Value of low tube voltage, low iodine concentration contrast medium combined with adaptive statistical iterative reconstruction-V in the follow-up of Stanford type B aortic dissection after endovascular repair
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摘要:
目的探讨低管电压、低浓度碘对比剂联合多模型迭代(ASIR-V)重建在Stanford B型主动脉夹层腔内修复术后(TEVAR)随访复查中的价值。 方法收集128例受试者并采用随机数字表法分为实验组(100 kVp,320 mgI/mL,FBP和ASIR-V重建,n= 64)和对照组(120 kVp,350 mgI/mL,FBP重建,n=64)。主动脉图像质量主观评价采用5分制评分法,客观评价采用信噪比(SNR)和对比噪声比(CNR),同时比较两组的辐射剂量和碘剂量。 结果两组主动脉在不同层面的CT值、SNR、CNR和主观图像质量评分差异无统计学意义(P>0.05)。在实验组,FBP和ASIR-V重建图像的噪声、SNR和CNR差异均有统计学意义(P < 0.05)。实验组辐射剂量和碘剂量比对照组低31.69%、24.14%(P < 0.05)。 结论低管电压、低浓度碘对比剂联合ASIR-V算法可用于Stanford B型主动脉夹层患者腔内修复术后随访复查,可在保持良好图像质量的前提下降低辐射和减少碘剂用量。 Abstract:ObjectiveTo explore the value of low tube voltage, low iodine concentration contrast medium (CM) and adaptive statistical iterative reconstruction-V (ASIR-V) protocol in the follow-up of Stanford type B aortic dissection after endovascular repair. Methods128 subjects were included and were randomly divided into the test (100 kVp, 320 mgI/mL, FBP and ASIR-V reconstruction, n=64) and control (120 kVp, 350 mgI/mL, FBP reconstruction, n=64) groups. Image quality of the aorta was evaluated subjectively by a 5 points grading scale and objectively by calculating the signal- and contrast-to-noise ratios (SNR and CNR, respectively). Radiation and CM doses were also evaluated. ResultsThe CT attenuation, SNR, CNR, and subjective image quality assessment of different levels of aorta didn't exhibit significant differences between the groups (P>0.05). In the test group, images reconstructed with FBP and ASIR-V showed significant differences in image noise, SNR and CNR (P < 0.05). The test group resulted in 31.69% less radiation (P < 0.05) and 24.14% less iodine weight than the control group (P < 0.05). Conclusions Protocol of low tube voltage, low iodine concentration CM and ASIR-V algorithm can be used in the follow-up of Stanford type B aortic dissection after endovascular repair. It can decrease the radiation and iodine doses while maintaining good image quality. -
表 1 低浓度和高浓度碘对比剂组基本特征及扫描参数比较
Table 1. Comparation of demographics and characteristics of low and high concentration iodine contrast agent guoups (n=64, Mean±SD)
指标 低碘组 高碘组 t P 男/女 39/25 36/28 - 0.7199 年龄(岁) 56.40±14.39 55.65±14.78 1.9550 0.0580 体质量(leg) 64.75±6.58 65.35±5.32 0.3090 0.7590 身高(cm) 164.84±6.45 163.70±6.49 0.5425 0.5906 BMl(kg/m2) 25.44±1.34 25.35±1.58 0.1935 0.8476 扫描长度 651.38±26.64 663.13±40.31 1.0590 0.2961 碘对比剂(mgI/mL) 320 350 - - 管电压(kVp) 100 120 - - 管电流(mA) 自动管电流 自动管电流 - - 重建算法 FBP +ASIR-V FBP - - FBP: 反投影算法; ASIR-V: 多模型迭代重建. 表 2 主动脉CTA图像质量主观评价标准
Table 2. The subjective score criteria of image quality for aortic CTA
