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冠状动脉粥样硬化与颈动脉、脑动脉粥样硬化密切相关[1-5]。研究表明,32.4%无心脏症状的脑梗死患者同时合并有冠状动脉重度狭窄[6]。因此,全面准确地评价心脑血管动脉粥样硬化的程度及两者的关系,能够进行早期干预,对降低心脑血管事件的发生具有重要的临床意义。传统上,用多层螺旋CT行冠状动脉、头颈部动脉一体化成像时,总辐射剂量高、对比剂用量大、操作费时,且心率均需控制在60次/min。本研究旨在突破心率限制,通过评价CT心脑血管一体化成像的客观图像质量、主观图像质量和辐射剂量,分析图像质量的影响因素,探讨该方法的关键技术点,为临床提供一种无创的评价心脑血管的影像学方法。
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由表 1可见,A组和B组患者间年龄(t=0.58,P>0.05)、性别(χ2=1.45,P>0.05)、BMI(t=1.20,P>0.05)差异无统计学意义;在平均心率、心率变异性方面进行比较,差异均有统计学意义(t=12.48、3.48,均P<0.05);其余方面的比较差异均无统计学意义。
变量 A组/n=300 B组/n=193 检验值 P值 年龄/岁 54.27±9.63 53.56±10.64 t=0.58 0.847 性别/%(男) 66.33(199) 33.16(64) χ2=1.45 0.228 体重指数/(kg/m2) 22.50±2.37(10.6~32.6) 22.15±2.01(19.8~27.5) t=1.20 0.277 最低心率/(次/min) 71.60±11.91(45~128) 61.12±4.10(53~103) t=7.84 0.001 最高心率/(次/min) 78.50±21.62(54~285) 73.33±21.28(57~130) t=1.93 0.055 平均心率/(次/min) 74.00±11.00(52~128) 57.00±5.00(56~108) t=12.48 0.001 心率变异性 6.90±20.63(0~299) 16.00±22.18(0~67) t=3.48 0.001 扫描长度/mm 478.98(26.41 486.51±56.24 t=1.84 0.067 管电流/mAs 359.70±83.66 373.83±15.78 t=1.77 0.077 管电压/kV 98.60±9.53 100.17±1.88 t=1.73 0.083 注:表中,A组采用第三代双源CT(Force,德国西门子Healthcare公司)前瞻性心电门控大螺距模式扫描;B组米用第二代双源CT(Definiton Flash,德国西门子Healthcare公司)前瞻性心电门控大螺距模式扫描。 表 1 心脑血管一体化CT成像493例患者的基线资料
Table 1. Characteristics of 493 patients subjected to integrated imaging in coronary combined with carotid and cerebrovascular CT angiography
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通过对A组和B组心脑血管一体化成像的客观图像质量进行比较,A组颈总动脉、颈内动脉、大脑中动脉和椎动脉V4段的CT值、噪声均低于B组,差异均有统计学意义(t=1.98~4.49,均P<0.05);A组的剂量长度乘积明显低于B组,且差异有统计学意义(t=18.69,P=0.001);A组有效辐射剂量较B组降低了30%,差异有统计学意义(t=14.79,P=0.001)。A组的对比剂用量、扫描时间、时间分辨率均明显低于B组,且差异有统计学意义(t=45.51、12.27、14.79,均P=0.001),图像质量其他方面的差异均无统计学意义(表 2)。
患者图像质量比较参数/ (HU,x±s) A组/n=300 B组/n=193 t值 P值 主动脉根部CT值 449.46±109.24 457.29±86.43 0.68 0.495 主动脉根部噪声 23.86±7.76 24.11±5.46 0.31 0.755 颈总动脉CT值 454.94±125.44 512.83±87.83 4.49 0.001 颈总动脉噪声 14.57±5.94 16. ±5.96 2.17 0.031 颈内动脉CT值 452.79±121.53 488.82±102.18 2.46 0.004 颈内动脉噪声 15.32±10.48 18.56±8.72 2.91 0.002 大脑中动脉CT值 406.49±112.16 470.83±87.96 5.48 0.001 大脑中动脉噪声 19.22±8.87 26.85±16.14 6.09 0.001 椎动脉V4段CT/ 384.53±102.75 470.18±97.37 7.63 0.049 椎动脉V4段噪声 20.24±8.44 22.08±8.17 1.98 0.049 主动脉层面SNR 25.09±12.03 23.10±6.12 1.67 0.095 主动脉层面CNR 22.07±11.25 19.96±6.49 1.87 0.062 剂量长度乘积/mGy.cm 