龔萬(wàn)灃 敖煒群 賈玉柱

[摘要] 目的 探討基于雙源CT不同技術(shù)手段對(duì)冠脈CT血管造影（CTA）檢查效率和質(zhì)量的影響。 方法 收集2018年6月～2019年10月在浙江省立同德醫(yī)院冠脈CTA患者107例，采用簡(jiǎn)單隨機(jī)分組方法將其分為A組（55例，采用小劑量測(cè)試技術(shù)）及B組（52例，采用造影劑自動(dòng)追蹤技術(shù)）。記錄兩組患者年齡、體重指數(shù)（BMI）、心率、輻射劑量及檢查時(shí)間，測(cè)量?jī)山M患者圖像信噪比（SNR）、對(duì)比噪聲（CNR）及CT值，評(píng)價(jià)并比較兩組患者冠脈的圖像質(zhì)量。結(jié)果 兩組患者年齡、BMI、心率、容積CT劑量指數(shù)、有效劑量、冠脈不同節(jié)段CT、主動(dòng)脈根部及冠脈各節(jié)段SNR比較，差異無(wú)統(tǒng)計(jì)學(xué)意義（P > 0.05）。B組右冠遠(yuǎn)段及回旋支遠(yuǎn)段CNR優(yōu)于A組，差異有統(tǒng)計(jì)學(xué)意義（P < 0.05）。兩組患者圖像質(zhì)量評(píng)級(jí)比較，差異無(wú)統(tǒng)計(jì)學(xué)意義（P > 0.05）。B組檢查時(shí)間顯著短于A組，差異有高度統(tǒng)計(jì)學(xué)意義（P < 0.01）。 結(jié)論 造影劑自動(dòng)追蹤技術(shù)能在保證圖像質(zhì)量的前提下提高檢查效率。

[關(guān)鍵詞] CT血管造影技術(shù);體層攝影技術(shù);檢查效率;輻射劑量;圖像質(zhì)量

[中圖分類號(hào)] R541.4 ? ? ? ? ?[文獻(xiàn)標(biāo)識(shí)碼] A ? ? ? ? ?[文章編號(hào)] 1673-7210（2020）07（a）-0020-04

[Abstract] Objective To investigate the effects of different techniques based on dual-source CT on examination efficiency and quality of coronary CT angiography （CTA）. Methods A total of 107 patients undergoing coronary CTA in Tongde Hospital of Zhejiang Province from June 2018 to October 2019 were collected， while they were divided into group A （55 cases， using low-dose test technology） and group B （52 cases， using contrast agent automatic tracking technology） by simple random grouping method. The age， body mass index （BMI）， heart rate， radiation dose and examination time of the two groups were recorded， and the image signal-to-noise ratio （SNR）， contrast noise （CNR） and CT values of the two groups were measured， while the coronary artery image quality were evaluated and compared. Results There were no significant differences in age， BMI， heart rate， volume CT dose index， effective dose， CT of different segments of coronary artery， SNR of aortic root and each segment of coronary artery between the two groups （P > 0.05）. The CNR of distal right coronary artery and distal left circumflex artery in group B were superior to group A， and the differences were statistically significant （P < 0.05）. There was no statistically significant difference in image quality ratings between the two groups （P > 0.05）. The examination time of group B was significantly shorter than that of group A， and the difference was highly statistically significant （P < 0.01）. Conclusion Contrast agent automatic tracking technology can improve the inspection efficiency under the premise of ensuring image quality.

[Key words] CT angiography; Tomography; Examination efficiency; Radiation dose; Image quality

隨著人口老齡化進(jìn)程加速，中國(guó)心血管病危險(xiǎn)因素流行趨勢(shì)明顯，導(dǎo)致心血管病發(fā)病人數(shù)持續(xù)增加[1]。冠脈CT血管造影（CTA）作為一項(xiàng)無(wú)創(chuàng)檢查，逐漸成為排除冠脈狹窄的首選檢查[2-4]。隨著檢查需求日益增長(zhǎng)，患者行冠脈CTA檢查等待的時(shí)間延長(zhǎng)。怎樣在保證圖像質(zhì)量及輻射可控的前提下提高檢查效率，是當(dāng)前面臨的主要問(wèn)題。本研究基于雙源CT冠脈CTA，對(duì)不同技術(shù)進(jìn)行比較，以期得到最佳解決方案。

本研究亦存在一些不足之處，缺少冠脈DSA“金標(biāo)準(zhǔn)”對(duì)照、沒有計(jì)入檢查前準(zhǔn)備時(shí)間、樣本量相對(duì)較小，還需進(jìn)行大樣本研究。

綜上所述，造影劑自動(dòng)追蹤技術(shù)能夠在滿足圖像質(zhì)量和輻射劑量可控的前提下縮短檢查時(shí)間，提高檢查效率。

[參考文獻(xiàn)]

[1] ?胡盛壽，高潤(rùn)霖，劉力生，等.《中國(guó)心血管病報(bào)告2018》概要[J].中國(guó)循環(huán)雜志，2019，34（3）：209-220.

[2] ?Sabarudin A，Sun Z，Ng KH. Coronary computed tomography angiography with prospective electrocardiography triggering：a systematic review of image quality and radiation dose [J]. Singapore Med J，2013，54（1）：15-23.

