头颈部CTA中GSI扫描联合“双低”技术在中老年人群体的应用价值

张晓龙; 赵英明; 张国祥; 魏方生; 陈呈

doi:10.15953/j.ctta.2024.072

头颈部CTA中GSI扫描联合“双低”技术在中老年人群体的应用价值

张晓龙^{1, 2,},
赵英明^2, ,,
张国祥²,
魏方生²,
陈呈²

1.
蚌埠医科大学研究生院，安徽蚌埠 233030
2.
中国科学技术大学附属第一医院（安徽省立医院）影像科，合肥 230001

基金项目: 中国科学技术大学附属第一医院医学人工智能联合基金创新项目（MAI2023C006）。

详细信息

作者简介:
张晓龙，男，影像技术专业研究生，主要从事血管造影术、能谱CT等研究，E-mail：1254264064@qq.com

通讯作者:
赵英明✉，男，副主任技师，主要从事能谱CT、血管造影术等研究，E-mail：wisezhao158@ustc.edu.cn。

中图分类号: R 816.1；R 818.7
计量
- 文章访问数: 128
- HTML全文浏览量: 35
- PDF下载量: 22
出版历程
- 收稿日期: 2024-05-19
- 修回日期: 2024-06-18
- 录用日期: 2024-06-23
- 网络出版日期: 2024-08-15
- 刊出日期: 2025-03-04

Analysis of the Value of GSI Scanning Combined with “Double-low” Technology in Head and Neck CTA in Middle-aged and Elderly Individuals

1.
Graduate School of Bengbu Medical University, Bengbu 233030, China
2.
The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230001, China

摘要

摘要:
目的：探讨头颈部CTA中GSI扫描联合“双低”技术在中老年人群体的应用价值。材料和方法：回顾性收集2023年2月至12月行头颈CTA检查患者的影像资料150例，根据不同的扫描方式分为A、B和C 3组，各50例。A组和B组均为常规螺旋扫描，管电压分别为120 kV和100 kV，均为管电流自动调制300~500 mA，对比剂用量及流速均为固定55 mL和4.5 mL/s，盐水以与对比剂相同用量及流速进行注射。C组能谱扫描，平扫组管电压为80 kV，增强组管电压为80~140 kV瞬时切换，管电流均为恒定的320 mA，采用个性化对比剂注射方案。对3组影像资料进行主观评价、客观评价及比较对比剂用量、平均注射速率。结果：B组头颈部各血管平均CT值大于A组和C组，差异具有统计学意义；主动脉弓层面，B组SNR及CNR参数优于A组和C组，差异具有统计学意义；其余血管层面C组SNR、CNR、SD参数均优于A组和B组，除颈总动脉层面，差异具有统计学意义；C组DLP相较于A组和B组分别降低53.9%和27.6%，对比剂用量降低27.2%。C组对比剂平均注射速率为（3.9±0.5）mL/s低于A组和B组固定流速4.5 mL/s。结论：在中老年人群体中，以GSI扫描模式联合“双低”技术行头颈CTA可有效降低辐射剂量、减少对比剂用量及改善图像质量。
- CT血管造影术 /
- 能谱单能量 /
- 辐射剂量 /
- 对比剂
Abstract:
Objective: This study aimed to investigate the value of gemstone spectral imaging (GSI) scanning combined with "double-low" technology in head and neck computed tomography angiography (CTA) in middle-aged and elderly individuals. Materials and Methods: One hundred fifty patients who underwent head and neck CTA from February to December 2023 were retrospectively collected and divided into three groups, comprising 50 patients each, according to different scanning modalities; A, B, and C. Groups A and B underwent conventional spiral scans, with tube voltages of 120 kV and 100 kV, respectively, and tube currents of 300~500 mA were automatically modulated, and the dose and flow rate of the contrast agent were fixed at 55 mL, 4.5 mL/s, saline with the same dose and flow rate for flushing and group C energy spectrum scanning, the tube voltage of the flat scanning group was 80 kV, the tube voltage of the enhancement group was 80~140 kV instantaneous switching, and the tube current was a constant 320 mA in all cases, with a personalized contrast agent injection scheme. The subjective evaluation, objective evaluation, and comparison of contrast use dose were performed on the imaging data of all groups. Results: The mean CT values of head and neck vessels in group B were greater than those in groups A and C, with statistically significant differences. At the aortic arch level, the SNR and CNR parameters in group B were better than those in groups A and C, with statistically significant differences. At the level of the remaining blood vessels, the SNR, CNR, and SD parameters of group C were better than those in groups A and B, excluding the common carotid artery level, with statistically significant differences. The radiation dose in group C was 53.9% and 27.6% lower than that in groups A and B, respectively, and the contrast dose was 27.2% lower. Conclusion: In middle-aged and elderly individuals, head and neck CTA with GSI scanning combined with “double-low” technique can effectively reduce radiation and contrast doses and improve image quality.
- computed tomography angiography /
- energy spectrum single energy /
- radiation dose /
- contrast agent

