查看更多>>摘要：目的 探讨GE 256排Revolution CT低剂量扫描结合个体化对比剂方案在冠状动脉支架内再狭窄评估中的图像质量、辐射剂量及诊断效能。 方法 回顾性选取2020年8月至2022年8月在北京市仁和医院行冠状动脉支架植入后复查的120例(共142个支架)患者作为研究对象，根据随机数字表法随机分为观察组(60例70个)和常规组(60例72个)，均行GE 256排Revolution CT检查。其中，常规组注入70 ml碘普罗胺对比剂；观察组根据体质量指数(BMI)给予个体化剂量。常规组管电压120 kV，管电流534 mAs，观察组管电压、管电流根据患者BMI调节，调节范围为管电压80～120 kV，管电流150～534 mAs。两组患者均于CCTA检查后7～14 d复查冠状动脉造影。对比两组患者的CT图像质量、辐射剂量及碘摄入量、诊断效能。 结果 常规组与观察组在左冠状动脉主干的CT值、对比噪声比、晕状伪影、支架内径差异方面差异无统计学意义(P>0.05)。常规组在CT剂量指数、CT剂量长度乘积、有效辐射剂量及碘摄入量方面均高于观察组(t＝10.30、8.75、10.27、4.60，P<0.05)。观察组、常规组与冠状动脉造影结果诊断效能的一致性分析Kappa值分别为0.904和0.879，结果一致性很好；常规组与观察组在敏感度、特异度方面差异无统计学意义(P>0.05)。 结论 GE 256排Revolution CT低剂量扫描结合个体化对比剂方案所获得的图像质量及诊断效能与常规方案相当，可有效降低辐射剂量、碘摄入量，值得推广。 Objective To investigate the image quality, radiation dose, and diagnostic efficiency of the regimen of GE 256-slice Revolution CT low-dose scanning, combined with an individualized contrast agent, in the assessment of coronary in-stent restenosis. Methods A total of 120 patients (with 142 stents) treated with coronary stent implantation at the Beijing Renhe Hospital from August 2020 to August 2022 were enrolled in this study. They were randomly divided into an observation group (60 cases with 70 stents) and a conventional group (60 cases with 72 stents) using the random number table method. Both groups received GE 256-slice Revolution CT examinations. Patients in the conventional group were injected with 70 ml of iopromide as a contrast agent each, while those in the observation group were given individualized doses based on their body mass indices (BMIs). A tube voltage of 120 kV and a tube current of 534 mA were applied to the conventional group, whereas the tube voltage and current for the observation group were adjusted within the ranges of 80-120 kV and 150-534 mAs based on patients’ BMIs. Both groups received coronary angiography 7-14 d after coronary computed tomography angiography (CCTA). Finally, the CT image quality, radiation dose, iodine intake, and diagnostic efficiency were compared between the two groups. Results Both groups exhibited no significant differences in CT values, contrast-to-noise ratios, blooming artifacts, and stent diameters of the left main coronary artery (P > 0.05). The conventional group manifested higher CT dose index, CT dose length product, effective dose, and iodine intake compared to the observation group ( t = 10.30, 8.75, 10.27, 4.60, P < 0.05). With coronary angiography result as the gold standard, the observation and conventional groups yielded Kappa values of 0.904 and 0.879, respectively, suggesting high consistency in diagnostic performance. Additionally, the two groups demonstrated nonsignificant differences in sensitivity and specificity ( P > 0.05). Conclusions The regimen of GE 256-slice Revolution CT low-dose scanning, combined with an individualized contrast agent, yielding image quality and diagnostic efficiency equivalent to those of the conventional regimen, can effectively reduce radiation dose and iodine intake. Therefore, this regimen merits wide applicability.
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