138.57±31.62 219.57±54.62 18.69 0.001 (73.5-258.0) (142.0-399.0) 时间分辨率/ms 66 75 14.79 0.001 扫描时间/s 0.78±0.12 0.94±0.06 12.27 0.001 对比剂/mL 50.00±0.00 60.00±0.00 45.51 0.001 有效辐射剂量/mSv 1.48±0.33 2.14±0.52 14.79 0.001 (0.79-2.77) (1.36-4.08) 注:表中,A组采用第三代双源CT(Force,德国西门子Healthcare公司)前瞻性心电门控大螺距模式扫描;B组米用第二代双源CT(Definiton Flash,德国西门子Healthcare公司)前瞻性心电门控大螺距模式扫描。SNR:信噪比;CNR:对比噪声比。 表 2 A、B两组患者心脑血管一体化CT成像图像质量客观评价比较(x±s)
Table 2. Comparision of objective integrated imaging in coronary combined with carotid and cerebrovascular CT angiography between 3rd and 2nd dual-source CT
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对图像质量进行评价的一致性检验Kappa值为0.912。A1、A2、B1、B2各组患者间年龄(t=0.18~0.37,P>0.05)、性别(χ2=0.42~2.82,P>0.05)、BMI(t=0.30~0.82,P>0.05)差异均无统计学意义。由表 3可知:①与B组进行比较,A组的冠状动脉CTA平均图像质量的评分更好(t=0.018,P < 0.05)、冠状动脉4级血管基于患者数的不可诊断率更低(χ2=6.63,P < 0.05),且差异均有统计学意义;②与B组进行比较,A组的头颈部CTA评分更好(t=0.013,P < 0.05)、头颈部4级血管基于患者数的不可诊断率更低(χ2=4.38,P < 0.05),且差异均有统计学意义;③不同扫描间期A1组和A2组的图像质量进行比较,A2组可取得与A1组同样的图像质量评分,差异均无统计学意(t=0.82、0.88,χ2=0.18、0.82,均P>0.05)。高心率患者采用第三代双源CT成像较二代CT成像的成功率高(88.74% vs.67.32%,χ2=22.06,P < 0.05),典型病例的图像见图 1和图 2。
变量 冠状动脉CTA平均图像质量评分 头颈部CTA平均图像质量评分 冠状动脉4级血管基于患者数/%(例) 头颈部4级血管基于患者数/%(例) A组/n=300 1.09±0.42 1.05±0.34 1.00(3/300) 0.06(2/300) A1组/n=69,心率≤65次/min 1.08±0.44 1.08±0.41 1.44(1/69) 1.44(1/69) A2组/n=201,心率 > 65次/min 1.09±0.38 1.04±0.32 0.86(2/231) 0.43(1/231) B组/n=193 1.44±0.88a 1.19±0.61a 4.66(9/193)a 3.11(6/193)a B1组/n=92,心率≤65次/min 1.26±0.73 1.07±0.45 5.43(5/92) 2.17(2/92) B2组/n=101,心率 > 65次/min 1.60±0.98b 1.30±0.71b 4.95(5/101)b 3.96(4/101) 注:表中,A组采用第三代双源CT(Force,德国西门子Healthcare公司)前瞻性心电门控大螺距模式扫描;B组采用第二代双源CT(Defmiton Flash,德国西门子Healthcare公司)前瞻性心电门控大螺距模式扫描。a:与A组比较,差异均有统计学意义t=0.018、0.013, ;χ2=6.63、4.38,均P < 0.05); b:与A2组比较,差异均有统计学意义t=2.013、4.357, χ2=5.68、5.89,均P < 0.05)。CTA: CT血管造影。 表 3 不同扫描间期心脑血管一体化成像图像质量主观评分
Table 3. Comparision of subjective integrated imaging in coronary combined with carotid and cerebrovascular CT angiography between 3rd and 2nd dual source CT in different scan interval
CT心脑血管一体化成像的图像质量评价
Evaluation of the image quality of integrated imaging in coronary combined with carotid and cerebrovascular computed tomography angiography
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摘要:
