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低管电压、低浓度碘对比剂联合多模型迭代重建在Stanford B型主动脉夹层腔内修复术后随访复查中的价值

刘芸 何昌银 严高武

刘芸, 何昌银, 严高武. 低管电压、低浓度碘对比剂联合多模型迭代重建在Stanford B型主动脉夹层腔内修复术后随访复查中的价值[J]. 分子影像学杂志, 2021, 44(1): 13-21. doi: 10.12122/j.issn.1674-4500.2021.01.03
引用本文: 刘芸, 何昌银, 严高武. 低管电压、低浓度碘对比剂联合多模型迭代重建在Stanford B型主动脉夹层腔内修复术后随访复查中的价值[J]. 分子影像学杂志, 2021, 44(1): 13-21. doi: 10.12122/j.issn.1674-4500.2021.01.03
Yun LIU, Changyin HE, Gaowu YAN. 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[J]. Journal of Molecular Imaging, 2021, 44(1): 13-21. doi: 10.12122/j.issn.1674-4500.2021.01.03
Citation: Yun LIU, Changyin HE, Gaowu YAN. 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[J]. Journal of Molecular Imaging, 2021, 44(1): 13-21. doi: 10.12122/j.issn.1674-4500.2021.01.03

低管电压、低浓度碘对比剂联合多模型迭代重建在Stanford B型主动脉夹层腔内修复术后随访复查中的价值

doi: 10.12122/j.issn.1674-4500.2021.01.03
基金项目: 

四川省卫生健康委员会科研课题 19PJ284

详细信息
    作者简介:

    刘芸,在读硕士研究生,医师,E-mail: liuyun7705@163.com

    何昌银,本科,主治医师,E-mail: 834978223@qq.com

    通讯作者:

    严高武,在读博士研究生,主治医师,E-mail: yangaowu1989@ 163.com

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

  • 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。

     

  • 图  1  不同层面测量主动脉及椎旁肌肉的CT值和标准差

    A: 主动脉弓层面; B: 肺动脉主干层面; C: 主动脉瓣层面; D: 腹腔干层面; E: 肠系膜下动脉层面; F: 腹主动脉分叉层面

    Figure  1.  Measurements of mean attenuation values with standard deviations of aorta and paraspinal muscles at different levels.

    图  2  主动脉容积再现(A)及最大密度投影(B)图像的主观评价,均为5分

    Figure  2.  Assessment of subjective image quality in the volume render (A) and maximum intensity projection (B) aorta. The subjective scores were 5 points for both.

    图  3  低和高浓度碘对比剂组主动脉在不同层面的噪声比较

    Figure  3.  Image noise in aortic segments in the low-iodine and high-iodine groups. Segments include the aortic arch, pulmonary trunk level, aortic valve, inferior mesenteric artery, and abdominal aorta bifurcation levels. *P < 0.05.

    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.
    下载: 导出CSV

    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 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 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
    下载: 导出CSV

    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.
    下载: 导出CSV

    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
    下载: 导出CSV

    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/m2n=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
    下载: 导出CSV

    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/m2n=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
    下载: 导出CSV

    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.
    下载: 导出CSV
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  • 收稿日期:  2020-11-04
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