分值 图像质量 血管强化 伪影 噪声 诊断信心 5 非常好 非常清晰 很少 很少 完全能诊断 4 好 清晰 较少 较少 能较好地诊断 3 一般 不太清晰 一般 一般 可以诊断 2 差 不清晰 明显 明显 影响诊断 1 非常差 没有显示 严重 严重 无法诊断 表 3 低浓度和高浓度碘对比剂组不同层面主动脉CT值、图像噪声、SNR及对CNR比较
Table 3. Comparation of attenuation, image noise, SNR, and CNR in anatomic regions of interest of aorta (n=64, Mean±SD)
项目 低碘组 高碘组 t P CT值 主动脉弓层面 330.32±22.73 342.82±21.96 1.725 0.093 肺动脉主干层面 334.96±24.76 337.88±22.66 0.380 0.706 主动脉瓣层面 336.36±18.46 348.93±19.99 2.014 0.051 腹腔干层面 339.34±21.73 347.49±24.52 1.804 0.285 肠系膜下动脉层面 328.48±23.51 342.10±22.21 1.835 0.074 腹主动脉分叉层面 334.64±21.80 344.32±23.50 1.317 0.196 图像噪声 主动脉弓层面 19.72±3.08 26.43±3.58 6.188 < 0.0001 肺动脉主干层面 19.26±3.40 27.61±3.87 7.063 < 0.0001 主动脉瓣层面 19.98±3.48 28.89±4.28 7.036 < 0.0001 腹腔干层面 22.81±2.94 27.77±4.15 4.245 0.0001 肠系膜下动脉层面 19.98±3.06 26.64±3.72 6.025 < 0.0001 腹主动脉分叉层面 19.11±3.38 28.25±3.91 7.715 < 0.0001 SNR 主动脉弓层面 14.48±1.98 15.42±2.97 1.147 0.259 肺动脉主干层面 14.99±2.37 15.16±3.06 0.1848 0.854 主动脉瓣层面 13.92±2.55 15.05±2.48 1.386 0.174 腹腔干层面 13.62±2.91 13.78±2.39 0.1886 0.851 肠系膜下动脉层面 13.21±2.22 14.36±2.65 1.455 0.154 腹主动脉分叉层面 14.43±2.65 15.16±2.85 0.8132 0.421 CNR 主动脉弓层面 12.28±3.12 12.14±2.73 0.1528 0.879 肺动脉主干层面 11.81±2.84 13.58±3.02 1.864 0.070 主动脉瓣层面 11.87±2.91 11.63±3.26 0.2427 0.810 腹腔干层面 12.24±3.04 12.23±2.89 0.0068 0.995 肠系膜下动脉层面 12.88±2.57 13.02±2.96 0.1558 0.877 腹主动脉分叉层面 12.10±3.06 11.72±2.62 0.4115 0.683 SNR: 信噪比; CNR: 对比噪声比. 表 4 低浓度碘对比剂组不同层面主动脉CT值、图像噪声、SNR及CNR比较
Table 4. Comparation of attenuation, image noise, SNR, and CNR in low-iodine group (n=32, Mean±SD)
项目 FBP组 ARIR-V组 t P CT值 主动脉弓层面 325.69±31.77 321.45±28.23 0.4349 0.666 肺动脉主干层面 335.73±26.32 333.79±28.36 0.2184 0.828 主动脉瓣层面 312.22±30.71 327.65±51.59 1.526 0.135 腹腔干层面 323.26±29.26 334.48±26.25 1.853 0.072 肠系膜下动脉层面 316.71±29.12 334.59±31.75 1.809 0.078 腹主动脉分叉层面 327.57±29.01 337.77±29.14 1.081 0.287 图像噪声 主动脉弓层面 23.06±3.05 19.58±3.47 3.278 0.002 肺动脉主干层面 23.75±3.03 19.82±3.65 3.309 0.001 主动脉瓣层面 23.40±4.31 19.34±3.20 3.296 0.002 腹腔干层面 22.54±3.40 20.34±2.75 2.294 0.034 肠系膜下动脉层面 22.31±4.35 19.25±3.64 2.353 0.024 腹主动脉分叉层面 25.30±4.10 20.16±3.01 4.409 < 0.001 SNR 主动脉弓层面 10.26±2.39 12.10±3.04 2.076 0.045 肺动脉主干层面 9.81±2.19 12.31±3.09 2.871 0.007 主动脉瓣层面 10.70±2.07 12.54±3.02 2.192 0.035 腹腔干层面 10.46±2.16 12.42±2.56 2.447 0.015 肠系膜下动脉层面 10.60±2.05 13.63±2.92 3.703 0.001 腹主动脉分叉层面 9.49±2.45 12.94±2.97 3.902 0.001 CNR 主动脉弓层面 10.55±2.14 13.19±3.16 3.018 0.005 肺动脉主干层面 9.90±2.76 12.04±3.50 2.088 0.044 主动脉瓣层面 9.30±1.93 12.84±3.20 4.135 0.000 腹腔干层面 10.45±2.03 14.00±3.12 4.149 0.000 肠系膜下动脉层面 10.27±2.07 13.25±3.37 3.285 0.002 腹主动脉分叉层面 10.64±2.26 13.19±3.33 2.765 0.009 表 5 低BMI组不同层面主动脉的CT值、图像噪声、SNR及CNR比较
Table 5. Comparation of attenuation, image noise, SNR, and CNR in various regions of aorta in lowiodine and high-iodine group in patients stratified by BMI (Mean±SD)
