Application of Coronary Computed Tomography Angiography in Overweight Patients: Comparison of Automated Tube Voltage Selection Versus 100 kVp Tube Voltage
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摘要:
目的 在自动管电压选择（automated tube voltage selection，APSCM）与定向100 KVp管电压两种情况下，比较超重患者冠状动脉计算机体层血管造影（coronary computed tomography angiography，CCTA）的图像质量和辐射剂量。 方法 选取115位体重指数（BMI）在25～30 kg / m2 之间，并且体重低于90 kg的患者在第二代双源CT扫描仪上进行CCTA检查，所有检查均采用前瞻性心电门控及大螺距（3.4）模式。所有患者被随机分为A、B两组：A组75例，采用APSCM技术进行检查；B组40例，接受固定100 kVp管电压检查。测量CT衰减和图像噪声，并计算信噪比（signal-to-noise ratio，SNR）和对比噪声比（contrast-to-noise ratio，CNR）。对两组图像质量及辐射剂量进行比较。 结果 A组中，1例（1.3%）、51例（68%）和23例（30.7%）患者的管电压自动选择为80 kVp、100 kVp、120 kVp，平均CT衰减和图像噪声显著低于B组（P < 0.001）。A组的平均CNR高于B组，平均SNR较低（ P < 0.05）。两组的主观图像质量得分无显著差异（ P > 0.05），B组的辐射剂量比A组低22.2%（ P = 0.004）。 结论 对于BMI高于25 kg / m2、低于30 kg / m2，且体重低于90 kg的患者，与使用APSCM的CCTA相比，100 kVp CCTA可以降低辐射剂量而不影响图像质量。 Abstract:Objective To compare the image quality and radiation dose of automated tube voltage selection （APSCM） and 100 kVp coronary computed tomography angiography （CCTA） in overweight patients. Methods A total of 115 patients with a body mass index （BMI） higher than 25 kg/m2 and less than 30 kg/m2 and body weight lower than 90 kg underwent high-pitch prospectively ECG-triggered CCTA on a second-generation dual-source CT scanner. All patients were classified into two groups: Group A, 75 patients were examined with APSCM; Group B, 40 patients with a fixed tube voltage of 100 kVp. The attenuation and image noise were measured and signal-to-noise ratio （SNR） and contrast-to-noise ratio （CNR） were calculated. Image quality was evaluated and radiation dose was recorded. Results In Group A, 80 kVp, 100 kVp and 120 kVp were automatically selected in 1 （1.3%）, 51 （68.0%） and 23 （30.7%） patients, respectively. The mean CT attenuations and image noise in APSCM group were significantly lower than those in Group B （all P < 0.001）. Group A showed a higher mean CNR but a lower mean SNR （all P < 0.05） than Group B. The subjective image quality scores have no significant difference between the two groups （all P < 0.05）. The radiation dose in Group B was 22.2% lower than in Group A （ P = 0.004）. Conclusion In patients with BMI higher than 25 kg/m2 and less than 30 kg/m2, 100 kVp CCTA allows lower radiation dose without compromising image quality when compared with CCTA using APSCM. -
Key words:
- Computed tomography /
- Angiography /
- Coronary artery /
- Tube potential /
- Radiation dose
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图 1 100 kVp CCTA组和APSCM CCTA组的曲面重组（CPR）图像质量对比
A：100 kVp CCTA组；B：APSCM CCTA组；C：100 kVp CCTA组；D：APSCM CCTA组。
Figure 1. Comparison of curved planar reformations （CPR）image quality between 100 kVP CCTA group and APSCM CCTA group
图 2 100 kVp组和APSCM组的CT图像示例
A：100 kVp CCTA组；B：100 kVp CCTA组；C：100 kVp CCTA组；D：100 kVp CCTA组；E：APSCM CCTA组；F：APSCM CCTA组；G：APSCM CCTA组；H：APSCM CCTA组。
Figure 2. Examples of CT images from the 100 kVp group and the APSCM group
表 1 两组CCTA的客观图像质量比较（
$\bar x \pm s $ ）Table 1. Objective image quality evaluation of CCTA in the two groups （
$\bar x \pm s $ ）位置 APSCM组 100 kVp组 t P RCA CT（HU） 426.0 ± 95.0 504.0 ± 71.0 −4.527 < 0.001* SNR 28.2 ± 16.4 33.7 ± 18.0 −1.761 0.038* CNR 31.4 ± 5.5 27.2 ± 5.8 3.841 < 0.001* LMA CT（HU） 431.0 ± 105.0 505.0 ± 83.0 −3.915 < 0.001* SNR 36.0 ± 21.0 43.4 ± 23.6 −2.282 0.005* CNR 31.5 ± 5.3 27.3 ± 6.0 3.924 < 0.001* LAD CT（HU） 422.0 ± 88.0 488.0 ± 88.0 −3.842 < 0.001* SNR 31.1 ± 31.0 38.7 ± 30.3 −1.660 0.053* CNR 31.1 ± 4.6 26.5 ± 6.0 4.631 < 0.001* LCX CT（HU） 428.0 ± 95.0 501.0 ± 97.0 −3.895 < 0.001* SNR 30.5 ± 24.8 38.3 ± 15.4 −1.705 0.001* CNR 31.6 ± 5.2 27.3 ± 7.3 3.652 0.002* 平均 CT（HU） 426.0 ± 88.0 500.0 ± 78.0 −4.432 < 0.001* SNR 31.4 ± 15.2 39.8 ± 13.1 −2.976 0.004* CNR 31.4 ± 4.5 27.0 ± 6.1 4.349 < 0.001* 图像噪声（HU） 17.0 ± 3.0 22.0 ± 4.0 −8.410 < 0.001* 注：*P < 0.05。 
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表 2 两组冠状动脉的主观图像质量评分比较（
$\bar x \pm s $ ）Table 2. Subjective image quality scores of coronary arteries in the two groups （
$\bar x \pm s $ ）血管 100 kVp组 80 kVp组 U P RCA 3.5 ± 0.8 3.3 ± 1.0 1396.50 0.488 LMA 3.9 ± 0.3 3.9 ± 0.3 1450.00 0.528 LAD 3.5 ± 0.7 3.3 ± 0.8 1287.50 0.162 LCX 3.4 ± 0.7 3.1 ± 0.8 1242.00 0.096 平均 3.6 ± 0.4 3.4 ± 0.6 1277.00 0.181
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表 3 两组辐射剂量比较（
$ \bar x \pm s$ ）Table 3. Radiation dose comparison between the two CCTA groups （
$\bar x \pm s $ ）参数 APSCM组 100 kVp组 t P CTDI （mGy） 4.3 ± 1.6 3.3 ± 0.3 3.909 0.046* DLP （mGy×cm） 74.5 ± 27.6 58.3 ± 7.2 3.651 0.040* ED （mSv） 1.0 ± 0.4 0.8 ± 0.1 3.651 0.040* SSDE （mGy） 5.4 ± 1.8 4.2 ± 0.4 3.909 0.004* 注：*P < 0.05；CTDIvol = CT容积剂量指数；DLP = 剂量长度乘积；ED = 有效剂量；SSDE = 体型特异性剂量估计。
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