分都≥3分，符合诊断标准，两组间的主观图像质量整体评分差异无统计学意义(P>0.05)。对照组和试验组受检者CCTA检查的有效剂量E分别为7.58与4.49 mSv (Z＝－5.46, P<0.05)，对比剂用量分别为66与45 ml，试验组受检者辐射剂量和对比剂用量分别较对照组降低41%和32%。 结论 在I级肥胖患者群体中，使用低管电压(100 kVp)和低碘流率(1.5 gI/s)进行CCTA检查是可行的，能够在不影响图像质量的情况下降低辐射剂量和碘对比剂用量。 Objective To evaluate the feasibility of low radiation dose and low contrast dosage in coronary CT angiography (CCTA) of class I obese patients. Methods This prospective study enrolled 57 patients (male/female, 50/7, age, 25-77 years) with body mass index (BMI) of 30-38 kg/m2 and body weight of 85-119 kg scheduled for CCTA from August 2022 to March 2023 in our hospital. The patients were divided into two groups: control group (group A, n = 20) and low-dose group (group B, n = 37). Group A employed a standard-dose protocol: tube voltage 120 kVp and IDR 2.2 g I/s, while group B were scanned using the low-dose protocol: tube voltage 100 kVp and IDR 1.5 g I/s. Images in Group A and Group B were reconstructed with hybrid iterative reconstruction (HIR) at strength 4 and 8, respectively. Other scanning and reconstruction parameters were the same in two groups. Methods The image quality was assessed by measuring the CT values and noise in the aortic root, left anterior descending artery and right coronary artery, and the signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were calculated. Subjective image quality was evaluated for vessels according to the 18-segment classification system using a 4-point scale (1. poor, 4. excellent). The effective dose E and contrast dosage were compared. Statistical analysis was performed using independent samples t-test, Mann-Whitney U test or χ 2 test. Results The BMI of groups A and B were 31.89 (30.77, 33.81) and 31.22 (30.46, 32.83) kg/m2, respectively (P>0.05). No statistically significant differences in CT values, noise, SNR, CNR were noticed between the two groups (allP>0.05). The mean subjective score of all coronary artery segments in the two groups were not less than 3, meeting the requirement of clinical diagnosis. There was no statistically significant difference in the overall subjective image quality between the two groups (P>0.05). The radiation doseE in groups A and B were 7.58 and 4.49 mSv, respectively (Z=-5.46, P<0.05). The contrast dosage in groups A and B were 66 and 45 ml, respectively. The radiation doseE and contrast dosage in group B were 41% and 32% lower than that in group A, respectively. Conclusions For class I obese patients, it was feasible to use a low tube voltage (100 kVp) and low IDR (1.5 gI/s) protocol in CCTA. Radiation dose and contrast dosage can be reduced reasonably without compromising the CCTA image quality.

    冠状动脉CT血管成像肥胖低剂量碘流率对比剂

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    全脑CT灌注成像在侧枝循环评估中的辐射剂量和临床应用价值