HTML全文

图 1 对比剂剂量的比较

Figure 1. Comparison of contrast agents

下载: 全尺寸图片幻灯片

图 2 3组血管轴位图及 VR 图

注：（a）颈内动脉轴位图像、（b）VR 图像。患者年龄 51 岁，采用管电压 120 kV，血管 CT 值为 401.90 HU、SD 值为 12.4、SNR 为 29.99、CNR 为 25.03，对比剂用量为 55 mL、主观评分为 3 分。（c）颈内动脉轴位图像、（d）VR 图像。患者年龄 73 岁，采用管电压 100 kV，血管 CT 值为 460.40 HU、SD 为 17.6、SNR 为 26.16、CNR 为 22.08，对比剂用量为 55 mL、主观评分为 3分。（e）颈内动脉轴位图像、（f）VR 图像。患者年龄 51 岁，采用 80/140 kVp，血管 CT 值为 433.50 HU、SD 为 11.7、SNR 为 37.05、CNR 为 31.05，对比剂用量为 33 mL、主观评分为 4 分。其中 100 kV 组 CT 值最高，80/140 kVp 组图像质量参数均优于其他两组，差异具有统计学意义，且 100 kV 及 120 kV 组 VR 图像均有钙化未去除。

Figure 2. Axial and VR maps of three groups of vessels

下载: 全尺寸图片幻灯片

表 1 患者的一般资料

Table 1 Patients’ general information

项目	组别			统计检验
项目	A组（n=50）	B组（n=50）	C组（n=50)	$F/\chi^2 $	P
性别	34∶16	32∶18	27∶23	$\chi^2 $=2.207	0.332
年龄	61.02±10.25	65.46±9.45	62.90±9.29	F=2.655	0.074
BMI	23.80±1.84	23.28±1.39	23.53±1.63	F=1.285	0.280

下载: 导出CSV

表 2 DLP、CTDIvol及ED的比较

Table 2 Comparison of DLP, CTDIvol, and ED

项目	组别			统计检验
项目	A组	B组	C组	F	P
DLP/（mGy·cm）	1078.40±70.47	686.51±40.10	497.04±26.84	1808.23	0.000
CTDIvol/mGy	13.08±0.43	8.43±0.16	5.65±0.00	9977.39	0.000
ED/mSv	3.34±0.22	2.13±0.12	1.54±0.90	1801.38	0.000

