一站式评估中用于减少肾移植患者的辐射和造影剂剂量的个体化方案。
Individualized protocol for radiation and contrast medium dose reduction in one-stop assessment for kidney transplantation patients.
机构信息
Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
GE Healthcare, Computed Tomography Research Center, Beijing, 100176, China.
出版信息
Eur J Radiol. 2021 Jul;140:109757. doi: 10.1016/j.ejrad.2021.109757. Epub 2021 May 7.
OBJECTIVE
To compare image quality, radiation, and contrast medium (CM) doses between individualized and conventional scan protocols in combined coronary CT angiography (CCTA) and iliac artery CTA for kidney transplantation patients.
METHODS
148 patients needing assessment for coronary and iliac arteries before kidney transplantation were prospectively enrolled and randomly divided into the conventional and individualized groups. All patients underwent one-stop combined scans on a 256-row CT scanner with automatic tube current modulation, 50 % pre-ASIR-V to control radiation dose. CCTA was performed first using one heartbeat axial scan mode with bolus tracking technique and iliac CTA was performed 3 s after CCTA using a spiral scan. The conventional group (n = 72) used the standard protocol: 100 kVp, 60 mL of 350 mgI/mL CM at 4.5 mL/s flow rate. The individualized group (n = 76) used a body-mass-index (BMI)-dependent protocol: kVp: 80 (BMI < 24) and 100 (BMI ≥ 24) and CM: 19 mgI/kg (BMI < 18); 21 mgI/kg (18 ≤ BMI < 24); and 22 mgI/kg (BMI ≥ 24). Image quality radiation and CM doses of the two groups were compared.
RESULTS
There was no significant difference in patient demographic data. Compared with the conventional group, the individualized group reduced contrast flow rate (in mL/s) by 14.4 % (3.85 ± 0.72 vs. 4.5), contrast dose (in mL) by 35.8 % (38.53 ± 7.18 vs. 60) and radiation dose (in mSv) by 34.3 % (4.30 ± 1.73 vs. 6.54 ± 1.45). The individualized group had significantly higher subjective image quality score (P ＜ 0.05), lower noise (17.30 ± 4.97 HU vs. 19.13 ± 4.73 HU, P = 0.02) and higher signal-to-noise ratio (22.09 ± 7.41 vs. 19.55 ± 6.18, P = 0.03) for the three main vessels in CCTA compared with the conventional group. There were no differences in both subjective scores and objective measurements in iliac artery CTA between the two groups.
CONCLUSION
The individualized scanning protocol in the one-stop assessment of coronary and iliac arteries before kidney transplantation significantly reduces both radiation and CM doses while maintaining image quality in iliac artery CTA and providing better coronary artery images in CCTA.
目的
比较个体化和常规扫描方案在用于评估肾移植患者的冠状动脉 CT 血管造影术（CCTA）和髂动脉 CT 血管造影术（CTA）时的图像质量、辐射和对比剂（CM）剂量。
方法
前瞻性纳入 148 例需要评估冠状动脉和髂动脉的肾移植患者，并将其随机分为常规组和个体化组。所有患者均在配备自动管电流调制的 256 排 CT 扫描仪上进行一站式联合扫描，50%的预 ASIR-V 用于控制辐射剂量。CCTA 采用单次心跳轴位扫描模式，使用团注追踪技术进行，CCTA 后 3s 进行髂动脉螺旋扫描。常规组（n=72）使用标准方案：100 kVp，60mL 浓度为 350mgI/mL 的 CM，流速为 4.5mL/s。个体化组（n=76）采用基于体重指数（BMI）的方案：kVp：80（BMI＜24）和 100（BMI≥24），CM：19mgI/kg（BMI＜18）；21mgI/kg（18≤BMI＜24）；22mgI/kg（BMI≥24）。比较两组的图像质量、辐射和 CM 剂量。
结果
两组患者的人口统计学数据无显著差异。与常规组相比，个体化组的对比剂流速（mL/s）降低了 14.4%（3.85±0.72 比 4.5），对比剂剂量（mL）降低了 35.8%（38.53±7.18 比 60），辐射剂量（mSv）降低了 34.3%（4.30±1.73 比 6.54±1.45）。个体化组的主观图像质量评分显著更高（P＜0.05），噪声更低（17.30±4.97 HU 比 19.13±4.73 HU，P=0.02），信噪比（22.09±7.41 比 19.55±6.18，P=0.03）更高，用于评估 CCTA 中冠状动脉的三支主要血管。两组髂动脉 CTA 的主观评分和客观测量均无差异。
结论
在用于评估肾移植患者的冠状动脉和髂动脉的一站式检查中，个体化扫描方案可显著降低辐射和 CM 剂量，同时保持髂动脉 CTA 的图像质量，并为 CCTA 提供更好的冠状动脉图像。
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