Study on the Influence of Head and Neck CTA Image Quality under Different Tube Voltages
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摘要: 目的：研究不同管电压对头颈部CTA图像质量的影响。资料与方法：收集亭林医院2021年9月至2022年1月临床怀疑头颈部血管疾病的患者共67例，其中男37例，女30例，平均年龄（68.94±11.68）岁，根据施加的管电压不同分成3组，将患者分配到A、B、C三组，A组为120 kV 23例、B组为100 kV 24例、C组为80 kV 20例。采用单因素ANOVA检验，比较3组间的主动脉弓、颈内动脉、大脑中动脉M1段以及胸锁乳突肌的CT值、SD值、SNR、CNR，以及图像质量主观评分、TDLP以及ED，采用Kappa检验法，检验两名医师主观评分的一致性。结果：3组间主动脉弓、颈内动脉、大脑中动脉M1段血管CT值及SD值差异有统计学意义；主动脉弓、颈内动脉、大脑中动脉M1段血管CT值及SD值随管电压下降而上升，上升幅度为15％～55％；3组间SNR及CNR差异无统计学意义；3组间的图像质量主观评分差异有统计学意义，B组＞A组＞C组，以B组评分最高；两名医师主观评分的Kappa=0.80，为高度一致；3组间TDLP以及ED有统计学差异，TDLP以及ED随管电压下降而下降，下降幅度为25％ 和39％。结论：根据CT辐射剂量诊断参考水平的要求，在进行头颈部CTA检查时，3种管电压以100 kV为最佳管电压条件。Abstract: Objective: To explore the influence on the image quality of head and neck CTA under different tube voltages. Materials and methods: A total of 67 patients with clinically suspected head and neck vascular diseases in Tinglin hospital from September 2021 to January 2022 were collected as the research objects, including 37 males and 30 females, with an average age of 68.94. According to the applied tube voltage, the patients were randomly assigned into groups A, B and C. There were 23 cases of 120 kV in group A, 24 cases of 100 kV in group B and 20 cases of 80 kV in group C. Single factor ANOVA test was used to compare the CT value, SD value, SNR, CNR of aortic arch, internal carotid artery, M1 segment of middle cerebral artery and sternocleidomastoid muscle among the three groups, and furthermore the subjective score of image quality, TDLP and ED. Kappa test was used to evaluate the consistency of subjective scores of the two physicians. Results: There were statistical differences in CT and SD values of aortic arch, internal carotid artery and M1 segment of middle cerebral artery among the three groups; The CT and SD values of aortic arch, internal carotid artery and M1 segment of middle cerebral artery increased with the decrease of tube voltage, with an increase range of 15%～55%. There was no statistical difference in SNR and CNR among the three groups; There was statistical difference in subjective score of image quality among the three groups; Group B > group A > group C, and group B showed the highest score; the kappa value of the subjective score of the two phsicianss=0. 80, which was highly consistent; There were statistical differences in TDLP and ED among the three groups, TDLP and ED decreased with the decrease of tube voltage, with the decrease ranges of 25% and 39%. Conclusion: According to the requirements of CT radiation dose diagnosis reference level, 100 kV is the best tube voltage condition for head and neck CTA.
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Keywords:
- head and neck CTA /
- tube voltages /
- image quality
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图 1 管电压为120 kV的VR、MIP、CPI及头颅横断面图
（a）～（d）分别为120 kV管电压的VR、MIP、CPI及头颅横断面图，图像质量较好，血管与组织对比较好，解剖结构较清晰，噪声较小，双盲5分值评价法，4分。头颈部CTA诊断：双侧颈内动脉起始部及C6段钙化斑块伴右侧颈内动脉C6段管腔轻度狭窄。
Figure 1. VR、MIP、CPI and head cross-sectional drawing under pipe voltage of 120 kV
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图 2 管电压为100 kV的VR、MIP、CPI及头颅横断面图
（a）～（d）分别为100 kV管电压的VR、MIP、CPI及头颅横断面图，图像质量好，血管与组织对比鲜明，细微解剖结构清晰，噪声小，双盲5分值评价法，5分。头颈部CTA诊断：右侧颈内C6-7段钙化斑块伴管腔轻度狭窄，双侧椎动脉走形迂曲。
Figure 2. VR、MIP、CPI and head cross-sectional drawing under pipe voltage of 100 kV
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图 3 管电压为80 kV的VR、MIP、CPI及头颅横断面图
（a）～（d）分别为80 kV管电压的VR、MIP、CPI及头颅横断面图，图像质量一般，血管解剖结构显示一般，噪声略大，双盲5分值评价法，3分。头颈部CTA诊断：右侧颈内起始部及C5-6段动脉钙化斑块伴C5-6段管腔轻度狭窄；左侧颈内动脉起始部混合斑块伴局部管腔轻度狭窄；左侧颈内C5-6段钙化斑块伴管腔中度狭窄。
Figure 3. VR、MIP、CPI and head cross-sectional drawing under pipe voltage of 80 kV
表 1 三组病例一般资料、主观评分和辐射剂量之间比较
Table 1 Comparison of general information, subjective score and radiation dose among the three groups
项目 组别 统计检验 A组 B组 C组 F P 男/女 15/8 11/13 11/9 0.88 0.42 年龄/Y 66.83±11.76 69.00±11.59 71.15±10.55 0.78 0.46 身高/mm 165.04±8.67 161.96±6.70 162.65±7.28 1.05 0.36 体重/kg 67.17±12.60 62.04±8.05 62.30±9.16 1.85 0.17 主观评分 4.70±0.47 4.88±0.34 4.40±0.68 4.87 0.01 TDLP/mGy·cm 1169.57±116.07 873.17±56.98 716.70±44.38 180.75 0.00 ED/mGy·cm 9.63±0.96 7.18±0.47 5.90±0.37 180.75 0.00 
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表 2 三组病例CT值、SD值、SNR及CNR之间比较
Table 2 Comparison of CT value SD value, SNR and CNR among the three groups
部位 参数 组别 统计检验 A组 B组 C组 F P 升主动脉 血管CT值/HU 296.61±69.92 342.13±76.21 460.50±130.44 17.11 0.00 SD 10.61±3.61 12.92±4.09 16.00±4.15 9.98 0.00 SNR 86.83±38.32 94.69±32.52 97.74±38.14 0.53 0.53 CNR 71.65±34.33 77.03±28.57 84.42±35.46 0.82 0.45 颈动脉分叉 血管CT值/HU 352.13±90.94 429.63±99.42 574.95±136.12 22.77 0.00 SD 5.00±2.83 5.79±6.22 7.40±3.03 4.01 0.02 SNR 103.80±48.11 119.34±45.70 121.33±41.98 1.00 0.38 CNR 88.63±44.04 101.67±41.96 108.00±39.43 1.21 0.31 大脑中动脉
M1段血管CT值/HU 334.21±69.42 385.00±85.53 502.50±110.17 19.94 0.00 SD 5.83±4.72 7.29±6.20 10.80±6.44 4.08 0.02 SNR 97.79±42.20 108.52±47.52 107.70±37.78 0.44 0.64 CNR 82.61±37.93 90.86±43.18 94.37±34.03 0.53 0.59 胸大肌 软组织CT值/HU 52.70±8.43 62.12±6.72 60.55±7.27 10.40 0.00 SD 3.74±0.92 4.08±1.86 5.15±1.93 4.32 0.02
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