下载: 导出CSV

表 3 客观评价

Table 3 Objective evaluation

项目		组别			统计检验
项目		A组	B组	C组	F	P
血管平均CT值/HU	左侧大脑中动脉	409.79±52.93	480.63±55.47	403.15±55.98	30.697	0.000
	左侧颈内动脉	415.92±56.54	490.26±56.59	419.81±53.47	28.370	0.000
	左侧颈总动脉	425.56±57.97	497.53±57.60	427.66±60.15	24.439	0.000
	主动脉弓动脉	408.15±46.07	483.11±52.22	429.49±54.44	28.640	0.000
SD/HU	左侧大脑中动脉	14.23±1.57	15.90±1.49	12.67±1.79	45.599	0.000
	左侧颈内动脉	14.34±2.07	15.80±1.82	12.37±1.53	44.313	0.000
	左侧颈总动脉	12.68±1.94	14.51±1.34	12.42±1.54	24.489	0.000
	主动脉弓动脉	24.64±4.96	27.29±4.36	25.10±4.01	8.231	0.000
SNR	左侧大脑中动脉	29.11±4.78	30.45±4.32	32.24±5.24	5.349	0.006
	左侧颈内动脉	29.51±5.34	31.41±5.10	34.57±5.62	11.384	0.000
	左侧颈总动脉	34.11±5.84	34.52±4.90	34.76±5.47	0.180	0.835
	主动脉弓动脉	17.31±4.37	18.16±3.58	15.58±2.93	6.393	0.002
CNR	左侧大脑中动脉	24.64±4.52	26.54±3.99	27.11±4.68	4.304	0.015
	左侧颈内动脉	25.29±5.07	27.53±4.74	29.17±5.38	7.399	0.001
	左侧颈总动脉	29.16±5.55	30.20±4.66	30.38±5.03	0.523	0.594
	主动脉弓动脉	14.97±3.97	16.07±3.36	13.72±2.88	5.805	0.004
	主观评分	3.06±0.37	3.12±0.44	3.14±0.41	0.528	0.591

下载: 导出CSV

参考文献(27)

