三联排除法心脏CT血管造影的对比剂和辐射剂量降低策略：冠状动脉CT血管造影后全胸部非心电图门控低千伏扫描的可行性研究
Contrast material and radiation dose reduction strategy for triple-rule-out cardiac CT angiography: feasibility study of non-ECG-gated low kVp scan of the whole chest following coronary CT angiography.
作者信息
Kidoh Masafumi, Nakaura Takeshi, Nakamura Shinichi, Namimoto Tomohiro, Nozaki Toshimitsu, Sakaino Naritsugu, Harada Kazunori, Yamashita Yasuyuki
机构信息
Diagnostic Radiology, Amakusa Medical Center, Kumamoto, Japan Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
Diagnostic Radiology, Amakusa Medical Center, Kumamoto, Japan Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
出版信息
Acta Radiol. 2014 Dec;55(10):1186-96. doi: 10.1177/0284185113514886. Epub 2013 Dec 5.
BACKGROUND
Dedicated coronary computed tomography (CT) scan has been proven to be an accurate diagnostic modality in evaluating coronary artery disease. A second phase scan starting immediately after the coronary CT scan might enable visualization of the different vascular territories of the entire chest.
PURPOSE
To investigate the feasibility of a contrast material and radiation dose reduction triple-rule-out (TRO) CT angiography (CTA) protocol with serial non-ECG-gated low kVp scan of the whole chest, which utilizes a recirculated contrast agent.
MATERIAL AND METHODS
Thirty patients were scanned with the new TRO-CTA protocol; after the coronary scan with retrospective ECG-gating, non-ECG-gated whole-chest CTA was performed at 80 kVp to evaluate aortic arch (AAr) and pulmonary trunk (PT). Another 30 patients were scanned by our conventional TRO-CTA protocol at 120 kVp with retrospective ECG-gating. We compared the estimated effective dose (ED), contrast material (CM) dose, contrast-to-noise ratio (CNR) of the ascending aorta (AAo), and the rate of patients who could achieve adequate attenuation of the AAr and PT between the two protocols.
RESULTS
The total ED of the new TRO-CTA protocol was 29.6% lower than that of the conventional protocol (P < 0.01). The amount of CM used for the new TRO-CTA protocol was significantly lower than in the conventional protocol (60.1 ± 9.6 mL vs. 91.8 ± 22.6 mL, P < 0.01). The CNR of the AAo was 30.2% higher with the new TRO-CTA protocol than with the conventional protocol (P < 0.01). There was no significant difference in the success rate of adequate attenuation of the AAr and PT between the two protocols (P > 0.05).
CONCLUSION
The new TRO-CTA protocol can reduce the total dose of radiation and the contrast dose and yield adequate vascular enhancement compared with the conventional protocol.
背景
专用冠状动脉计算机断层扫描（CT）已被证明是评估冠状动脉疾病的一种准确诊断方式。在冠状动脉CT扫描后立即开始的第二阶段扫描可能有助于观察整个胸部不同的血管区域。
目的
探讨采用经循环利用的对比剂对全胸部进行非心电门控低千伏连续扫描的对比剂和辐射剂量降低的三联排除（TRO）CT血管造影（CTA）方案的可行性。
材料与方法
对30例患者采用新的TRO-CTA方案进行扫描；在回顾性心电门控冠状动脉扫描后，以80千伏进行非心电门控全胸部CTA，以评估主动脉弓（AAr）和肺动脉干（PT）。另外30例患者采用我们传统的TRO-CTA方案，在120千伏进行回顾性心电门控扫描。我们比较了两种方案之间的估计有效剂量（ED）、对比剂（CM）剂量、升主动脉（AAo）的对比噪声比（CNR）以及能够实现AAr和PT充分衰减的患者比例。
结果
新TRO-CTA方案的总ED比传统方案低29.6%（P < 0.01）。新TRO-CTA方案使用的CM量显著低于传统方案（60.1±9.6毫升对91.8±22.6毫升，P < 0.01）。新TRO-CTA方案的AAo的CNR比传统方案高30.2%（P < 0.01）。两种方案在AAr和PT充分衰减的成功率方面无显著差异（P > 0.05）。
结论
与传统方案相比，新的TRO-CTA方案可降低辐射总剂量和对比剂剂量，并产生足够的血管强化效果。
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