光子计数CT“双低”扫描方案在冠状动脉CT血管成像中的应用价值

doi:10.3969/j.issn.1003-9198.2025.12.004

摘要/Abstract

摘要： 目的探讨采用低辐射剂量与低对比剂用量(“双低”扫描方案)的光子计数CT(PCCT)对冠状动脉CT血管成像(CCTA)图像质量与辐射剂量的影响。方法前瞻性选取2024年6—8月于郑州大学第一附属医院收治的临床疑似冠心病患者80例,按随机数表法分为2组:对照组(A组,n=40)采用传统能量积分探测器CT(EID-CT)行CCTA扫描,管电压为100 kVp,对比剂剂量为0.6 mL/kg;实验组(B组,n=40)采用PCCT行CCTA扫描,管电压为140 kVp,对比剂剂量为0.3 mL/kg。记录并比较2组的辐射剂量参数、对比剂用量及图像质量主客观评价结果。由2名医师使用5分法对各组图像进行双盲法主观质量评分,并使用Cohen’s Kappa检验评估观察者间一致性。结果 B组有效辐射剂量较A组显著降低了51.2%[(3.24±1.49)mSv 比(6.64±2.93)mSv];对比剂用量较A组降低了49.7%[(25.91±7.92)mL比(51.52±9.29)mL](均P<0.001)。客观评价显示,B组主动脉根部及冠状动脉各节段分支信噪比(SNR)和对比噪声比(CNR)均显著高于A组(P<0.05),其中CNR提升幅度为42%～90%。主观评分显示,B组图像质量优良率(4～5分)达95%,在对比度、噪声及伪影3个方面均显著高于A组(P<0.05)。结论在CCTA中应用PCCT“双低”扫描方案,可在显著降低辐射剂量和对比剂用量的同时,获得满足诊断要求的图像质量。

关键词: 心血管造影术, 光子计数CT, 辐射剂量, 对比剂, 图像质量

Abstract: Objective To evaluate the image quality and reduction in radiation achieved by a “dual-low” protocol (low radiation dose and low contrast agent volume) using photon-counting CT (PCCT) in coronary CT angiography (CCTA). Methods Eighty patients with suspected coronary artery disease were prospectively enrolled between June and August 2024 and randomly assigned to two groups. The control group (group A, n=40) underwent CCTA with a conventional energy-integrating detector CT (EID-CT) at 100 kVp and a standard contrast agent dose (0.6 mL/kg). The experimental group (group B, n=40) was scanned using PCCT at 140 kVp with a reduced contrast agent dose (0.3 mL/kg). Radiation dose parameters, including CT does index volume (CTDIvol), dose length product(DLP), effective does(ED) and contrast agent volume, both subjective and objective image quality assessments were compared. Two radiologists independently scored image quality using a 5-point Likert scale in a blinded manner, with interobserver agreement assessed by Cohen’s Kappa. Results The ED was significantly lower in group B (3.24±1.49 mSv) than that in group A (6.64±2.93 mSv), representing a 51.2% reduction (P<0.001). The contrast agent volume was also significantly reduced in group B (25.91±7.92 mL vs 51.52±9.29 mL, P<0.001), representing a 49.7% decrease. Objective analysis revealed significantly higher signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) in the aortic root and all coronary segments in group B than those in group A (all P <0.05), with CNR improvements ranging from 42% to 90%. Subjective scores showed that the rate of excellent and good image quality (4-5 points) in group B reached 95%, which was significantly higher than that in group A in terms of contrast, noise and artifacts (P<0.05). Conclusions The PCCT “dual-low” protocol for CCTA significantly reduces radiation exposure and contrast agent volume while simultaneously improving image quality.

Key words: angiocardiography, photon-counting CT, radiation dose, contrast agent, image quality

中图分类号:

张炜珽, 李舒梦, 段奥博, 唐倩, 张炯, 侯平, 张永高, 刘杰. 光子计数CT“双低”扫描方案在冠状动脉CT血管成像中的应用价值[J]. 实用老年医学, 2025, 39(12): 1207-1212.

ZHANG Weiting, LI Shumeng, DUAN Aobo, TANG Qian, ZHANG Jiong, HOU Ping, ZHANG Yonggao, LIU Jie. Value of photon-counting CT with a “dual-low” protocol in coronary CT angiography[J]. Practical Geriatrics, 2025, 39(12): 1207-1212.

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