| 曹俊涛,胡铭,徐婷,梁冰,屠建春,张欢.双源螺旋CT三种扫描模式肺动脉造影诊断肺栓塞[J].中国医学影像技术,2021,37(10):1552~1557 |
| 双源螺旋CT三种扫描模式肺动脉造影诊断肺栓塞 |
| Three scanning modes of dual-source spiral CT pulmonary angiography for diagnosis of pulmonary embolism |
| 投稿时间：2020-05-07 修订日期：2021-05-01 |
| DOI：10.13929/j.issn.1003-3289.2021.10.028 |
| 中文关键词: 肺栓塞 体层摄影术,X线计算机 血管造影术 |
| 英文关键词:pulmonary embolism tomography, X-ray computed angiography |
| 基金项目:昆山高层次医学人才柔性引进团队项目（01201802）。 |
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| 中文摘要: |
| 目的 比较双源螺旋CT双能量模式（DE）、单能量模式（SE）和单能量低kV（SELOW）3种模式下CT肺动脉造影（CTPA）图像质量、辐射剂量和肺动脉栓子分布的差异。方法 将130例临床疑诊肺动脉栓塞（PE）而接受CTPA患者随机分为DE组（43例）、SE组（42例）和SELOW组（45例）；评价图像质量，分析主观评分的观察者间一致性；比较3组扫描长度、扫描时间、剂量长度乘积（DLP）、容积CT剂量指数（CTDIvol）和有效剂量（ED），以及各组非PE患者肺动脉干及各段肺动脉CT值、平均肺动脉信号噪声比（SNR）和对比噪声比（CNR）、肺动脉与邻近血管（各段肺静脉及上腔静脉、主动脉）相对密度比及肺动脉栓子分布的差异。结果 各组图像质量主观评分均以2、3级为主，未见0级病例。DE组检查时间长于SE组和SELOW组（P均<0.05），SELOW组ED显著低于DE组和SE组（P均<0.001），后2组差异无统计学意义（P<0.05）。SELOW组非PE患者肺动脉CT值高于DE组和SE组（P均<0.05），后2组之间差异无统计学意义（P>0.05）；SELOW组SNR和CNR均高于SE组（P均<0.05），DE组与SE组差异均无统计学意义（P>0.05）。3组肺动脉与邻近血管相对密度比差异均无统计学意义（P均>0.05）。对47例PE共检出262个栓子，包括DE组17例112个、SE组11例64个及SELOW组19例86个；使用DE Vessels&PBV亚组对肺段以下肺栓子的检出率高于不使用亚组（P<0.05）。结论 SELOW CTPA的 SNR和CNR较高，辐射剂量较低，能满足诊断PE需求；DE CTPA对诊断肺段以下PE具有重要价值。 |
| 英文摘要: |
| Objective To observe the image quality, radiation dose and distribution of pulmonary emboli in CT pulmonary angiography (CTPA) under dual-source spiral CT dual energy mode (DE), single energy mode (SE) and single energy low kV mode (SELOW). Methods Totally 130 patients with clinically suspected pulmonary embolism (PE) who underwent CTPA examination were enrolled and randomly divided into DE group (n=43), SE group (n=42) and SELOW group (n=45). The imaging qualities were subjectively and objectively evaluated, respectively, and the intra-observer consistencies of subjective evaluation results were analyzed. The scan length, scan time, dose-length product (DLP), volume CT dose index (CTDIvol) and effective dose (ED) of 3 groups were analyzed. The average pulmonary artery signal-to-noise ratio (SNR), the contrast-to-noise ratio (CNR) and the relative density ratio of pulmonary artery with adjacent blood vessels (each segmental pulmonary vein, superior vena cava and aorta) in PE-negative patients and the distribution of pulmonary emboli under different modes were compared. Results The subjective evaluation results were 2 and 3 grade in all 3 groups, no one with 0 grade. The intra-observer consistency of subjective evaluation results of image quality was good in all 3 groups (Kappa=0.75, P<0.001). The examination time in DE group was longer than that in SE group and SELOW group (both P<0.05), while ED in SELOW group was significantly lower than in DE group and SE group (both P<0.001), but there was no significant difference between DE group and SE group (P>0.05). In non-PE patients, CT value of pulmonary artery in SELOW group was higher than that in DE group and SE group (both P<0.05), whereas there was no significant difference between DE group and SE group (P>0.05). SNR and CNR in SELOW group was higher than those in SE group (both P<0.05), while there was no significant difference between DE group and SE group (P>0.05). There was no significant difference of relative density ratio of pulmonary artery and adjacent blood vessels among 3 groups (all P>0.05). Totally 262 emboli were detected in 47 PE patients, including 112 emboli in 17 cases of DE group, 64 emboli in 11 cases of SE group and 86 emboli in 19 cases of SELOW group. The detection rate of pulmonary emboli below the segment in Vessels＆PBV subgroup was higher than that in without Vessels＆PBV subgroup of DE group (both P<0.05). Conclusion SELOW CTPA had higher SNR and CNR and a reduction of radiation dose, which could meet the needs of diagnosing PE. DE CTPA played an important role in diagnosing PE below segmental pulmonary. |
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