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双源CT大螺距前瞻心电触发血管成像评价全主动脉及冠状动脉

Electrocardiographically triggered CT angiography of the whole aorta and coronary arteries with high-pitch dual-source CT

摘要目的 利用128层双源CT心电门控大螺距扫描(FLASH)血管成像技术评价全主动脉及冠状动脉,探讨其在诊断大血管疾病的同时对冠状动脉评价的可行性.方法 本研究为前瞻性研究,入组患者为48例临床诊断或可疑主动脉病变,行全主动脉CTA检查的患者.在不控制心率的条件下,使用双源大螺距前瞻心电触发FLASH扫描模式(螺距3.2),行全主动脉及冠状动脉一次性联合成像.采用多种重组方式显示主动脉及主动脉瓣、冠状动脉图像,比较低心率组20例(≤65次/min)和高心率组28例(>65次/min)受检者全主动脉和冠状动脉图像质量.记录扫描时间、有效辐射剂量、对比剂用量.利用Kappa检验比较观察者间差异;Mann-Whitney检验比较计数资料组间差异;方差检验比较计量资料组间差异.结果 48例受检者均成功完成检查.100%(48/48)的全主动脉及主动脉瓣、94.0% (551/586)的冠状动脉节段图像可用于诊断.其中低心率组冠状动脉检查成功率略高于高心率组[94.7%(232/245)、93.5%(319/341),Z=-2.504,P<0.05].2名观察者在95.8% (46/48)患者的主动脉及主动脉瓣,96.6%(566/586)的冠状动脉节段取得一致图像质量评分,观察一致性为优(Kappa=0.81和0.89).所有患者图像平均CT值均高于300 HU.低心率组图像CT值[(357.0 ~ 446.0)HU]高于高心率组[(316.4~383.7)HU],但差异无统计学意义(P>0.05).除右冠状动脉近段,低心率组图像CNR(24.5 ~ 29.0)明显高于高心率组(20.0~23.1,P<0.05),且主动脉SNR(13.7~17.9)明显高于高心率组(11.5~ 13.9,P<0.05).平均扫描时间(1.56±0.08)s,有效辐射剂量为(4.12±1.23) mSv,对比剂用量(72.8 ±2.1)ml.结论 双源CT大螺距心电门控CTA检查能够快速(<2 s)完成全主动脉和冠状动脉一次性联合扫描,对大血管疾病诊断的同时可用于冠状动脉评价,且辐射剂量和对比剂用量较低.但高心率能导致冠状动脉图像质量下降.

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abstractsObjective To investigate the feasibility of comprehensive assessment of the whole aorta and coronary arteries (CA) simultaneously with high-pitch 128-slice dual-source CT ECG-gated FLASH protocol.Methods A total of 48 consecutive patients with suspected aortic diseases underwent CTA examination of the whole aorta and CA using a ECG-gated FLASH CT protocol (pitch =3.2) without heart rate (HR) control.Aorta,aortic valves and CA were shown with different post-processing modalities.The image quality of the aorta,aortic valves and CA was evaluated and compared according to HR (low HR group ≤ 65 bpm,high HR group > 65 bpm).The scan time,effective dose and contrast medium volume were recorded.Inter-observer differences were calculated by Kappa test.Differences between groups were analyzed by Mann-Whitney test with count data and variance test with measurement data.Results All examinations were completed successfully.The image quality was acceptable in the aorta,aortic valve (100%,48/48) and CA (94.0%,551/586).Percentage of diagnostic quality images was slightly higher in low HR group (94.7%,232/245,93.5%,319/341,Z =-2.504,P < 0.05).Inter-reader reproducibility was 95.8% (46/48) in the aorta and aortic valve,96.6% (566/586) in CA,yielded good agreement (Kappa =0.81 and 0.89).The mean attenuation of aorta and CA were higher than 300 HU,especially in low HR group (357.0-446.0) HU.Except proximal segment of right CA,the CNR of whole aorta and coronary arteries were significantly higher in the low HR group (24.5-29.0) than that in the high HR group (20.0-23.1,P <0.05).SNR of the whole aorta was higher in the low HR group (13.7-17.9) than the high HR group (11.5-13.9,P < 0.05).The mean scan time was (1.56 ± 0.08) s,effective dose was (4.12 ± 1.23) mSv (2.77-6.77 mSv),and contrast medium volume was (72.8 ± 2.1) ml.Conclusions CT angiography of whole aorta and coronary arteries could be performed simultaueously within 2 seconds with CT ECG-gated FLASH protocol.The images were of diagnostic quality for aortic and CA disease with low dose of radiation and contrast media.However,high HR could decrease the image quality of CA.

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2013年47卷4期

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