低管电压结合低对比剂用量及迭代重建在搭桥术后患者中的应用

doi:10.3881/j.issn.1000-503X.10309

Acta Academiae Medicinae Sinica

Acta Academiae Medicinae Sinica ›› 2018, Vol. 40 ›› Issue (6): 744-749.doi: 10.3881/j.issn.1000-503X.10309

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Value of CT Angiography Using Low Tube Voltage and Low Contrast Combined with Iterative Model Reconstruction in Patients with Coronary Artery Bypass Grafts

LUO Chuncai,TANG Tian,LI Tao(),YANG Li,LI Jinfeng,ZHANG Xinghua,ZHANG Jing

Department of Radiology,Chinese PLA General Hospital,Beijing 100853,China

Received:2018-01-29 Online:2018-12-20 Published:2019-01-03
Supported by:
Supported by the Capital Clinical Featured Applications Grant(Z141107002514098)

Abstract

Abstract:

Objective To assess the value of CT angiography using low-voltage and low-concentration contrast media (CM) combined with knowledge-based iterative model reconstruction (IMR) in patients with coronary artery bypass grafts (CABG).
Methods Totally 71 patients after CABG undergoing CT angiography in our center from June to November 2016 were prospectively enrolled and randomly assigned into groups A and B. The scan protocol for group A was 80 kVp with 300 mgI/ml contrast at an injection rate of 4 ml/s;images were reconstructed by IMR algorithm. The scan protocol for group B was 100 kVp with 370 mgI/ml contrast at an injection rate of 5 ml/s;images were reconstructed by hybrid iterative reconstruction technique. Aorta,left ventricular,and grafts were chosen as regions of interest. The image quality,radiation dose,and contrast load were compared between two groups.
Results The signal to noise ratio (SNR) and contrast to noise ratio (CNR) of the ascending aorta,descending aorta,left ventricular,and venous bridge in group A [SNR:19±5,20±5.7,19.1±4.9,and 37±34;CNR:17±4.7,18±5,16±5.4,and 34±32] were significantly higher than those in group B [SNR:16±6 (P=0.012),15.6±5.5 (P=0.002),15±6 (P=0.002),24±8.3 (P=0.035);CNR:14±5.5 (P=0.010),13.8±5(P=0.002),13±5.7 (P=0.014),21±7.8 (P=0.031)],except for left internal mammary artery graft (LIMA),which was not inferior to that in group B. An effective radiation dose reduction of 49% was achieved in group A [(2.3±0.4) mSv,compared with group B (4.5±0.5) mSv (P=0.000)]. The iodine load of group A was (20±1.4) g compared with (29±1.6) g in group B,resulting in a reduction of 31% (P=0.000).
Conclusions The low tube voltage (80 kVp) and low contrast protocol combined with IMR in patients with CABG can reduce radiation dose and improve image quality of aorta,left ventricular and venous graft. The image quality of LIMA graft in low dose group is not inferior to that in regular dose group.

Key words: coronary artery bypass graft, image reconstruction, multidetector computed tomography, contrast medium, computed tomography angiography

CLC Number:

R445.3

LUO Chuncai,TANG Tian,LI Tao,YANG Li,LI Jinfeng,ZHANG Xinghua,ZHANG Jing. Value of CT Angiography Using Low Tube Voltage and Low Contrast Combined with Iterative Model Reconstruction in Patients with Coronary Artery Bypass Grafts[J].Acta Academiae Medicinae Sinica, 2018, 40(6): 744-749.

Figures/Tables 4

Fig 1

Table 1

Basic information of the patients"

分组 Group	年龄 ( $x ?$ ±s,岁) Age ( $x ?$ ±s,years)	男性/女性 Male/female (n)	体重 Weight ( $x ?$ ±s,kg)	体质量指数 Body mass index ( $x ?$ ±s,kg/m²)
改良组 Improved group	63.0±8.6	36/5	72.0±16.0	26.8±3.4
常规组 Regular group	61.0±7.1	28/2	73.7±11.0	26.5±3.1
t/χ²	1.2	0.1	-0.5	0.4
P	0.2	0.7	0.6	0.7

Table 1

Table 2

Table 3

Density,noise,signal to noise ratio,and contrast to noise ratio of each region of interest in two groups (x?±s)"

分组Group	ROI密度Density in ROI(HU)
分组Group	升主动脉 Ascending aorta	降主动脉 Descending aorta		左心室 Left ventricular		动脉桥血管 Arterial bridge		静脉桥血管 Venous bridge		肌肉 Muscle
改良组Improved group(n=41)	550±83	536±79		514±98		544±117		597±120		56±11
常规组Regular group(n=30)	495±94	490±86		467±101		402±77		485±90		57±12
t	2.600	2.300		1.900		5.400		3.900		-0.650
P	0.011	0.024		0.056		0.000		0.000		0.516
分组Group	ROI噪声Noise in ROI
分组Group	升主动脉 Ascending aorta		降主动脉 Descending aorta		左心室 Left ventricular		动脉桥血管 Arterial bridge		静脉桥血管 Venous bridge
改良组Improved group(n=41)	30±6.0		28±5.7		30±7.5		31±17.0		24±14.0
常规组Regular group(n=30)	33±6.6		36±9.0		42±8.8		21±7.8		19±8.7
t	-2.100		-4.000		-6.300		3.100		1.500
P	0.042		0.000		0.000		0.003		0.142
分组Group	ROI信噪比Signal to noise ratio in ROI
分组Group	升主动脉/噪声 Ascending aorta/noise		降主动脉/噪声 Descending aorta/noise		左心室/噪声 Left ventricular/noise		动脉桥血管/噪声 Arterial bridge/noise		静脉桥血管/噪声 Venous bridge/noise
改良组Improved group(n=41)	19±5.0		20±5.7		19±4.9		24±18.0		37±34.0
常规组Regular group(n=30)	16±6.0		15±5.5		15±6.0		21±8.8		24±8.3
t	2.600		3.300		3.200		0.925		2.200
P	0.012		0.002		0.002		0.359		0.035
分组Group	ROI对比噪声比Contrast to noise ratio in ROI
分组Group	(升主动脉- 肌肉)/噪声 (Ascending aorta- muscle)/noise		(降主动脉- 肌肉)/噪声 (Descending aorta- muscle)/noise		(左心室- 肌肉)/噪声 (Left ventricular- muscle)/noise		(动脉桥- 肌肉)/噪声 (Arterial bridge- muscle)/noise		(静脉桥- 肌肉)/噪声 (Venous bridge- muscle)/noise
改良组Improved group(n=41)	17±4.7		18±5.0		16±5.4		22±16.7		34±32.0
常规组Regular group(n=30)	14±5.5		14±5.0		13±5.7		18±8.2		21±7.8
t	2.600		3.300		2.500		1.200		2.200
P	0.010		0.002		0.014		0.248		0.031

Table 3

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分组 Group		剂量长度乘积 Dose length product (mGy×cm)		有效射线剂量 Effective radiation dose (mSv)		对比剂用量 Dosage of contrast agent (ml)		总注射碘量 Total injection of iodine (g)
改良组 Improved group(n=41)		161±30		2.3±0.4		67.0±4.7		20.0±1.4
常规组 Regular group(n=30)		319±39		4.5±0.5		78.0±4.4		29.0±1.6
t	-19.1		-19.2		-9.6		-23.0
P	0.000		0.000		0.000		0.000

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Value of CT Angiography Using Low Tube Voltage and Low Contrast Combined with Iterative Model Reconstruction in Patients with Coronary Artery Bypass Grafts

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