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目的 探讨柔性减影（CE-Boost）技术在低流率、低对比剂剂量肺动脉CT血管造影中的应用价值。方法前瞻性收集100例疑似肺动脉栓塞的患者，随机分为两组进行肺动脉CT血管造影：A组（n=50）为“双低”组，采用流率3 mL/s，总量30 mL对比剂，其中A1组为混合迭代重建图像，A2组为A1组图像经CE-Boost技术后处理后生成；B组（n=50）为常规组，采用流率4 m L/s，总量50 mL对比剂，图像只采用混合迭代重建。测量3组图像中主肺动脉、肺动脉分支和主肺动脉层面竖脊肌的CT值及标准差（SD值），并计算信噪比（SNR）及对比噪声比（CNR），同时对3组图像整体图像质量及亚段肺动脉小血管显示进行主观评价。结果 A1、A2、B组在各测量区域的平均CT值分别为376.21 HU、547.91 HU、465.00 HU；平均SNR值分别为20.64、30.96、21.68；平均CNR值分别为19.17、33.74、23.22。A2组在各测量区域CT值、SNR和CNR均最高，CT值、SNR和CNR与其他2组相比差异均具有统计学意义（P<0.05）,A1与B组在各测量区域的CT值对比差异具有统计学意义（P<0.05），但其SNR和CNR对比差异无统计学意义（P>0.05）。3组SD值差异无统计学意义（P>0.05）。主观分析中，观察者间对A1、A2、B组图像质量评分Kappa值分别为0.862、0.754、0.756，一致性较好，A2组图像整体主观评分高于A1组和B组图像（A1、A2、B组分别为3.42±0.07、3.85±0.04、3.69±0.06）,A2组在亚段肺动脉小血管显示的主观评分高于其他2组（A1、A2、B组分别为3.12±0.05、3.77±0.04、3.47±0.06），差异具有统计学意义（P<0.05）。结论 CE-Boost技术联合低流率、低对比剂剂量进行肺动脉CT血管造影，能有效提高图像质量并减少对比剂辐射。
Abstract：Objective To evaluate the impact of contrast-enhancement boost(CE-Boost) technology on CT pulmonary angio-graphy(CTPA) with low contrast volume and low flow rate. Methods A total of 100 patients with suspected pulmonary embolism were prospectively enrolled and randomly divided into two groups. CTPA in the “double low” group(50 patients) was performed using 30mL of contrast at flow rate of 3 mL/s. A1 images were obtained using only hybrid iterative reconstruction(HIR) and A2 images were generated by applying CE-Boost to the A1 images. The control group(50) underwent CTPA using the conventional contrast dose of50 m L at a flow rate of 4 mL/s and HIR. The CT values and standard deviation(SD) of the main, left, right, upper, and lower pulmonary arteries and the erectus spinae muscle at the level of the main pulmonary artery were measured and the signal-to-noise ratio(SNR)and contrast-to-noise ratio(CNR) were calculated. The image quality and sub-segmental pulmonary vessel visualization were subjectively evaluated. Results Group A2 demonstrated significantly(P<0.05) higher CT values(547.91 HU) and insignificantly(P>0.05) higher SNR(30.96) and CNR(33.74) across all measured areas than that of A1(376.21 HU, 20.64, 19.17) and control(465.00 HU, 21.68,23.22) groups. There were no significant differences in SD values among the three groups( P > 0. 05). Subjective analysis revealed consistent inter-observer agreement in image quality with Kappa values of 0.862 for group A1, 0.754 for group A2, and 0.756 for the control. The overall(3.85±0.04) and sub-segmental(3.77 ±0.04) pulmonary vessel visibility scores of group A2 were significantly(P <0.05) higher than those for group A1(3.42 ±0.07, 3.12±0.05) and control group(3.69 ±0.06, 3.47 ±0.06). Conclusion CTPA with CE-Boost, low contrast agent volume and flow rate improves the image quality and reduces beam hardening artifact from contrast agent.
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基本信息:
中图分类号:R563.5;R816.4
引用信息:
[1]黄木兰,谢定祥,王瑾珠,等.柔性减影CE-Boost技术在“双低”肺动脉CT血管造影中的应用[J].影像诊断与介入放射学,2025,34(01):9-15.
基金信息:
国家自然科学基金青年基金（82202217）