项目 BMI≤25 kg/m2(n=72) 低碘组(n=39) 高碘组(n=33) t P CT值 主动脉弓层面 337.64 ± 16.32 339.17± 11.90 0.2272 0.823 肺动脉主干层面 334.82 ±21.10 340.20 ± 22.48 0.5238 0.607 主动脉瓣层面 318.25 ± 17.84 342.97 ± 24.57 0.2524 0.804 腹腔干层面 331.68 ± 17.28 339.43 ± 15.41 0.9572 0.351 肠系膜下动脉层面 345.62 ±23.95 339.89 ±25.14 0.4952 0.626 腹主动脉分叉层面 332.90 ±21.51 338.66 ± 22.20 0.5594 0.583 图像噪声 主动脉弓层面 22.02 ± 2.34 23.85 ± 2.88 1.486 0.155 肺动脉主干层面 21.61 ± 2.36 23.95 ± 2.54 2.03 0.057 主动脉瓣层面 22.11 ± 1.59 23.96 ± 2.54 1.852 0.081 腹腔干层面 22.21 ± 1.42 23.75 ± 1.94 1.922 0.071 肠系膜下动脉层面 21.11 ±2.23 23.05 ± 2.03 1.924 0.070 腹主动脉分叉层面 22.22 ± 2.43 22.94 ± 3.05 0.5549 0.586 SNR 主动脉弓层面 13.13 ± 1.81 12.18± 1.14 1.232 0.234 肺动脉主干层面 13.74±1.44 12.99±2.02 0.8954 0.382 主动脉瓣层面 11.92±2.11 12.59±2.09 0.6769 0.507 腹腔干层面 12.32±1.55 13.09±2.05 0.9022 0.379 肠系膜下动脉层面 12.52±1.37 12.28±1.54 0.3483 0.732 腹主动脉分叉层面 12.22±1.39 12.69±1.65 0.6517 0.523 CNR 主动脉弓层面 12.22±2.45 12.89±1.29 0.7281 0.476 肺动脉主干层面 11.51 ± 1.87 13.30±2.59 1.678 0.111 主动脉瓣层面 13.53 ±2.22 13.50±2.40 0.029 0.977 腹腔干层面 13.13 ±1.86 14.31 ± 1.78 1.377 0.186 肠系膜下动脉层面 13.13 ± 1.81 11.77± 1.71 1.632 0.120 腹主动脉分叉层面 12.52±2.08 12.89±2.57 0.3367 0.740 表 6 高BMI组不同层面主动脉的CT值、图像噪声、SNR及CNR比较
Table 6. Comparation of attenuation, image noise, SNR, and CNR in various regions of aorta in lowiodine and high-iodine group in patients stratified by BMI (Mean±SD)
项目 BMI≤25 kg/m2(n=72) 低碘组(n=39) 高碘组(n=33) t P CT值 主动脉弓层面 324.21±24.57 315.26±31.36 0.6737 0.509 肺动脉主干层面 321.28±21.88 333.63±28.50 1.032 0.316 主动脉瓣层面 319.06±29.71 317.29±26.86 0.1324 0.896 腹腔干层面 319.26±18.76 339.52±33.31 1.59 0.129 肠系膜下动脉层面 341.08±22.77 337.39±16.98 0.3896 0.701 腹主动脉分叉层面 337.24±28.15 342.77±12.16 0.5409 0.595 图像噪声 主动脉弓层面 28.18±3.79 26.19±4.82 0.9719 0.344 肺动脉主干层面 27.78±4.89 27.81±5.00 0.0167 0.987 主动脉瓣层面 28.28±4.95 29.33±4.39 0.4795 0.637 腹腔干层面 28.99±4.91 29.33±4.15 0.1634 0.827 肠系膜下动脉层面 28.08±4.13 29.33±3.38 0.7072 0.489 腹主动脉分叉层面 28.28±5.09 30.65±3.71 1.131 0.273 SNR 主动脉弓层面 11.21±1.94 11.98±2.44 0.7408 0.468 肺动脉主干层面 12.73±1.87 11.57±1.59 1.407 0.177 主动脉瓣层面 10.50±2.40 11.06±2.05 0.5341 0.600 腹腔干层面 11.11±2.47 10.56±1.83 0.5375 0.598 肠系膜下动脉层面 13.03±1.46 11.57±2.23 1.637 0.119 腹主动脉分叉层面 11.62±2.44 12.38±1.97 0.7353 0.472 CNR 主动脉弓层面 11.41±2.12 12.18±2.49 0.7058 0.489 肺动脉主干层面 10.30±2.70 10.45±3.49 0.1061 0.917 主动脉瓣层面 11.62±1.76 12.99±1.75 1.669 0.113 腹腔干层面 10.61±1.76 9.95±2.52 0.6389 0.531 肠系膜下动脉层面 10.50±2.56 12.79±2.54 1.904 0.073 腹主动脉分叉层面 10.71±1.76 11.47±2.23 0.8096 0.429 表 7 低浓度和高浓度碘对比剂组间辐射剂量及碘剂量比较
Table 7. Comparison of radiation dose and contrast medium (n=32, Mean±SD)
项目 低碘组 高碘组 t P CTDIvol (mGy) 4.17±0.28 7.91±1.46 7.097 < 0.0001 DLP (mGy · cm) 278.78±14.21 432.45±25.47 22.38 < 0.0001 ED (mSv) 5.28±0.29 7.73±0.21 6.934 < 0.0001 碘剂用量(g) 22.85±1.63 30.12±1.31 10.38 < 0.0001 CTDIvol: CT容积质量指数; DLP: 剂量长度乘积; ED: 有效剂量. -
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