低管电压联合迭代重建技术对自体上肢动静脉内瘘CTA成像质量及辐射剂量的影响

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摘要目的：探讨低管电压（80、100 kV）联合标准迭代重建技术对上肢动静脉内瘘（AVF）患者CT血管造影图像质量及辐射剂量的影响。方法：将72例自体上肢动静脉内瘘功能不全的疑似患者随机编入120 kV、100 kV和80 kV管电压组，每组各24例，采用320排Toshiba Aquilion ONE完成CTA检查，低管电压组联合标准自适应迭代降剂量技术（AIDR 3D）以改善图像质量。采用轴位图像结合曲面重建（CPR）、容积再现（VR）等重建技术观察AVF血管显示情况。分别比较3组患者的一般情况及血管内密度（VD）、噪声、信噪比（SNR）、对比信噪比（CNR）、图像质量主观评分、辐射剂量。结果：100 kV与80 kV组CTDIvol与DLP明显低于常规120 kV组（P＜0.05），但100 kV与80 kV组间差异无统计学意义（P＞0.05）。结合标准迭代重建，随着管电压降低VD明显增高（P＜0.05）。100 kV组与120 kV组图像噪声差异无统计学意义（P＞0.05）；当管电压降到80 kV时，其图像噪声比100 kV组及120 kV组大（P＜0.05）。80 kV组SNR和CNR最高，比120 kV组分别高67.5%、78.6%，但与100 kV组差异无统计学意义（P＞0.05）。低管电压组与常规120 kV组图像主观评分差异无统计学意义（P＞0.05），3组图像质量均良好。结论：100 kV管电压扫描联合标准水平迭代重建算法方案可在降低辐射剂量的同时获得高质量的上肢AVF图像，具有一定的临床运用价值。

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关键词 ：上肢血管内瘘CT造影成像, 迭代重建, 低辐射剂量, 体层摄影术, X线计算机

Abstract：Objective: To study the effect of low-tube voltage (80, 100 kV) combined with the iterative algorithm (IR) on image quality and radiation dose in upper limb intravascular fistula CT angiography. Methods: 72 cases of suspected upper limb arteriovenous fistula (AVF) dysfunction were randomized into 120 kV, 100 kV and 80 kV voltage groups (24 cases per group). The CTA was undertaken with a 320-row scanner (Toshiba Aquilion ONE), and the low tube voltage groups combined with standard adaptive iterative dose reduction technique (AIDR 3D). The states of AVF were observed by using axial images combined with CPR, VR and other reconstruction techniques. The general conditions, vessel density (VD), SNR, CNR, subjective image quality score and radiation dose of the three groups were compared respectively. Results: CTDIvol and DLP in the 100 kV and 80 kV groups were significantly lower than those in the conventional 120 kV group (P<0.05), but the difference between the 100 kV and 80 kV groups was not significant (P>0.05). Combined with the standard iterative reconstruction, VD increased significantly with tube voltage reduction (P<0.05); There was no significant difference in image noise between the 100 kV group and the 120 kV group (P>0.05); When the tube voltage rduced to 80 kV, the image noise increased comparing with the 100 kV and 120 kV groups (P<0.05). SNR and CNR in the 80 kV group were the highest, 67.5% and 78.6% higher than those in the 120 kV group, but the difference between the 80 kV and 100 kV groups was not significant (P>0.05). There was no significant difference in subjective score between the low-tube voltage group and the conventional 120 kV group (P>0.05), and all the three groups had good image quality. Conclusion: Low tube vohage (100 kV) combined with standard IR algorithm can significantly improve the image quality and reduce radiation dose in upper limb intravascular fistula CT angiography. It has certain clinical application value.

Key words： upper limb intravascular fistula CT angiography iterative reconstruction low radiation dose tomography, X-ray computed

收稿日期: 2018-06-25

基金资助:温州市科技计划项目（Y20160157，2017Y1099）。

作者简介: 陈永华（1986-），男，浙江永嘉人，住院医师，硕士。

链接本文:

https://xb.wmu.edu.cn/CN/ 或 https://xb.wmu.edu.cn/CN/Y2019/V49/I4/289

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