目的：探讨在相同的低碘流率情况下，不同浓度对比剂对低剂量冠状动脉CTA图像质量的影响。方法：前瞻性收录我院90例冠状动脉CTA检查者，随机分为A、B、C三组，每组30例。A组采用常规剂量滤波反投影（FBP）重建，使用350 mgI/mL的对比剂。B、C组为低剂量组，采用管电压100 kV，iDOSE4 Level 4重建，分别使用350 mgI/mL、270 mgI/mL的对比剂，B、C两组间碘流率一致。比较三组主、客观图像质量、辐射剂量及碘负荷的差异。结果：A、B、C三组冠脉内CT值、图像噪声及对比噪声比均无统计学差异。B、C组主观图像质量评分各项均≥3分，均能满足临床诊断需要。B和C组间管腔对比度无显著差异。血管边缘锐利度、主观噪声及图像总体质量三组评分均无显著性差异。B、C组碘负荷无显著性差异，较A组减少36.9%～39.6%。B组有效辐射剂量与C组无显著性差异，较A组降低约37.9%。结论：在相同的低碘流率情况下，使用两种不同浓度对比剂（270 mgI/mL和350 mgI/mL），所获冠脉CTA图像质量相当，且均与常规剂量FBP重建所获图像质量无明显差异。
Abstract
Objective: To compare the image quality(IQ) of different contrast materials(CM) injection protocols with low identical iodine delivery rate(IDR) for low-dose coronary CT angiography(CCTA) with iterative reconstruction(IR) technique. Methods: Ninety consecutive patients who underwent prospective electrocardiogram-CCTA on a 256-MDCT scanner were randomized to three groups: group A, which received CM(350 mgI/mL), was scanned by using the conventional tube output(120 kV) with filtered back projection(FBP). Group B which received CM(350 mgI/mL) and group C which received CM(270 mgI/mL) had identical IDR adapted to body mass index and weight, and scanned by 100 kV with iDOSE4 level 4. The subjective IQ, objective IQ, radiation dose and iodine load were compared among the three groups. Results: There were no significant differences in the image noise, contrast-to-noise ratio and attenuation of coronary among these three groups. Group B and C had good scores of the subjective IQ(≥3), and it could satisfy the clinical use. There was no significant difference of lumen contrast between group B and C. No significant differences of sharpness, subjective noise, and acceptability of images were observed, but the contrast dose of group A was significantly higher than group B and C. Mean iodine load of group A were 36.9%～39.6% higher than group B and C, and there was no difference between group B and C. The effective radiation dose of group B and C was 37.9% lower than group A, and there was no difference between group B and C. Conclusions: Equivalent and adequate diagnostic IQ can be achieved by using different iodine-concentration contrast materials(270 mgI/mL and 350 mgI/mL) when the IDR were kept identical in low-dose 256-MDCT coronary angiography with iDOSE4 level 4, compared with the IQ by using conventional tube output and FBP.
关键词
冠状动脉疾病；冠状血管造影术；辐射剂量；体层摄影术 /
螺旋计算机
中图分类号：
Ｒ543.3
Ｒ814.42
R814.43
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