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目的 探讨使用双层探测器光谱CT(SDCT)虚拟单能级图像优化显示冠状动脉尤其是远段分支血管，以提高诊断的精准度。方法 回顾性收集我院2024年5月—8月采用SDCT行冠状动脉CT血管造影（CTA）增强检查的100例患者，获得120 keVp混合能量及40～100 keVp虚拟单能级图像，选取冠状动脉左主干、左前降支、回旋支、右冠状动脉直径大于2 mm处，钝缘支、对角支、锐缘支、后降支直径小于2 mm处及相同层面胸壁肌肉兴趣区（ROI）,ROI直径大于1 mm，以胸壁肌肉为背景，通过主观评价及测量并计算其CT值、标准差（SD）、信噪比（SNR）和对比度噪声比（CNR），客观评价分析8组冠状动脉图像质量。组间比较采用t检验，以P<0.05为差异有统计学意义。结果 主观评价冠状动脉近段血管60 keVp图像4分有76例，为最佳；冠状动脉远段血管50 keVp图像4分有71例，为最佳。冠状动脉近段血管混合能量与50 keVp、60 keVp,40 keVp与50 keVp、60 keVp,70 keVp与50 keVp、60 keVp的组间差异有统计学意义（P<0.05）；冠状动脉远段血管混合能量与40 keVp、50 keVp、60 keVp、70 keVp,40 keVp与50 keVp、70 keVp,50 keVp与60 keVp、70 keVp,60 keVp与70 keVp组间差异有统计学意义（P<0.05）。各动脉节段虚拟单能级图像的CT值、SD、SNR及CNR均随keVp升高而减低，且配对t检验P值均<0.01，差异有统计学意义。结论 SDCT虚拟单能级图像技术对于冠状动脉血管，尤其是远段血管的成像效果明显优于传统CT，使诊断结果更为精确。
Abstract：Objective To investigate the use of virtual monoenergetic image( VMI) of dual-layer spectral detector CT(SDCT) to optimize the visualization of the coronary arteries, especially the distal branch vessels. Methods A total of 100patients who underwent enhanced coronary computed tomography angiography( CTA) using SDCT in our hospital from May 2024to August 2024 were included in this retrospective study. Mixed energy images at 120 keVp and VMIs ranging from 40 keVp to 100 keVp were obtained. Segments of the left main coronary artery, left anterior descending artery, circumflex artery, and right coronary artery with diameters >2 mm, segments of the obtuse marginal, diagonal, acute marginal, and posterior descending branches with diameters <2 mm, were selected. Regions of interest of the chest wall muscles at the same levels as the arteries were drawn with diameters >1 mm. With the chest wall muscles as the background, subjective evaluation as well as objective analysis of the CT value, standard deviation(SD), signal-to-noise ratio(SNR), and contrast-to-noise ratio(CNR) were performed to assess the image quality of the 8 coronary artery segments. The t-test was used for comparison between groups with statistical significance defined as P <0.05. Results The 60 keVp images of the proximal coronary arteries had the highest subjective scores of 4 points in 76 artery segments. The 50 keVp images had the highest subjective scores of 4 points in 71 distal artery segments. There were significant differences between the mixed energy images and the 50 keVp, 60 keVp images, between the40 keVp images and the 50 keVp, 60 keVp images, and between the 70 keVp images and the 50 keVp, 60 keVp images for the proximal coronary arteries( P < 0. 05). For the distal coronary arteries, there were significant differences between the mixed energy images and the 40 keVp, 50 keVp, 60 keVp, 70 keVp images, between the 40 keVp images and the 50 keVp, 70 keVp images, between the 50 keVp images and the 60 keVp, 70 keVp images, and between the 60 keVp images and the 70 keVp images(P<0.05). The CT values, SD, SNR, and CNR of the VMIs of each arterial segment significantly(P<0.01) decreased as the keVp increased. Conclusion The VMI technology of SDCT significantly outperforms traditional CT in the imaging of coronary arteries,especially the distal branches.
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基本信息:
中图分类号:R816.2
引用信息:
[1]李雯娴,沈海林,叶娟,等.光谱CT在冠状动脉CTA成像中优化远段分支显示的应用[J].影像诊断与介入放射学,2025,34(02):103-108.
基金信息:
苏州市科技计划项目（SYSD2020077）
2025-04-25
2025-04-25