团注追踪法下不同监测点对冠状动脉CT血管成像图像质量的影响

doi:10.11958/20220216

摘要/Abstract

摘要：

目的评估对比剂团注追踪法下不同监测点对冠状动脉CT血管成像（CCTA）图像质量的影响。方法前瞻性将128例拟行CCTA检查患者随机分为不同监测点组：左心房（LA）组、左心室（LV）组、升主动脉（AA）组、降主动脉（DA）组,每组32例。阈值为130 HU,对比剂使用碘美普尔（含碘400 g/L）,注射速率为4 mL/s,用量为40 mL。比较4组间的主、客观图像评价指标及辐射剂量参数的差异。结果 4组患者的主动脉根部、左主干CT值差异有统计学意义（均P<0.05）,其中LA组主动脉根部及左主干CT值均高于其他3组;4组前降支近段、回旋支近段及右冠状动脉中段CT值差异无统计学意义（均P>0.05）。4组图像噪声、左主干及右冠状动脉对比噪声比间差异有统计学意义（均P<0.05）,LA组图像噪声较低。4组主动脉根部信噪比及对比噪声比、左主干及右冠状动脉信噪比间差异无统计学意义（均P>0.05）。4组间主观图像质量评分及辐射剂量相关参数比较差异均无统计学意义（均P>0.05）。结论在使用对比剂团注追踪法的CCTA扫描中,将监测点定位于左心房内可以获得更好的图像质量,左心房是CCTA检查较为理想的监测点。

关键词: 冠状血管, 冠状血管造影术, 冠状动脉疾病, 图像质量, 团注追踪法

Abstract:

Objective To evaluate the effect of different monitoring points on the image quality of coronary CT angiography (CCTA) under the bolus-tracking method. Methods A total of 128 prospective patients undergoing CCTA examination were randomly divided into 4 different monitoring points groups: the left atrium (LA) group, the left ventricle (LV) group, the ascending aorta (AA) group and the descending aorta (DA) group. Each group contained 32 patients. The ROI threshold was 130 HU, the contrast agent was iomeprol (contain iodine 400 g/L), and the injection rate was 4 mL/s and the dosage was 40 mL. The differences in subjective and objective image evaluation indicators and radiation dose parameters were compared between the 4 groups. Results There were significant differences in CT values of aortic root and left main of coronary artery between the 4 groups (P<0.05). The CT values of aortic root and left main were higher in the LA group than those of the other three groups. There were no significant differences in CT values of proximal left anterior descending artery, proximal left circumflex artery and the mid of right coronary artery in the 4 groups (P>0.05). The differences in image noise and right coronary contrast-to-noise ratio (CNR) were statistically significant between the 4 groups (all P<0.05). The image noise in the LA group was 21.00±4.11, which was lower than other three groups. There were no significant differences in aortic signal-to-noise ratio (SNR) and CNR, left main and right coronary artery SNR between the 4 groups (P>0.05). There were no significant differences in subjective image quality score and radiation dose-related parameters between the 4 groups (P>0.05). Conclusion In CCTA scan using contrast agent bolus tracking method, positioning the monitoring point in left atrium can obtain better image quality, which is an ideal monitoring point for CCTA examination.

Key words: coronary vessels, coronary angiography, coronary artery disease, image quality, bolus-tracking method

中图分类号:

R445.3

图/表 7

表1 各组患者的一般资料比较（n=32）

Tab. 1 Comparison of general data of patients between the four groups

组别	年龄（岁）	性别（男/女）	身高（m）	体质量（kg）	BMI （kg/m²）
LA组	59.66±9.49	14/18	1.66±0.06	68.89±9.13	25.06±2.46
LV组	63.16±11.33	15/17	1.67±0.07	71.03±7.83	25.37±1.67
AA组	61.84±9.28	19/13	1.68±0.07	73.84±10.25	26.24±2.87
DA组	63.31±10.06	15/17	1.64±0.06	68.41±10.88	25.29±3.57
F或χ²	0.901	1.844	1.503	2.137	1.153