[3] ?Nakazato R，Arsanjani R，Shalev A，et al. Diagnostic Accuracy，Image Quality，and Patient Comfort for Coronary CT Angiography Performed Using Iso-Osmolar versus Low-Osmolar Iodinated Contrast [J]. Acad Radiol，2016， 23（6）：743-751.

[4] ?韓迎春，樊剛，曹文廣，等.64層螺旋CT冠脈成像與DSA血管造影在疾病中診斷價(jià)值的比較分析[J].中國(guó)CT和MRI雜志，2016，14（1）：56-58，98.

[5] ?Hausleiter J，Meyer T，Hermann F，et al. Estimated radiation dose associated with cardiac CT angiography [J]. JAMA，2009，301（5）：500-507.

[6] ?Hou Y，Zheng J，Wang Y，et al. Optimizing Radiation Dose Levels in Prospectively Electrocardiogram-Triggered Coronary Computed Tomography Angiography Using Iterative Reconstruction Techniques：A Phantom and Patient Study [J]. PLoS One，2013，8（2）：e56295.

[7] ?Neefjes LA，Dharampal AS，Rossi A，et al. Image Quality and Radiation Exposure Using Different Low-Dose Scan Protocols in Dual-Source CT Coronary Angiography：Randomized Study [J]. Radiology，2011，3（3）：779-786.

[8] ?中華醫(yī)學(xué)會(huì)放射學(xué)分會(huì)心胸學(xué)組，《中華放射學(xué)雜志》心臟冠脈多排CT臨床應(yīng)用指南寫作專家組.心臟冠脈CT血管成像技術(shù)規(guī)范化應(yīng)用中國(guó)指南[J].中華放射學(xué)雜志，2017，51（10）：732-743.

[9] ?陳瑩.冠脈CTA對(duì)比劑注射延時(shí)掃描時(shí)間的優(yōu)化[D].北京：首都醫(yī)科大學(xué)，2013.

[10] ?陳剛，凌志青，曾蒙蘇.64排螺旋CT冠脈成像三種預(yù)測(cè)增強(qiáng)延遲時(shí)間技術(shù)的比較研究[J].臨床放射學(xué)雜志，2011，30（5）：735-737.

[11] ?李鋒坦，李東，張?jiān)仆?管電壓對(duì)CT值測(cè)量、輻射劑量及圖像質(zhì)量影響的模型研究[J].中華放射學(xué)雜志，2013， 47（5）：458-461.

[12] ?Ippolito D，F(xiàn)ior D，F(xiàn)ranzesi CT，et al. Diagnostic accuracy of 256-row multidetector CT coronary angiography with prospective ECG-gating combined with fourth-generation iterative reconstruction algorithm in the assessment of coronary artery bypass：evaluation of dose reduction and image quality [J]. Radiol Med，2017，122（12）：893-901.

[13] ?Zhao L，Yang X，Hao F，et al. Ultra-Low Radiation Dose and Contrast Medium of Coronary CT Angiography Using Prospectively ECG-Triggered Without Heart Rate Control：A New Strategy [J]. J Med Imaging Radiat Oncol，2017，7（8）：1863-1869.

[14] ?周星，黃剛，張常青，等.雙源CT低管電壓結(jié)合低濃度對(duì)比劑掃描模式在冠脈CTA中的應(yīng)用研究[J].醫(yī)學(xué)影像學(xué)雜志，2016，26（11）：1980-1986.

[15] ?American College of Cardiology Foundation Task Force on Expert Consensus Documents，Mark DB，Berman DS，et al. ACCF/ACR/AHA/NASCI/SAIP/SCAI/SCCT 2010 expert consensus document on coronary computed tomographic angiography：a report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents [J]. Circulation，2010，121（22）：2509-2543.

[16] ?曹劍，易妍，王怡寧，等.70kV超低管電壓低對(duì)比劑用量冠脈CTA研究[J].放射學(xué)實(shí)踐，2014，29（6）：589-592.

[17] ?Sabarudin A，Sun Z，Ng KH. Coronary computed tomography angiography with prospective electrocardiography triggering：a systematic review of image quality and radiation dose [J]. Singapore Med J，2013，54（1）：15-23.

[18] ?Becker GR，Hong C，Knez A，et al. Optimal contrast application for cardiac 4-detector-row computed tomography [J]. Invest Radiol，2003，38（11）：690-694.

[19] ?Cademartiri F，Mollet NR，Lugt A，et al. Intravenous Contrast Material Administration at Helical 16-Detector Row CT Coronary Angiography：Effect of Iodine Concentration on Vascular Attenuation [J]. Radiology，2005，236（2）：661-665.

[20] ?黃元斌，張振宇，黃曉兵，等.多排螺旋CT冠脈血管造影診斷冠狀動(dòng)脈狹窄的臨床價(jià)值[J].中外醫(yī)學(xué)研究，2018，16（11）：50-52.

[21] ?陳華文，彭光明，陳楚欽，等.128層螺旋CTA在可疑急性冠脈綜合征診斷中的應(yīng)用價(jià)值[J].中國(guó)醫(yī)學(xué)創(chuàng)新，2019，16（20）：60-63.

[22] ?許麗君，陳晨，張桂敏.CT增強(qiáng)掃描中碘比醇造影劑不良反應(yīng)的預(yù)防與護(hù)理[J].解放軍護(hù)理雜志，2017，34（20）：75-76.

（收稿日期：2020-02-26）