    刘青李伟粟王娇娇张宗望...
    47-52页
    查看更多>>摘要：目的 探究一站式全脑CT灌注成像(CTP)在急性缺血性脑卒中(AIS)患者侧枝循环评估中的辐射剂量和临床应用价值。 方法 回顾性收集32例AIS患者的全脑CTP图像和数字减影血管造影(DSA)图像。通过固定管电压(100 kVp)、分段设置管电流的方式优化CTP采集同时获得的CT血管成像(CTA)的图像质量。记录容积剂量指数(CTDIvol)、剂量长度乘积(DLP)，计算有效剂量(E)，与文献进行比较。患者核心梗死区域和对侧半脑健康区域脑灌注参数比较采用配对t检验。一名放射科医师分别基于CTP、多时相CTA联合CTP两种模式，采用5分法评估患者侧枝循环状态。由另外一名放射科医师基于DSA图像采用同样的5分法进行评分。以DSA结果作为参照，计算其余方法评估结果的准确率。评分结果的相关性采用Pearson相关系数分析，一致性采用Kappa分析。 结果 平均CTDIvol为184.18 mGy，和文献报道相当(184.19 mGy)。相较于文献报道的CTP和CTA联合扫查，一站式全脑CTP检查的平均有效辐射剂量降低了39% (6.1 vs. 10 mSv)。核心梗死区域和对侧半脑健康区域脑血容量(CBV)、脑血流量(CBF)、平均通过时间(MTT)、达峰时间(TTP)和残余函数达峰时间(Tmax)的差异均有统计学意义(t＝－6.11、－7.47、8.58、12.34、10.05，P<0.01)。CTP和DSA的评分相关系数为0.95 (95%CI：0.89～0.97，P<0.01)，多时相CTA联合CTP和DSA的评分相关系数为0.98 (95%CI：0.96～0.99，P<0.01)。DSA CTP评估结果的Kappa值为0.64 (t＝7.53，P<0.01)，与多时相CTA联合CTP评估的Kappa值为0.88 (t＝9.99，P<0.01)。CTP评估侧枝循环的准确率为71.9%，多时相CTA联合CTP评估的准确率则为90.6%。 结论 固定管电压、分段设置管电流的一站式全脑CTP能够同时提供可靠的CTP和多时相CTA，合理降低患者辐射剂量。借助多时相CTA联合全脑CTP能够准确判断颅内血管有无侧枝循环及脑组织状态，有助于临床中AIS患者诊断和治疗方案的制定。 Objective To assess the radiation dose and clinical value of "one-stop" whole-brain CT perfusion (CTP) imaging in the evaluation of collateral circulation for patients with acute ischemic stroke (AIS), regarding the digital subtraction angiography (DSA) as the reference. Methods This retrospective study included 32 AIS patients, for whom both CTP and DSA were obtained <24 h since onset. All CTP scans were acquired in whole-brain volume perfusion mode using a 320-row CT with the phase-specific settings of tube currents to optimize the image quality of CTA images, where multiple-phase (mp) CTA images were extracted from the CTP data in post-processing. The volume CT dose index (CTDI vol), dose length product (DLP), and effective dose were compared to those reported in previous studies. The perfusion parameters of the infarct lesions and their contralateral regions were compared using the paired t-tests. One radiologist scored the collateral circulation with only the CTP and with the CTP plus mp-CTA using a 5-point scale. Another radiologist performed the same evaluation on the DSA. The diagnostic accuracy was calculated referring to the result based on DSA. The scores were analyzed using the Pearson correlation coefficient. The agreement of scores was quantified with the Kappa test. Results The mean CTDIvol was 184.18 mGy, which was comparable to the result of a previous study (184.19 mGy), and the mean effective dose was reduced 39% compared to that reported in the literature for combined CTP and CTA scanning (6.1 vs 10 mSv). There were statistically significant differences in cerebral blood volume (CBV), cerebral blood flow (CBF), mean transit time (MTT), transit time to peak (TTP), and time-to-maximum (Tmax) between the infarct lesions and their contralateral regions (P<0.01). The scores between CTP and DSA were significantly correlated (r=0.95, P<0.01), as well as the scores between CTP plus mp-CTA and DSA (r=0.98, P<0.01). The Kappa value was 0.64 (t=7.53, P<0.01) between CTP and DSA, while it increased to 0.88 (t=9.99, P<0.01) for CTP plus mp-CTA. With the result of DSA as a reference, the diagnostic accuracy was 71.9% and 90.6% for CTP and CTP plus mp-CTA, respectively. Conclusions The "one-stop" whole-brain CTP imaging with phase-specific settings of tube currents can provide reliable CTP and multiple-phase CTA images simultaneously, which could reasonably reduce the radiation dose. Combined use of multi-phase CTA and CT perfusion improves the diagnostic accuracy of collateral circulation in AIS patients.

