双源CT大螺距扫描结合对比剂优化方案在复杂型先天性心脏病患儿成像中的应用
Application of optimizing contrast medium injection protocol for dual-source CT high-pitch spiral acquisition in children with complex congenital heart disease
目的 探讨双源CT大螺距扫描模式对比剂优化方案对小儿复杂型先天性心脏病的临床应用价值.方法 前瞻性搜集60例复杂型先天性心脏病患儿,按照随机数字表法等分成A、B两组.A组为常规对比剂方案组,对比剂剂量为2.0 ml/kg,对比剂注射方案为3时相组,即快速注射对比剂、慢速注射对比剂,最后注射生理盐水.B组为优化对比剂方案组,对比剂用量为1.0~1.5 ml/kg,对比剂注射方案为同时注射对比剂与生理盐水(其比例分别为8:6,6:4,4:6,2:8).分别测量上腔静脉、右心房、右心室、升主动脉、降主动脉、主肺动脉、左心房、左心室的CT值、噪声,计算信噪比,并进行主观评分.60例患者均行手术治疗,统计共有心内外结构异常22种、121处,A组56处,B组65处.各测量部位的CT值、噪声、信噪比、图像均匀度及组间对比剂用量的差异采用两样本t检验进行比较,组间图像质量主观评分的差异采用Mann-Whitney U秩和检验进行比较,诊断准确性比较采用x2检验.结果 A、B两组的诊断准确性分别为96.9%(52/56),96.4%(62/65),差异无统计学意义(x2=0.28,P=0.59).A、B组间对比剂用量分别为(15.7±6.5)、(10.4±2.4) ml,差异有统计学意义(t=4.14,P<0.01).B组图像均匀度[(36.5±18.0)HU]优于A组[(272.0±124.5)HU],差异有统计学意义(t=10.30,P<0.01).A、B两组间心内结构及大血管的主观评分分别为(3.3±0.5)、(3.5±0.5)分,差异无统计学意义(Z=396.00,P=0.39).上腔静脉硬化束伪影评分分别为(3.2±0.9),(3.7±0.7)分,差异有统计学意义(Z=300.50,P=0.02).结论 优化扫描方案能消除上腔静脉硬化伪影,提高了复杂型先天性心脏病的图像质量,具有较好的临床应用价值.
更多Objective To explore clinical value of optimizing the contrast medium injection protocol for dual-source CT high-pitch spiral acquisition in children with complex congenital heart disease.Methods Sixty patients with complex congenital heart disease were prospectively recruited and randomly divided into group A and group B by the random number table method.Patients in group A received a conventional contrast medium injection protocol,i.e.a diluted contrast material with fast and slow rate respectively,and then a flush with normal saline.The volume of contrast medium was 2.0 ml/kg.Patients in group B received an optimized injection protocol,i.e.a four-phase diluted contrast material with contrast/ saline ratio of 8:2,6:4,4:6,2:8 respectively.The volume of contrast medium was 1.0-1.5 ml/kg.Attenuation and noise were measured in superior vena cava,right atrium,right ventricle,the main pulmonary artery,left atrium,left ventricle,ascending and the descending aorta in the two groups and compared by t test.The image uniformity was assessed by t test.Subjective image quality and artifacts of superior vena cava were analyzed by the Mann-Whitney U test.Diagnostic accuracy was evaluated by x2 test.All the patients undergone the surgical treatment and demonstrated 121 abnormalities (22 species) of internal and external heart structure,i.e.56 in group A and 65 in group B.Results There was no significant difference in diagnostic accuracy between group A and group B (A:96.9%,52/56,vs.B:96.4%,62/65;x2=0.28,P=0.59).While,significant difference was found in the amount of consumed iodine between the two groups [A:(15.7±6.5) ml vs.B:(10.4±2.4) ml;t=4.14,P<0.01].Furthermore,the image uniformity in group B was statistically higher than that in group A[A:(36.5± 18.0)HU vs.B:(272.0± 124.5)HU;t=10.30,P<0.01].As for subjective image quality,no significant difference were observed (A:3.3±0.5 vs.B:3.5±0.5;Z=396.00,P=0.39);while significant difference was found in artifacts of superior vena cava (A:3.2±0.9 vs.B:3.7 ± 0.7;Z=300.50,P=0.02).Conclusion The optimized contrast medium injection protocol for children with complex congenital heart disease could eliminate the image artifacts of superior vena cava and improve the image quality.
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