目的 评价双源CT心脑血管一体化成像的图像质量和有效辐射剂量,探讨该方法的关键技术点,为临床提供一种评价心脑血管疾病的无创性影像学方法。 方法 前瞻性收集临床同时行冠状动脉和头颈部动脉CT动脉成像(CTA)的连续性患者共493例。根据CT扫描机型分为2组:A组300例,采用第三代双源CT前瞻性心电门控大螺距模式扫描,根据心率进一步分为A1组(n=69,心率≤65次/分)和A2组(n=231,心率>65次/分);B组193例,采用第二代双源CT前瞻性心电门控大螺距模式扫描,根据心率进一步分为B1组(n=92,心率≤65次/分)和B2组(n=101,心率>65次/分)。分别客观、主观地评价图像质量,计算辐射剂量。计量资料采用独立样本t检验,患者临床资料中的频数参数构成比采用χ2检验,评价图像质量评分一致性采用Cohen Kappa分析。 结果 (1)A组和B组患者间年龄(t=0.58,P=0.847)、性别(χ2=1.45,P=0.228)、体重指数(t=1.20,P=0.277)差异均无统计学意义。(2)图像质量客观评价:A组颈总动脉、颈内动脉、大脑中动脉和椎动脉V4段CT值、噪声均低于B组,差异均有统计学意义(t=1.98~4.49,均P < 0.05),两组患者的主动脉根部CT值(t=0.68,P=0.495)和噪声(t=0.31,P=0.755)差异无统计学意义。(3)图像质量主观评价的一致性Kappa值为0.912。①与B组进行比较,A组的冠状动脉CTA平均图像质量的评分更好(t=0.018,P=0.001)、冠状动脉4级血管基于患者数的不可诊断率更低(χ2=6.63,P=0.014),且差异均有统计学意义;②与B组进行比较,A组的头颈部CTA评分更好(t=0.013,P=0.004)、头颈部4级血管基于患者数的不可诊断率更低(χ2=4.38,P=0.036),且差异均有统计学意义;③A组有效辐射剂量为(1.48±0.33)mSv,较B组[(2.14±0.52)mSv]降低了30%,差异有统计学意义(t=14.79,P=0.001)。 结论 第三代双源CT心脑血管一体化成像采用不同心率采集不同扫描时间窗的办法,能提供较好的图像质量,且降低了辐射剂量,是一种评价心脑血管疾病的无创性影像学方法。 -
关键词:
- 体层摄影术, X线计算机 /
- 心血管造影术 /
- 脑血管造影术 /
- 图像质量
Abstract:Objective To evaluate the image quality, radiation dose and key technologies of integrated imaging in coronary combined with carotid and cerebrovascular computed tomography angiography (CTA), which hopes to offer a non-invasive imaging method for cardiovascular and cerebrovascular diseases evaluation. Methods A total of 493 symptomatic patients referred for simultaneous coronary, carotid, and cerebrovascular CTA were prospectively included. The subjects were divided into two groups according to CT model. Group A (300 cases), on which 3rd generation dual-source CT was performed, was further divided into groups A1 (n=69, HR ≤ 65 bpm) and A2 (n=231, HR>65 bpm), while group B (113 cases), on which 2nd generation dual-source CT was performed, was further divided into groups B1 (n=92, HR ≤ 65 bpm) and B2 (n=101, HR>65 bpm).Objective and subjective image quality and radiation dose were nalyzed, factors influencing image quality were determined, and the key technologies of the method were described. The measurement data were tested by independent sample t test, the frequency parameter composition ratio in the patient's clinical data was tested by chi-square χ2 test, and Cohen Kappa analysis was used to evaluate the consistency of the image quality score. Results (1) No statistically significant difference between groups A and B was found in terms of age (t=0.58, P=0.847), gender (χ2=1.45, P=0.228), and body mass index (t=1.20, P=0.277). (2)Objective evaluation of image quality:Common carotid artery, internal carotid artery, middle cerebral artery, and vertebral artery CT values and noise in group A were significantly lower than those in group B (t=1.98-4.49, all P < 0.05), although no statistically significant difference between groups was found in terms of aortic root CT values (t=0.68, P=0.495) and noise score (t=0.31, P=0.755). (3) The consistency of the image quality assessment was good (Kappa value=0.912). ① Subjective evaluation of image quality:The average coronary CTA image quality score of group A was better than that of group B (t=0.018, P=0.001), and the rate of non-diagnostic coronary grade 4 vessels based on number of patients in group A was lower than that in group B (χ2=6.63, P=0.014). ② Carotid-cerebrovascular CTA score of group A was better than group B (t=0.013, P=0.004), and carotid-cerebrovascular grade 4 vessels were less likely to be diagnosed in group A than in group B (χ2=4.38, P=0.036). ③ The effective radiation dose of group A was significantly lower than that of group B[(1.48±0.33) mSv vs. (2.14±0.52) mSv; t=14.79, P=0.001]. Conclusions Integrated imaging by coronary and cerebrovascular CTA is a non-invasive imaging method which adopted different heart rates were captured by different scan time windows can providing high image quality with significant reduction of radiation for evaluation of coronary and cerebrovascular disease. -
Key words:
- Tomography, X-ray computed /
- Angiocardiography /
- Cerebral angiography /
- Image quality
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表 1 心脑血管一体化CT成像493例患者的基线资料
Table 1. Characteristics of 493 patients subjected to integrated imaging in coronary combined with carotid and cerebrovascular CT angiography
变量 A组/n=300 B组/n=193 检验值 P值 年龄/岁 54.27±9.63 53.56±10.64 t=0.58 0.847 性别/%(男) 66.33(199) 33.16(64) χ2=1.45 0.228 体重指数/(kg/m2) 22.50±2.37(10.6~32.6) 22.15±2.01(19.8~27.5) t=1.20 0.277 最低心率/(次/min) 71.60±11.91(45~128) 61.12±4.10(53~103) t=7.84 0.001 最高心率/(次/min) 78.50±21.62(54~285) 73.33±21.28(57~130) t=1.93 0.055 平均心率/(次/min) 74.00±11.00(52~128) 57.00±5.00(56~108) t=12.48 0.001 心率变异性 6.90±20.63(0~299) 16.00±22.18(0~67) t=3.48 0.001 扫描长度/mm 478.98(26.41 486.51±56.24 t=1.84 0.067 管电流/mAs 359.70±83.66 373.83±15.78 t=1.77 0.077 管电压/kV 98.60±9.53 100.17±1.88 t=1.73 0.083 注:表中,A组采用第三代双源CT(Force,德国西门子Healthcare公司)前瞻性心电门控大螺距模式扫描;B组米用第二代双源CT(Definiton Flash,德国西门子Healthcare公司)前瞻性心电门控大螺距模式扫描。 表 2 A、B两组患者心脑血管一体化CT成像图像质量客观评价比较(x±s)