    脑卒中全脑灌注辐射剂量CT血管成像

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    深度学习重建算法在低辐射剂量头颈联合CT血管成像中的应用价值

    李杨飞朱卫萍侯怡迪庞坚信...
    53-59页
    查看更多>>摘要：目的 探讨深度学习重建算法(DLIR)与自适应统计迭代重建算法(ASiR-V)在头颈部CT血管成像(CTA)中检查剂量和成像质量的差异。 方法 前瞻性收集因头颈部血管疾病行头颈部CTA检查的患者80例。按照检查的先后顺序分为A组和B组，每组40例。A组采用管电压120 kV，噪声指数11.0，ASiR-V 50%重建；B组采用管电压80 kV，噪声指数9.0，分别采用ASiR-V 50%重建(B1组)和DLIR-H重建(B2组)。采用独立样本t检验比较两组的辐射剂量和图像质量。采用Kruskal-wallis检验和Wilcoxon秩和检验用于比较两种成像方式的辐射剂量和主观、客观图像质量。比较组间强化血管CT值，感兴趣区(ROI)的信号与噪声，计算信噪比(SNR)和对比信噪比(CNR)。 结果 A、B两组有效辐射剂量分别为(0.77±0.08)、(0.45±0.05)mSv，差异有统计学意义(t＝21.96，P<0.001)。A、B1、B2 3组图像的主动脉弓、颈动脉起始部、颈动脉分叉层面、大脑中动脉M1段强化血管CT值、SD、SNR、CNR，差异均有统计学意义(F＝67.69、68.50、50.52、74.10、63.10、91.22、69.16，P<0.001)。A、B1、B2 3组图像质量主观评分差异有统计学意义(Z＝71.06，P<0.05)。 结论 DLIR算法能够在进一步降低头颈部CTA检查辐射剂量的同时，明显地减少图像噪声，保证了图像质量，具有良好的临床应用价值。 Objective To explore the differences between the deep learning-based image reconstruction (DLIR) and the adaptive statistical iterative reconstruction V (ASiR-V) algorithms in the radiation dose and image quality of head and neck CT angiography (CTA). Methods The data of 80 patients undergoing head and neck CTA due to vascular diseases in the head and neck were prospectively collected. These patients were randomly divided into groups A and B based on their examination sequence. The CTA images of group A were reconstructed based on ASiR-V 50%, with a tube voltage of 120 kV and a noise index of 11.0. In contrast, those of group B were reconstructed based on ASiR-V 50% (for group B1) and DLIR-H (for group B2), with a tube voltage of 80 kV and a noise index of 9.0. Then, the radiation doses and image quality of both groups were compared using the independent-sample t-test. The radiation doses, and both subjective and objective image quality of the two imaging method were compared through the Kruskal-Wallis test and the Wilcoxon rank-sum test. The independent- or paired-sample t-test was employed to measure inter-group vascular enhanced CT values, as well as signals and noise from regions of interest (ROIs), with signal-to-noise ratios (SNRs) and contrast-to-noise ratios (CNRs) calculated. Results The effective doses of groups A and B were (0.77±0.08) and (0.45±0.05) mSv, respectively, with a statistically significant difference (t = 21.96, P < 0.001). The vascular enhanced CT values, SDs, SNRs, and CNRs in the arch of the aorta, the initial and bifurcation parts of the common carotid artery, and the M1 segment of the middle cerebral artery showed statistically significant differences among groups A, B1, and B2 ( F = 67.69, 68.50, 50.52, 74.10, 63.10, 91.22, 69.16, P < 0.001). Additionally, statistically significant differences were observed in the subjective scores of image quality among groups A, B1, and B2 ( Z = 71.06, P < 0.05). Conclusions The DLIR algorithm can further reduce the radiation dose in head and neck CTA examination while significantly reducing image noise and ensuring image quality, thus demonstrating high clinical application value.

    X射线计算机体层摄影术辐射剂量深度学习重建算法图像质量

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