摘要
目的探讨光子计数探测器CT(PCD-CT)使用“四低”技术(低对比剂剂量、低浓度、低流率、低辐射剂量)进行头颈部血管成像的可行性,并与能量积分探测器CT(EID-CT)获得的图像质量进行比较。方法前瞻性纳入2024年4至6月于郑州大学第一附属医院收治的疑似脑血管疾病患者105例,随机分为A、B、C 3组,每组35例,记录患者信息。A组患者采用EID-CT接受常规扫描方案,B组采用PCD-CT接受低对比剂量、低浓度、低流率扫描方案,C组采用PCD-CT接受“四低”技术扫描方案。测量各组图像升主动脉、颈总动脉、颈内动脉、椎动脉、基底动脉、大脑后动脉、大脑中动脉的CT值、噪声(SD)、信噪比(SNR)和对比噪声比(CNR)等客观图像质量指标。2名医师使用5分李克特量表对各组图像进行主观质量评分。采用单因素方差分析和Kruskal-Wallis检验比较各组扫描方案、图像客观质量及主观评分上的差异。结果在扫描方案上,B、C两组对比剂剂量为(26.26±4.45)、(26.54±3.83)ml,较A组(42.78±6.64)ml减少39%、38%(P均<0.01);B、C两组对比剂碘浓度为320 mg/ml,较A组350 mg/ml降低8.5%;B、C两组注射流率为(3.39±0.61)、(3.55±0.51)ml/s,较A组(4.28±0.66)ml/s降低21%、17%(P均<0.01);A、B两组有效辐射剂量(ED)分别为(1.40±0.15)、(1.40±0.19)mSv,差异无统计学意义(P>0.05),C组ED为(0.99±0.09)mSv,较A、B组降低30%、29%(P均<0.01)。客观图像质量对比上,3组图像SD在椎动脉、颈内动脉、大脑后动脉及大脑中动脉上的差异有统计学意义(P均<0.05),且B及C组图像SD低于A组,差异有统计学意义(P<0.05),而B、C两组的差异无统计学意义(P均>0.05);3组图像SNR在椎动脉、颈内动脉、基底动脉、大脑后动脉及大脑中动脉上的差异有统计学意义(P均<0.05),且B、C两组SNR较A组得到有效提升(P均<0.05);3组图像的CNR仅在颈内动脉上存在差异,B、C组均高于A组,差异有统计学意义(P均<0.05)。A、C两组主观图像质量评分差异无统计学意义(P>0.05),B组图像评分高于A和C组(P<0.05),3组图像得分均足够用于诊断。结论与EID-CT相比,PCD-CT联合“四低”技术可在降低对比剂用量和辐射剂量的同时进一步优化图像质量。
Objective To evaluate the feasibility of head and neck vascular imaging using photon-counting detector computed tomography(PCD-CT)combined with a“quadruple lows”protocol—characterized by low contrast media volume,low iodine concentration,low injection rate,and low radiation dose—and to compare the image quality with that obtained by energy-integrating detector CT(EID-CT).Methods A total of 105 patients with suspected cerebrovascular disease were prospectively enrolled at the First Affiliated Hospital of Zhengzhou University between April and June 2024.Patients were randomly assigned to three groups(n=35).Group A underwent conventional head and neck CTA using EID-CT.Group B underwent PCD-CT with a protocol involving ultra-low contrast media volume,low iodine concentration,and low injection rate.Group C underwent PCD-CT with the full“quadruple low”protocol.Objective image quality parameters—including CT attenuation,image noise(standard deviation,SD),signal-to-noise ratio(SNR),and contrast-to-noise ratio(CNR)—were measured at the ascending aorta,common carotid artery,internal carotid artery,vertebral artery,basilar artery,posterior cerebral artery,and middle cerebral artery.Two radiologists independently rated subjective image quality using a 5-point Likert scale.Differences among groups were analyzed using one-way ANOVA and the Kruskal-Wallis test.Results Compared to Group A[contrast volume:(42.78±6.64)ml],contrast agent volume was significantly reduced in Groups B and C[(26.26±4.45)ml and(26.54±3.83)ml,respectively],demonstrating reductions of 39%and 38%(both P<0.01).The iodine concentration was 320 mg/ml in Groups B and C,lower than 350 mg/ml in Group A(8.5%).The injection rate was also reduced in Groups B and C[(3.39±0.61)and(3.55±0.51)ml/s,respectively]compared to Group A[(4.28±0.66)ml/s],with reductions of 21%and 17%(both P<0.01).The effective dose(ED)was similar between Groups A and B[(1.40±0.15)vs.(1.40±0.19)mSv,P>0.05],while Group C demonstrated a significantly lower ED[(0.99±0.09)mSv],with a reduction of 30%compared to Group A and 29%compared to Group B(both P<0.01).In terms of objective image quality,significant differences in image noise(SD)were observed among the three groups at the vertebral artery,internal carotid artery,posterior cerebral artery,and middle cerebral artery(all P<0.05).Groups B and C showed significantly lower SD compared to Group A(P<0.05),with no significant difference between B and C(P>0.05).SNR was significantly higher in Groups B and C than in Group A at multiple vascular segments(all P<0.05).CNR differed only at the internal carotid artery,where Groups B and C demonstrated superior performance compared to Group A(P<0.05).Subjective image quality scores showed no significant difference between Groups A and C(P>0.05),while Group B had significantly higher scores than both A and C(P<0.05).All images were deemed diagnostically acceptable.ConclusionCompared with conventional EID-CT,PCD-CT combined with a“quadruple lows”protocol enables substantial reductions in contrast media and radiation dose while further improving image quality in head and neck CTA.
作者
张梦圆
聂可卉
原典
张怡存
齐珂
张炜珽
谷艳博
陈岩
高剑波
刘杰
Zhang Mengyuan;Nie Kehui;Yuan Dian;Zhang Yicun;Qi Ke;Zhang Weiting;Gu Yanbo;Chen Yan;Gao Jianbo;Liu Jie(Department of Radiology,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China;Siemens Healthineers Digital Technology(Shanghai)Co.,Ltd,Shanghai 200126,China)
出处
《中华放射学杂志》
北大核心
2025年第8期942-948,共7页
Chinese Journal of Radiology
基金
河南省卫生健康委员会科技攻关项目(212102310142)。