[1]	中国心血管健康与疾病报告编写组. 《中国心血管健康与疾病报告2022》概要[J]. 中国介入心脏病学杂志, 2023, 31(7): 485-508. DOI: 10.3969/j.issn.1004-8812.2023.07.002.
[2]	中国心血管健康与疾病报告编写组. 《中国脑卒中防治报告2021》概要[J]. 中国脑血管病杂志, 2023, 20(11): 783-793.
[3]	中华医学会放射学分会. 头颈部CT血管成像扫描方案与注射方案专家共识[J]. 中华放射学杂志, 2019, 53(2): 81-87. DOI: 10.3760/cma.j.issn.1005-1201.2019.02.001. Chinese Society of Radiology, Chinese Medical Association. Expert consensus of the head and neck CT angiography scanning and injection protocols[J]. Chinese Journal of Radiology, 2019, 53(2): 81-87. DOI: 10.3760/cma.j.issn.1005-1201.2019.02.001. (in Chinese).
[4]	JI K, WANG Y, DU L, et al. Research progress on the biological effects of low-dose radiation in China[J]. Dose Response, 2019, 17(1): 1559325819833488. DOI: 10.1177/1559325819833488.
[5]	李飞. 低管电压低剂量低浓度造影剂在增强CT检查中预防造影剂肾病的临床研究[J]. 中国CT和MRI杂志, 2021, 19(3): 92-94. DOI: 10.3969/j.issn.1672-5131.2021.03.031. LI F. Low-dose low-concentration contrast agent combined with low tube voltage in renal CT enhancement examination[J]. Chinese Journal of CT and MRI, 2021, 19(3): 92-94. DOI: 10.3969/j.issn.1672-5131.2021.03.031. (in Chinese).
[6]	王丽敏, 陈志华, 张梅, 等. 中国老年人群慢性病患病状况和疾病负担研究[J]. 中华流行病学杂志, 2019, 40(3): 277-283. DOI: 10.3760/cma.j.issn.0254-6450.2019.03.005. WANG L M, CHEN Z H, ZAHNG M, et al. Study of the prevalence and disease burden of chronic disease in the elderly in China[J]. Chinese Journal of Epidemiology, 2019, 40(3): 277-283. DOI: 10.3760/cma.j.issn.0254-6450.2019.03.005. (in Chinese).
[7]	孙亮. 宝石能谱CT多参数成像检查在卵巢肿瘤良恶性鉴别诊断中的应用价值[J]. 中国民康医学, 2023, 35(10): 134-136. DOI: 10.3969/j.issn.1672-0369.2023.10.040. SUN L. Application value of gemstone spectral CT multi-parameter imaging in differential diagnosis of benign and malignant ovarian neoplasms[J]. Medical Journal of Chinese People’s Health, 2023, 35(10): 134-136. DOI: 10.3969/j.issn.1672-0369.2023.10.040. (in Chinese).
[8]	马光明, 陈静, 韩冬, 等. 能谱CT双低减影法在头颈CTA成像中的应用[J]. 临床放射学杂志, 2020, 39(5): 1009-1013. DOI: 10.13437/j.cnki.jcr.2020.05.037. MA G M, CHEN J, HAN D, et al. Subtraction artery angiography in head and neck with low radiation and contrast dose dual-energy spectral CT[J]. Journal of Clinical Radiology, 2020, 39(5): 1009-1013. DOI: 10.13437/j.cnki.jcr.2020.05.037. (in Chinese).
[9]	徐军, 胡孝梨, 罗昆, 等. “双低”扫描联合个性化对比剂注射方案在颅脑CTA中的应用价值[J]. 临床放射学杂志, 2022, 41(12): 2301-2305. DOI: 10.13437/j.cnki.jcr.2022.12.027. XU J, HU X L, LUO K, et al. The application value of“double low”scanning combined with personalized contrast injection protocol in cranial CTA[J]. Journal of Clinical Radiology, 2022, 41(12): 2301-2305. DOI: 10.13437/j.cnki.jcr.2022.12.027. (in Chinese).
[10]	王帅, 石磊, 郑敏文, 等. 双低剂量对比剂和最佳单能谱成像在头颈部CTA中的应用价值[J]. 中国医疗设备, 2016, 31(7): 9-11, 15. DOI: 10.3969/j.issn.1674-1633.2016.07.003. WANG S, SHI L, ZHEN M W, et al. Effectiveness of application of double low-dose contrast agent and optimal gemstone spectral imaging in head and neck CT angiography[J]. China Medical Equipment, 2016, 31(7): 9-11, 15. DOI: 10.3969/j.issn.1674-1633.2016.07.003. (in Chinese).
[11]	靖婧, 苗延巍. 优化低剂量一站式全脑CT灌注成像联合CTA扫描方案[J]. 中国医学影像技术, 2018, 34(3): 424-428. DOI: 10.13929/j.1003-3289.201706077. JING J, MIAO Y W. Optimization of scanning protocol in low-dose one-stop CT perfusion imaging combined with CTA of whole brain[J]. Chinese Journal of Medical Imaging Technology, 2018, 34(3): 424-428. DOI: 10.13929/j.1003-3289.201706077. (in Chinese).
[12]	张贺, 徐凯, 王冲, 等. 优化对比剂注射方案联合低剂量扫描模式在头颈部CTA中的应用[J]. 中国CT和MRI杂志, 2023, 21(2): 49-51. DOI: 10.3969/j.issn.1672-5131.2023.02.018. ZHANG H, XU K, WANG C, et al. Application of optimized contrast injection program combined with low dose scanning mode in head and neck CTA[J]. Chinese Journal of CT and MRI, 2023, 21(2): 49-51. DOI: 10.3969/j.issn.1672-5131.2023.02.018. (in Chinese).
