个体化碘对比剂注射方案在头颈心多部位大范围联合CT血管成像中的应用
Study of individualized iodine contrast injection protocolin comprehensive multi-region CTA of head-neck-coronary
程晓奕 1张贺 2刘忠啸 2孟闫凯 2张恒伟 2董超 2张畅 1孙存杰2
作者信息
- 1. 221004 徐州,徐州医科大学医学影像学院
- 2. 221006 徐州,徐州医科大学附属医院医学影像科
- 折叠
摘要
目的 探讨个体化碘对比剂注射方案在第3代双源CT头颈心多部位大范围联合CTA中的可行性与应用价值,并比较该个体化方案在不同血管分支之间的异质性.方法 回顾性分析2022年9月至2023年6月于徐州医科大学附属医院医学影像科行头颈心CTA检查的90例患者.入组BMI≤22 kg/m2(低体重组)、22 kg/m2＜BMI≤26 kg/m2(中体重组)、26 kg/m2＜BMI≤30 kg/m2(高体重组),每组30例,并将3组患者再次分为亚组:个体化方案(45例)和对照方案(常规方案进行检查,45例),即每个BMI亚组15例.采用主观评分、CT值、强化变异系数(CV)对头颈和冠状动脉CTA的图像质量进行评估.获取各组CT容积剂量指数(CTDIvol)、剂量长度乘积(DLP)和有效辐射剂量(ED).广义加性模型进一步分析影响各分支血管图像质量的关联因素.结果 个体化各动脉强化CT值均低于对照(P＜0.001).个体化动脉强化CV均小于对照,个体化的动脉强化均一性更好.个体化的主观评分高于对照(P＜0.001),且2名医师主观评分一致性较好(Kappa=0.769).低体重组中,个体化、对照的所有目标血管的CT值差异均有统计学意义(P＜0.05),个体化的动脉强化CT值低于对照(P＜0.05);中体重组中,个体化、对照的所有目标血管的CT值差异均有统计学意义(P＜0.05),个体化的动脉强化CT值低于对照(P＜0.05).个体化的理想最佳强化(300～450 HU)血管节段数明显多于对照(P＜0.05).低体重组、中体重组中个体化的CTDIvol、ED、对比剂以及流速低于对照(P＜0.05).BMI是影响血管CT值的重要因素,经协变量校正后,BMI仍与CT值存在非线性关系.结论 在第三代双源CT中,根据BMI结合个体化碘对比剂注射方案行头颈心多部位大范围联合CTA,图像质量能满足临床诊断要求,且辐射剂量和对比剂用量更低.
Abstract
Objective This study is aimed to explore the feasibility and clinical value of an individualized iodine contrast agent injection protocolin multi body parts CTA of head-neck-coronary by using the third-generation dual-source CT and to compare the heterogeneity of the individualized scheme among different vascular branches.Methods A total of 90 patients who underwent head-neck-coronary CTA were assigned to three groups based on BMI:light weight(BMI ≤ 22 kg/m2,n=30),medium weight(22 kg/m2＜BMI ≤ 26 kg/m2,n=30),and high weight(26 kg/m2＜BMI≤30 kg/m2,n=30).These groups were further equally divided into the individualized group(n=45)and the control group(n=45),with each BMI subgroup containing 15 patients.The individualized group received the individualized protocol,while the control group received 80ml agent at a flow rate of 4.5 ml/s.Subjective assessment,CT val-ue and the reinforcement CV were used to assess the image quality.The CTDIvol,DLP and the ED were obtained.GAM was used to ana-lyze the related factors affecting the image quality of each vascular branch.Results In individualized group,the CT value of all vessels reinforcement were lower than that in the control group(P＜0.001).The arterial enhancement CV of individualized group was smaller than that of the control group.The homogenization of arterial en-hancement in the individualized group is better.The subjective image quality scores were higher than the control group(P＜0.001),and the subjective scores of the two physicians showed good consistency(Kappa=0.769).In light weight group,the differences in CT values of all target vessels between the individualized group and the control group were statistically significant(P＜0.05),the CT val-ues of the individualized group were lower than those of the control group(P＜0.05).In medium weight group,the differences in CT values of all target vessels between the individualized group and the control group were statistically significant(P＜0.05),the CT val-ues of the individualized group were lower than those of the control group(P＜0.05).The number of vessels in the optimal enhancement range(300-450 HU)counts more in individualized group than in the control group(P＜0.05).In light and medium weight subgroups,the CTDIvol,ED,contrast agent amount and velocity of individualized protocol were lower than that by control protocol(P＜0.05).BMI is an important factor affecting artery CT values.After covariate correction,there is still a non-linear relationship between BMI and CT values.Conclusion Head-neck-coronary CTA in multi body parts combined with an individualized contrast agent injection protocol based on BMI using the third-generation dual-source CT can achieve diagnostic requirements and the homogeneity of vascular enhance-ment is better than conventional protocols.
关键词
计算机体层成像/血管造影术/冠状动脉/头颈动脉/体质量指数Key words
computed tomography/angiography/coronary artery/headandneckartery/body mass index引用本文复制引用
出版年
2024
NETL
NSTL
万方数据