L-LWiDose4技术在新生儿先天性心脏病CT血管成像中的临床应用

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Abstract Objective: To evaluate the feasibility of CT angiography of neonatal congenital heart disease by using low radiation and isotonic contrast agents with low iodine doses combined with iDose4 iterative reconstruction technique. Methods: Prospectively, a total of 102 continuous patients from department of neonatology of our hospital between January 2015 and March 2018 who needed CT angiography of heart were divided into 2 groups randomly. Different scan protocols were adopted. Routine group (group A) included 53 patients using 100 kVp, 100 mAs, Iohexol (350 mg I/mL) and filtered back projection algorithm. Experimental group included 49 patients using 80 kVp, 80 mAs, Iodixanol (270 mg I/mL) and seven groups of images were acquired according to iDose4 iterative reconstruction algorithm (iDose4-1-iDose4-7), of which 5 groups (iDose4-2-iDose4-6) were selected and recorded as group B, group C, group D, group E, and group F. Individualized injections were given according to the weight of newborns and their iodine intake was calculated. CT value of aortic arch, descending aorta at the level of tracheal bifurcation, pulmonary trunk, pectoralis major and erector spinae on both sides at the level of aortic arch were measured. The standard deviation (SD) of CT value of the air around at the tracheal bifurcation level was recorded as background noise, and signal to noise ratio (SNR) and contrast to noise ratio (CNR) were calculated, and the quality of images was evaluated subjectively. Volume CT dose index (CTDIvol) and dose-length-product (DLP) were recorded, and the effective dose (ED) and size-specific dose estimate (SSDE) were calculated. The diagnostic coincidence rate for CTA examinations of these six groups was calculated and compared with the surgery or cardiac catheterization examination as the “gold standard”. Results: Compared with routine group, CTDIvol, SSDE, DLP, ED of experimental group descended by 57.08%, 56.62%, 58.31%, 56.97%, respectively (P<0.05). The iodine intake of experimental group and routine group was (1.83±1.27)g, (1.61±1.36)g
respectively, with significant statistical difference (t=2.124, P<0.05). The objective evaluation of group B and group F was not as good as that of group A, group C, group D and group E (P<0.05). Subjective evaluation of group A and group E was better than the other groups. Subjective evaluation of group C and group D was better than group B and group F. The diagnostic coincidence rate of the six groups was 98.6%, 81.6%, 87.7%, 97.9%, 97.9%, 96.9%, respectively (P>0.05). Conclusion: Using 80 kVp, 80 mAs and Iodixanol (270 mg I/mL) combined with iDose4 iterative reconstruction technique for CT angiography of neonatal congenital heart disease, the image quality could meet the requirement for clinical diagnosis, and the radiation dose and the iodine dose of contrast medium could be lowered.

Key words： radiation dose nonionic iodine contrast agent congenital heart disease iterative reconstruction tomography, X-ray computed

Received: 13 August 2018

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	XU Lei
	CHEN Bo
	CHEN Tinggang
	WU Aiqin
	CHENG Jianmin.

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https://xb.wmu.edu.cn/EN/ OR https://xb.wmu.edu.cn/EN/Y2019/V49/I3/189

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