用于主动脉评估的个体化CT血管造影方案：一项可行性研究。
Individualized CT Angiography Protocols for the Evaluation of the Aorta: A Feasibility Study.
作者信息
Kok Madeleine, de Haan Michael W, Mihl Casper, Eijsvoogel Nienke G, Hendriks Babs M F, Sailer Anna M, Derks Kris, Schnerr Roald S, Schurink Geert Willem H, Wildberger Joachim E, Das Marco
机构信息
Department of Radiology, Maastricht University Medical Center, P. Debyelaan 25, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands; CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, P. Debyelaan 25, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands.
Department of Radiology, Maastricht University Medical Center, P. Debyelaan 25, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands.
出版信息
J Vasc Interv Radiol. 2016 Apr;27(4):531-8. doi: 10.1016/j.jvir.2016.01.009. Epub 2016 Mar 2.
PURPOSE
Ionizing radiation and iodinated contrast media are potential drawbacks to repetitive follow-up CT angiography in current practice. The aim of the present study was to optimize radiation dose and contrast agent volume by using individualized CT angiography protocols.
MATERIALS AND METHODS
Eighty consecutive patients referred for CT angiography of the whole aorta were prospectively evaluated. Patients were divided into groups of patients with a body mass index (BMI) < 28 kg/m(2) (group 1; n = 50) and those with a BMI ≥ 28 kg/m(2) (group 2; n = 30). A control group consisted of 50 consecutive patients who were retrospectively evaluated. CT angiography parameters on a second-generation dual-source scanner were 128 × 0.6-mm collimation, pitch of 0.9, rotation time of 0.33 seconds, tube voltages of 80/100/120 kVp (group 1/group 2/control), reference tube current of 400 mA, and image reconstruction at 1-mm/0.8-mm slice thickness (kernels, B30f [control] and I30f/strength 3 [groups 1/2]). The control group received 120 mL of contrast agent (300 mgI/mL) at 4.8 mL/s; groups 1 and 2 received 44 mL and 53 mL at 3.3 mL/s and 4 mL/s, respectively. Effective dose was evaluated for each patient. Image quality was determined by qualitative image analysis at the levels of the thoracic, abdominal, and pelvic aorta as nondiagnostic, diagnostic, good, or excellent, and quantitative image analysis was performed, including attenuation values and contrast-to-noise ratio (CNR).
RESULTS
Mean effective radiation dose values for CT angiography of the aorta were 3.7 mSv ± 0.7 in group 1, 6.7 mSv ± 1.4 in group 2, and 8.7 mSv ± 1.9 in the control group (P < .001). Mean attenuation values and CNR levels were 334 HU ± 66 and 16 ± 8, respectively, in group 1, 277 HU ± 56 and 14 ± 5 in group 2, and 305 HU ± 77 and 11 ± 4 in the control group.
CONCLUSIONS
Iterative reconstruction algorithms resulted in 23%-57% less radiation in combination with 55%-63% less contrast agent volume compared with standard CT protocols.
目的
在当前实践中，电离辐射和碘化造影剂是重复进行CT血管造影随访的潜在缺点。本研究的目的是通过使用个性化CT血管造影方案来优化辐射剂量和造影剂用量。
材料与方法
对连续80例接受全主动脉CT血管造影检查的患者进行前瞻性评估。患者被分为体重指数（BMI）<28 kg/m²的患者组（第1组；n = 50）和BMI≥28 kg/m²的患者组（第2组；n = 30）。对照组由50例连续患者组成，进行回顾性评估。第二代双源扫描仪上的CT血管造影参数为128×0.6 mm准直、螺距0.9、旋转时间0.33秒、管电压80/100/120 kVp（第1组/第2组/对照组）、参考管电流400 mA，以及1 mm/0.8 mm层厚的图像重建（卷积核，对照组为B30f，第1/2组为I30f/强度3）。对照组以4.8 mL/s的速度注射120 mL造影剂（300 mgI/mL）；第1组和第2组分别以3.3 mL/s和4 mL/s的速度注射44 mL和53 mL。评估每位患者的有效剂量。通过对胸主动脉、腹主动脉和盆腔主动脉水平的图像进行定性分析来确定图像质量，分为非诊断性、诊断性、良好或优秀，并进行定量图像分析，包括衰减值和对比噪声比（CNR）。
结果
主动脉CT血管造影的平均有效辐射剂量值在第1组为3.7 mSv±0.7，在第2组为6.7 mSv±1.4，在对照组为8.7 mSv±1.9（P<.001）。第1组的平均衰减值和CNR水平分别为334 HU±66和16±8，第2组为277 HU±56和14±5，对照组为305 HU±77和11±4。
结论
与标准CT方案相比，迭代重建算法可使辐射减少23%-57%，同时造影剂用量减少55%-63%。
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