90kVp 低管电压 CT 肺动脉造影联合高级模型迭代重建算法：对肺动脉栓塞检测的辐射剂量、图像质量和诊断准确性的影响。
90-kVp low-tube-voltage CT pulmonary angiography in combination with advanced modeled iterative reconstruction algorithm: effects on radiation dose, image quality and diagnostic accuracy for the detection of pulmonary embolism.
机构信息
1 Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt , Frankfurt , Germany.
2 Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center , New York, NY , USA.
出版信息
Br J Radiol. 2018 Jul;91(1088):20180269. doi: 10.1259/bjr.20180269. Epub 2018 Jun 5.
OBJECTIVE
To evaluate low-tube-voltage 90-kVp CT pulmonary angiography (CTPA) with advanced modeled iterative reconstruction algorithm (Admire) compared to 120-kVp equivalent dual-energy (DE) acquisition with regards to radiation exposure, image quality and diagnostic accuracy for pulmonary embolism (PE) assessment.
METHODS
CTPA studies of 40 patients with suspected PE (56.7 ± 16.3 years) performed on a third-generation 192-slice dual-source CT scanner were retrospectively included. 120-kVp equivalent linearly-blended (60% 90-kVp, 40% 150-kVp) and 90-kVp images were reconstructed. Attenuation and noise of the pulmonary trunk were measured to calculate contrast-to-noise ratios (CNR). Three radiologists assessed the presence of central and segmental PE and diagnostic confidence. Interobserver agreement was calculated using intraclass correlation coefficient (ICC). Radiation exposure was assessed as effective dose (ED).
RESULTS
Pulmonary trunk CNR values were significantly increased in 90-kVp compared to linearly-blended series (15.4 ± 6.3 vs 11.3 ± 4.6, p < 0.001). Diagnostic accuracy for PE assessment was similar in both series with excellent interobserver agreement (p = 0.48; ICC, 0.83; p = 0.48). Overall confidence for PE assessment was rated excellent for both series with a significant advantage for linearly-blended series (p < 0.001; 4.1 vs 3.8). ED was reduced by 37.2% with 90-kVp compared to 120-kVp equivalent image series (1.1 ± 0.6 vs 1.7 ± 0.7 mSv, p < 0.001).
CONCLUSION
90-kVp CTPA with Admire provided increased quantitative image quality with similar diagnostic accuracy and confidence for PE assessment compared to 120-kVp equivalent acquisition, while radiation dose was reduced by 37.2%. Advances in knowledge: 90-kVp CTPA with an advanced iterative reconstruction algorithm results in excellent image quality and reduction of radiation exposure without limiting diagnostic performance.
目的
与 120kVp 等效双能（DE）采集相比，评估使用低管电压 90kVp CT 肺动脉造影（CTPA）联合高级模型迭代重建算法（Admire）在评估肺动脉栓塞（PE）方面的辐射暴露、图像质量和诊断准确性。
方法
回顾性纳入 40 例疑似 PE 患者（56.7±16.3 岁）的 CTPA 研究，这些患者均在第三代 192 层双源 CT 扫描仪上进行检查。分别重建 120kVp 等效线性混合（60% 90kVp，40% 150kVp）和 90kVp 图像。测量肺动脉干的衰减和噪声，以计算对比噪声比（CNR）。三位放射科医生评估中央和节段性 PE 的存在和诊断信心。使用组内相关系数（ICC）评估观察者间的一致性。以有效剂量（ED）评估辐射暴露。
结果
与线性混合系列相比，90kVp 组的肺动脉干 CNR 值显著增加（15.4±6.3 比 11.3±4.6，p＜0.001）。两种序列的 PE 评估诊断准确性相似，观察者间的一致性极好（p=0.48；ICC，0.83；p=0.48）。两种序列的整体 PE 评估置信度均被评为极好，线性混合序列具有显著优势（p＜0.001；4.1 比 3.8）。与 120kVp 等效图像系列相比，90kVp 组的 ED 降低了 37.2%（1.1±0.6 比 1.7±0.7mSv，p＜0.001）。
结论
与 120kVp 等效采集相比，Admire 联合 90kVp CTPA 可提高定量图像质量，同时不限制诊断性能，且在评估 PE 方面具有相似的诊断准确性和信心，而辐射剂量降低了 37.2%。知识的进步：使用高级迭代重建算法的 90kVp CTPA 可获得极好的图像质量，并降低辐射暴露，同时不限制诊断性能。
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