图1 Revolution CT团注追踪法ROI的定位及定时监测程序界面 A：定时监测的时间-密度曲线图,达到触发阈值时自动激发;B：定时监测的时间及其相应CT值;C：在定位像上放置ROI,本例放置于左心房区域（箭头示）;D：监测点达到阈值后图像。

Fig.1 Images showing Revolution CT bolus-tracking ROI positioning and timing monitoring program interface

表2 各组不同心血管部位CT值测量结果比较（n=32,HU,$\bar{x} \pm s$）

Tab. 2 Comparison of CT values of different cardiovascular sites between the four groups

组别	主动脉根部	左主干	前降支近段	回旋支近段	右冠状动脉中段
LA组	480.25±77.90	458.50±70.34	419.46±63.63	396.63±65.54	422.54±79.15
LV组	406.76±58.36^a	395.85±57.59^a	377.57±47.68	362.03±48.01	381.42±60.22
AA组	424.43±90.96^a	409.30±82.03^a	390.50±82.01	373.35±78.02	398.73±89.19
DA组	433.72±63.30^a	417.56±61.45^a	401.69±53.57	390.14±60.48	405.02±54.43
F	5.789^＊＊	4.968^＊＊	2.536	1.946	1.774

表3 各组图像噪声、CNR、SNR值测量结果比较（n=32,$\bar{x} \pm s$）

Tab. 3 Comparison of measurement results of images noise, CNR and SNR between the four groups

组别	图像噪声	SNR			CNR
组别	图像噪声	主动脉根部	左主干	右冠状动脉	主动脉根部	左主干	右冠状动脉
LA组	21.00±4.11	20.79±4.77	21.65±5.86	19.64±4.67	25.29±5.51	26.90±6.64	24.05±5.95
LV组	23.26±3.61	18.95±4.23	19.07±4.79	17.08±4.45	23.93±5.54	23.85±5.97	20.65±4.73^a
AA组	26.88±6.08^ab	18.20±4.94	19.16±6.78	18.87±5.55	22.99±5.87	24.38±7.96	23.76±6.15^b
DA组	23.49±4.99^ac	20.65±3.79	18.52±3.84	17.75±3.81	24.79±4.15	21.90±4.49^a	21.32±5.31
F	8.193^＊＊	2.634	2.111	1.911	1.161	3.332^＊	3.029^＊

图2 4组CCTA横断面影像对比 A：LA组患者,男,66岁,BMI为24.49 kg/m²,横断面影像显示左前降支钙化斑块（箭头）,影像对比良好,清晰度高,图像质量评分为5分;B：LV组患者,女,56岁,BMI为22.04 kg/m²,横断面影像主观噪声较大,图像对比尚可,清晰度欠佳,图像质量评分为3分;C：AA组患者,女,54岁,BMI为27.01 kg/m²,横断面影像对比尚可,清晰度尚可,图像质量评分为4分;D：DA组患者,男,65岁,BMI为25.95 kg/m²,横断面影像显示左前降支多发钙化斑块（箭头）,影像对比良好,清晰度高,图像质量评分为5分。

Fig.2 Comparison of CCTA cross-sectional images between the four groups

表4 各组图像质量评分的比较（例）

Tab. 4 Comparison of subjective scores of images between the four groups

组别	5分	4分	3分	2分	1分	合计
LA组	19	12	1	0	0	32
LV组	16	13	2	1	0	32
AA组	15	13	3	1	0	32
DA组	17	13	2	0	0	32
H	1.704

表5 各组辐射剂量相关参数的比较（n=32,$\bar{x} \pm s$）

Tab. 5 Comparison of radiation dose related parameters between the four groups

组别	CTDI_vol（mGy）	DLP（mGy·cm）	ED（mSv）
LA组	19.61±5.94	268.62±80.23	3.76±1.12
LV组	20.08±4.50	290.33±46.75	4.06±0.65
AA组	18.05±4.05	269.20±52.15	3.77±0.73
DA组	21.12±5.19	296.91±59.41	4.16±0.83
F	2.105	1.815	1.814

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