Alagic Zlatan, Eriksson Andreas, Drageryd Erika, Motamed Sara Rezaei, Wick Marius C
Functional Unit for Musculoskeletal Radiology, Function Imaging and Physiology, Karolinska University Hospital, Karolinska Vägen Solna, SE-17176, Stockholm, Sweden.
General Electrics Healthcare Sverige AB, Danderyd, Sweden.
Emerg Radiol. 2017 Oct;24(5):509-518. doi: 10.1007/s10140-017-1496-4. Epub 2017 Apr 5.
Computed tomography (CT) examinations, often using high-radiation dosages, are increasingly used in the acute management of polytrauma patients. This study compares a low-dose polytrauma multi-phase whole-body CT (WBCT) protocol on a latest generation of 16-cm detector 258-slice multi-detector CT (MDCT) scanner with advanced dose reduction techniques to a single-phase polytrauma WBCT protocol on a 64-slice MDCT scanner.
Between March and September 2015, 109 polytrauma patients (group A) underwent acute WBCT with a low-dose multi-phase WBCT protocol on a 258-slice MDCT whereas 110 polytrauma patients (group B) underwent single-phase trauma CT on a 64-slice MDCT. The diagnostic accuracy to trauma-related injuries, radiation dose, quantitative and semiquantitative image quality parameters, subjective image quality scorings, and workflow time parameters were compared.
In group A, statistically significantly more arterial injuries (p = 0.04) and arterial dissections (p = 0.002) were detected. In group A, the mean (±SD) dose length product value was 1681 ± 183 mGy*cm and markedly lower when compared to group B (p < 0.001). The SDs of the mean Houndsfield unit values of the brain, liver, and abdominal aorta were lower in group A (p < 0.001). Mean signal-to-noise ratios (SNRs) for the brain, liver, and abdominal aorta were significantly higher in group A (p < 0.001). Group A had significantly higher image quality scores for all analyzed anatomical locations (p < 0.02). However, the mean time from patient registration until completion of examination was significantly longer for group A (p < 0.001).
The low-dose multi-phase CT protocol improves diagnostic accuracy and image quality at markedly reduced radiation. However, due to technical complexities and surplus electronic data provided by the newer low-dose technique, examination time increases, which reduces workflow in acute emergency situations.
计算机断层扫描（CT）检查常使用高辐射剂量，在多发伤患者的急性处理中应用越来越广泛。本研究将新一代16厘米探测器258层多探测器CT（MDCT）扫描仪上采用先进剂量降低技术的低剂量多发伤多期全身CT（WBCT）方案与64层MDCT扫描仪上的单相多发伤WBCT方案进行比较。
2015年3月至9月期间，109例多发伤患者（A组）在258层MDCT上采用低剂量多期WBCT方案进行急性WBCT检查，而110例多发伤患者（B组）在64层MDCT上进行单相创伤CT检查。比较了对创伤相关损伤的诊断准确性、辐射剂量、定量和半定量图像质量参数、主观图像质量评分以及工作流程时间参数。
A组检测到的动脉损伤（p = 0.04）和动脉夹层（p = 0.002）在统计学上显著更多。A组的平均（±标准差）剂量长度乘积值为1681 ± 183 mGy*cm，与B组相比明显更低（p < 0.001）。A组大脑、肝脏和腹主动脉的平均亨氏单位值的标准差更低（p < 0.001）。A组大脑、肝脏和腹主动脉的平均信噪比（SNR）显著更高（p < 0.001）。A组所有分析解剖部位的图像质量评分显著更高（p < 0.02）。然而，A组从患者登记到检查完成的平均时间显著更长（p < 0.001）。
低剂量多期CT方案在显著降低辐射的情况下提高了诊断准确性和图像质量。然而，由于更新的低剂量技术带来的技术复杂性和多余的电子数据，检查时间增加，这降低了急性紧急情况下的工作流程效率。