Table 2. Comparision of objective integrated imaging in coronary combined with carotid and cerebrovascular CT angiography between 3rd and 2nd dual-source CT
患者图像质量比较参数/ (HU,x±s) A组/n=300 B组/n=193 t值 P值 主动脉根部CT值 449.46±109.24 457.29±86.43 0.68 0.495 主动脉根部噪声 23.86±7.76 24.11±5.46 0.31 0.755 颈总动脉CT值 454.94±125.44 512.83±87.83 4.49 0.001 颈总动脉噪声 14.57±5.94 16. ±5.96 2.17 0.031 颈内动脉CT值 452.79±121.53 488.82±102.18 2.46 0.004 颈内动脉噪声 15.32±10.48 18.56±8.72 2.91 0.002 大脑中动脉CT值 406.49±112.16 470.83±87.96 5.48 0.001 大脑中动脉噪声 19.22±8.87 26.85±16.14 6.09 0.001 椎动脉V4段CT/ 384.53±102.75 470.18±97.37 7.63 0.049 椎动脉V4段噪声 20.24±8.44 22.08±8.17 1.98 0.049 主动脉层面SNR 25.09±12.03 23.10±6.12 1.67 0.095 主动脉层面CNR 22.07±11.25 19.96±6.49 1.87 0.062 剂量长度乘积/mGy.cm 138.57±31.62 219.57±54.62 18.69 0.001 (73.5-258.0) (142.0-399.0) 时间分辨率/ms 66 75 14.79 0.001 扫描时间/s 0.78±0.12 0.94±0.06 12.27 0.001 对比剂/mL 50.00±0.00 60.00±0.00 45.51 0.001 有效辐射剂量/mSv 1.48±0.33 2.14±0.52 14.79 0.001 (0.79-2.77) (1.36-4.08) 注:表中,A组采用第三代双源CT(Force,德国西门子Healthcare公司)前瞻性心电门控大螺距模式扫描;B组米用第二代双源CT(Definiton Flash,德国西门子Healthcare公司)前瞻性心电门控大螺距模式扫描。SNR:信噪比;CNR:对比噪声比。 表 3 不同扫描间期心脑血管一体化成像图像质量主观评分
Table 3. Comparision of subjective integrated imaging in coronary combined with carotid and cerebrovascular CT angiography between 3rd and 2nd dual source CT in different scan interval
变量 冠状动脉CTA平均图像质量评分 头颈部CTA平均图像质量评分 冠状动脉4级血管基于患者数/%(例) 头颈部4级血管基于患者数/%(例) A组/n=300 1.09±0.42 1.05±0.34 1.00(3/300) 0.06(2/300) A1组/n=69,心率≤65次/min 1.08±0.44 1.08±0.41 1.44(1/69) 1.44(1/69) A2组/n=201,心率 > 65次/min 1.09±0.38 1.04±0.32 0.86(2/231) 0.43(1/231) B组/n=193 1.44±0.88a 1.19±0.61a 4.66(9/193)a 3.11(6/193)a B1组/n=92,心率≤65次/min 1.26±0.73 1.07±0.45 5.43(5/92) 2.17(2/92) B2组/n=101,心率 > 65次/min 1.60±0.98b 1.30±0.71b 4.95(5/101)b 3.96(4/101) 注:表中,A组采用第三代双源CT(Force,德国西门子Healthcare公司)前瞻性心电门控大螺距模式扫描;B组采用第二代双源CT(Defmiton Flash,德国西门子Healthcare公司)前瞻性心电门控大螺距模式扫描。a:与A组比较,差异均有统计学意义t=0.018、0.013, ;χ2=6.63、4.38,均P < 0.05); b:与A2组比较,差异均有统计学意义t=2.013、4.357, χ2=5.68、5.89,均P < 0.05)。CTA: CT血管造影。 -
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