摘要
目的探讨自由呼吸结合高阈值、短延时技术在降低肥胖患者冠状动脉CT血管造影(CCTA)辐射剂量和碘对比剂用量的可行性。方法前瞻性收集2023年2月至2024年5月于北京大学第三医院放射科行CCTA检查的73例肥胖受检者[体重>85 kg且体质量指数(BMI)>30 kg/m^(2)],根据检查日期奇偶数随机纳入对照组31例、观察组42例。CCTA检查时对照组行屏气状态,观察组行自由呼吸状态,两组的团注追踪(bolus tracking)阈值、延迟时间及对比剂注射时长分别为100 HU、7 s、12 s与250 HU、2 s、8 s,其余扫描和重建参数均一致。测量并比较主动脉(AO)根部、左前降支(LAD)、左回旋支(LCX)及右冠状动脉(RCA)管腔的CT值及其标准差(SD),计算信噪比(SNR)和对比噪声比(CNR),并采用4分法对冠状动脉18节段的图像质量进行主观评价。记录并比较两组受检者的有效辐射剂量E和碘对比剂用量。采用方差分析、Mann-Whitney U检验或χ^(2)检验分析以上指标的组间统计学差异。以受检者ICA结果作为金标准,评价自由呼吸结合高阈值、短延时技术在肥胖受检者CCTA检查的诊断效能。结果对照组和观察组冠状动脉图像在AO根部、LAD、LCX及RCA管腔的CT值、SNR、CNR值以及AO根部的SD值比较,差异均无统计学意义(P>0.05)。两组图像冠状动脉主观评分均≥3分,均符合诊断标准,两组比较差异无统计学意义(P>0.05)。对照ICA结果,基于23例观察组受检者冠状动脉节段分析,CCTA诊断>50%狭窄的准确率、敏感度、特异度分别为89%、86%、97%。观察组受检者CCTA对比剂用量(30 ml)较对照组(45 ml)降低33.3%,两组有效辐射剂量E比较差异无统计学意义(P>0.05)。结论自由呼吸结合高阈值、短延迟技术可以在维持CCTA图像质量及诊断效能的基础上,进一步降低肥胖患者的碘对比剂用量。
Objective To investigate the feasibility of the combination of free breathing with the high-threshold,short-delay technique in reducing radiation dose and the volumes of iodinated contrast agent in coronary computed tomography angiography(CCTA)for obese patients.Methods The data of 73 obese patients with weights>85 kg and body mass indices(BMIs)>30 kg/m^(2)who received CCTA in the Radiology Department of the Peking University Third Hospital from February 2023 to May 2024 were prospectively collected.These patients were divided into a control group(31 patients)and an experimental group(42 patients).Data were collected from the control group and experimental groups under breath-holding and free-breathing conditions,respectively.The bolus tracking thresholds,delay times,and ICA injection durations were set at 100 HU,7 s,and 12 s for the control group and at 250 HU,2 s,and 8 s for the experimental group,respectively.Other scanning and reconstruction parameters of both groups were consistent.The CT values and their standard deviations(SD)of both groups were assessed and compared,with the CT values involving the lumens of the aorta(AO)root,left anterior descending(LAD),left circumflex artery(LCX),and right coronary artery(RCA).The signal-to-noise ratios(SNR)and contrast-to-noise ratio(CNR)were also calculated.The subjective assessment of image quality was performed for the 18 coronary artery segments using a 4-point scale.The effective radiation doses(E)and the volumes of iodinated contrast agent of both groups were recorded and compared.The statistical differences in the aforementioned parameters between the groups were tested and analyzed using the analysis of variance(ANOVA),the Mann-Whitney U test,or theχ^(2)test.With the results of the ICA as the gold standard,the diagnostic performance of the combination of free-breathing with the high-threshold,short-delay technique in CCTA for obese patients was assessed.Results There was no statistically significant difference(P>0.05)in coronary artery images between both groups,specifically regarding the CT,SNR,and CNR values of the lumens of the AO roots,LAD,LCX,and RCA,as well as the SD values of the AO roots.Both groups received subjective scores of≥3 for coronary artery images,meeting the diagnostic criteria,with no statistically significant differences(P>0.05).Compared with the results of the ICA,the analyses of the coronary artery segments of 23 patients from the experimental group,revealed that the accuracy,sensitivity,and specificity of CCTA in the diagnosis of>50%stenosis were 89%,86%,and 97%,respectively.Compared to that(45 ml)of the control group,the volume(30 ml)of iodinated contrast agent of the experimental group decreased by 33.3%,with no statistically significant difference in the effective radiation dose(E)between both groups(P>0.05).Conclusions The combination of free breathing with the high-threshold,short-delay technique can further reduce the volume of the ICA for obese patients while maintaining high CCTA image quality and diagnostic performance.
作者
张艳
王莹
狄爱辉
李静
郎宁
袁慧书
Zhang Yan;Wang Ying;Di Aihui;Li Jing;Lang Ning;Yuan Huishu(Department of Radiology,Peking University Third Hospital,Beijing 100191,China;Shanghai United Imaging Healthcare Co.,Ltd.,Shanghai 201800,China;State Key Laboratory of Vascular Homeostasis and Remodeling(Peking University),Department of Radiology,Peking University Third Hospital,Beijing)
出处
《中华放射医学与防护杂志》
北大核心
2025年第9期904-910,共7页
Chinese Journal of Radiological Medicine and Protection
关键词
冠状动脉CT血管成像
肥胖
自由呼吸
屏气
碘对比剂
Coronary CT angiography(CCTA)
Obesity
Free breathing
Breath holding
Iodinated contrast agent