[13]	CHEN P A, CHEN C W, CHOU C C, et al. Quantitative and qualitative evaluation of low-dose craniocervical computed tomography angiography with a lower tube voltage protocol[J]. Acta Radiologica, 2019, 60(10): 1380-1389. DOI: 10.1177/0284185119825488.
[14]	冯晨, 方玉, 张德川, 等. 头颈CTA达峰时间相关因素的分析研究[J]. CT理论与应用研究, 2021, 30(6): 727-733. DOI: 10.15953/j.1004-4140.2021.30.06.08. FENG C, FANG Y, ZHANG D C, et al. The analysis of factors influencing the peak time of head and neck CTA[J]. CT Theory and Applications, 2021, 30(6): 727-733. DOI: 10.15953/j.1004-4140.2021.30.06.08. (in Chinese).
[15]	赵欣耘, 李曼. 颈动脉CTA过程中应用大螺距扫描配合能谱CT双低减影法的效果及对辐射剂量和对比剂用量的影响[J]. 影像科学与光化学, 2021, 39(3): 375-380. DOI: 10.7517/issn.1674-0475.201103. ZHAO X Y, LI M. Effect of large-pitch scanning combined with energy spectrum CT double-low subtraction in carotid CTA and the influence on the dose of radiation and contrast medium[J]. Imaging Science and Photochemistry, 2021, 39(3): 375-380. DOI: 10.7517/issn.1674-0475.201103. (in Chinese).
[16]	LI L L, WANG H, SONG J, et al. A feasibility study of realizing low-dose abdominal CT using deep learning image reconstruction algorithm[J]. Journal of X-ray Science and Technology, 2021, 29(2): 361-372. DOI: 10.3233/XST-200826.
[17]	陆晓军, 罗春材, 齐叶青, 等. 深度学习图像重建算法在胸腹主动脉CTA图像质量中的临床应用研究[J]. 临床放射学杂志, 2022, 41(7): 1359-1364. DOI: 10.13437/j.cnki.jcr.2022.07.028. LU X J, LUN C C, QI Y Q, et al. Clinical application value of deep learning image reconstruction algorithm in improving thoracic and abdominal aorta image quality[J]. Journal of Clinical Radiology, 2022, 41(7): 1359-1364. DOI: 10.13437/j.cnki.jcr.2022.07.028. (in Chinese).
[18]	JOHNSON T R, KRAUSS B, SEDLMAIR M, et al. Material differentiation by dual energy CT: Initial experience[J]. European Radiology, 2006, 17(6): 1510-1517. DOI: 10.1007/s00330-006-0517-6.
[19]	顾正山, 马燕, 普晓江, 等. 对比剂注射速率的不同对肺动脉CTA检查中上腔静脉伪影的影响[J]. 当代医药论丛, 2022, 20(5): 89-92. DOI: 10.3969/j.issn.2095-7629.2022.05.028. GU Z S, MA Y, PU X J, et al. Different rate of contrast medium injection on pulmonary artery CTA check upper vena cava artifacts[J]. Contemporary Medicine Symposium, 2022, 20(5): 89-92. DOI: 10.3969/j.issn.2095-7629.2022.05.028. (in Chinese).
[20]	CARANTE M P, ALTIERI S, BORTOLUSSI S, et al. Modeling radiation-induced cell death: Role of different levels of DNA damage clustering[J]. Radiation and Environmental Biophysics, 2015, 54(3): 305-316. DOI: 10.1007/s00411-015-0601-x.
[21]	BALLARINI F, ALTIERI S, BORTOLUSSI S, et al. The BIANCA model/code of radiation-induced cell death: Application to human cells exposed to different radiation types[J]. Radiation and Environmental Biophysics, 2014, 53(3): 525-533. DOI: 10.1007/s00411-014-0537-6.
[22]	FANG Y, GONG A Y, HALLER S T, et al. The ageing kidney: Molecular mechanisms and clinical implications[J]. Ageing Research Reviews, 2020, 63: 101151. DOI: 10.1016/j.arr.2020.101151.
[23]	ESPOSITO C, DAL C A. Functional changes in the aging kidney[J]. Journal of Nephrology, 2010, 23 (S15).
[24]	DENIC A, GLASSOCK R J, RULE A D. Structural and functional changes with the aging kidney[J]. Advances in Chronic Kidney Disease, 2016, 23(1): 19-28. DOI: 10.1053/j.ackd.2015.08.004.
[25]	SONG W, ZHANG T, PU J, et al. Incidence and risk of developing contrast-induced acute kidney injury following intravascular contrast administration in elderly patients[J]. Clinical Interventions in Aging, 2014, (9): 85-93. DOI:10.2147/CIA. S55157.
[26]	ARNER P, BERNARD S, APPELSVED L L, et al. Adipose lipid turnover and long-term changes in body weight[J]. Nature Medicine, 2019, 25(9): 1385-1389. DOI: 10.1038/s41591-019-0565-5.
[27]	赵林伟, 李勇, 董国礼, 等. 基于去脂体质量确定肝脏双能量CT对比剂碘剂量研究[J]. 实用放射学杂志, 2022, (12): 2059-2063. DOI: 10.3969/j.issn.1002-1671.2022.12.036. ZHAO L W, LI Y, DONG G L, et al. Determination of optimal contrast media iodine dose based on lean body weight at hepatic dual-energy CT[J]. Journal of Practical Radiology, 2022, (12): 2059-2063. DOI: 10.3969/j.issn.1002-1671.2022.12.036. (in Chinese).