低剂量恒流控制CT扫描在初治继发性肺结核随访中的价值

摘要
图/表
参考文献
相关文章 (6)

全文: PDF (735 KB)
输出: BibTeX | EndNote (RIS)

摘要目的探讨低剂量恒流控制CT扫描在初治继发性肺结核随访中对辐射剂量和图像质量的影响。方法对156例初治继发性肺结核患者首次CT检查行自动管电流调制扫描(120 kV,50~330 mA),在治疗期间的前3个月随访时行低剂量恒流控制扫描(120 kV,50 mA)。分别记录和计算两种扫描方式的辐射剂量指标:容积CT剂量指数、剂量长度乘积、有效剂量和体型特异性剂量估计值。客观图像质量评价包括分析主动脉弓和正常肺实质的信号强度、图像噪声、信噪比、对比噪声比和噪声的品质因数。采用5分制双盲法评价9种继发性肺结核CT基本病变的图像质量评分。结果与自动管电流调制CT扫描相比,低剂量恒流控制CT扫描的容积CT剂量指数、剂量长度乘积、有效剂量和体型特异性剂量估计值分别下降了68.2%(6.60/2.10 mGy)、69.9%(222.61/66.98 mGy×cm)、70.0%(3.23/0.97 mSv)和67.8%(8.66/2.79 mGy)(P＜0.001),主动脉噪声增加了56.2%(40.52/92.46)(P＜0.001)而信噪比降低了98.2%(1.04/0.44)(P＜0.001),肺实质噪声增加了47.9%(48.84/93.82)(P＜0.001),主动脉与肺实质的对比噪声比降低了95.0%(20.12/9.70)(P＜0.001),噪声品质因数降低了94.2%(21.89/1.26)(P＜0.001)。两种CT扫描方式的主动脉弓和肺实质CT值无统计学差异,对初治继发性肺结核患者9种CT基本病变的图像质量评分无统计学差异。结论低剂量恒流控制CT扫描比自动管电流调制更加显著地降低了辐射剂量,对主观图像质量评分无明显影响,推荐用于初治继发性肺结核的随访。

	服务

	把本文推荐给朋友
	加入我的书架
	加入引用管理器
	E-mail Alert
	RSS
	作者相关文章
	陈艳琼
	吴斌
	王耀彬
	张春平
	周毅方
	李龙

关键词 ：低剂量CT, 自动管电流调制, 恒流控制, 辐射剂量, 图像质量, 继发性肺结核

Abstract：Objective To assess the effect of low-dose constant current control (LD-CCC) scanning on radiation dose and image quality in chest CT for the follow-up of secondary pulmonary tuberculosis in the primary therapy.Methods A total of 156 patients with secondary pulmonary tuberculosis in the primary therapy were received the automatic tube current modulation (ATCM) technique (120 kV, 50~330 mA) at initial CT examinations, and the LD-CCC (120 kV, 50 mA) scanning at the first 3 months of follow up CT examinations. The radiation dose indexes of each scanning mode were recorded and calculate respectively,including the volumetric CT dose index (CTDIvol), dose length product (DLP), effective dose (ED) and size-specific dose estimates (SSDE).Objective image quality measures including CT attenuation, image noise, signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR) and figure of merit for the noise (FOMN) of aortic arch and normal lung parenchyma were assessed. Subjective image quality measures for nine forms of the basical lesions of secondary pulmonary tuberculosis were scored independently and blindingly on a five-point scale by two senior radiologists. The radiation dose and image quality indexes were compared by the paired Student t test. The consistency of CT image quality scores of two senior radiologists was evaluated by the Kappa test.Results Compared with the ATCM technique, CTDIvol, DLP, ED and SSDE of the LD-CCC scanning decreased by 68.2% (6.60/2.10 mGy), 69.9% (222.61/66.98 mGy×cm), 70.0% (3.23/0.97 mSv),and 67.8% (8.66/2.79 mGy), respectively (P＜0.001); the image noises of of aortic arch were increased by 56.2% (40.52/92.46)(P＜0.001) while SNRs were decreased by 98.2% (1.04/0.44)(P＜0.001); the image noises of of aortic arch were increased by 47.9% (48.84/93.82)(P＜0.001); and CNRs and FOMN of aortic arch and normal lung parenchyma were decreased by 95.0% (20.12/9.70) and 94.2% (21.89/1.26), respectively (P＜0.001). There were no significant differences in CT attenuation values of aortic arch and normal lung parenchyma between ATCM and LD-CCC scanning (P＞0.05). The consistency of CT image quality scores of two senior radiologists was excellent (Kappa=0.833,P＜0.05). No statistically significant difference in subjective image quality scores for nine forms of the basical lesions of secondary pulmonary tuberculosis between ATCM and LD-CCC scanning was observed.Conclusions LD-CCC scanning should be recommended for the follow-up of secondary pulmonary tuberculosis in the primary therapy, because the radiation dose of the LD-CCC scanning are more significantly reduced than those of the ATCM technique, and subjective image quality scores have not been obviously changed.

Key words： low-dose computed tomography automatic tube current modulation constant current control radiation dose image quality secondary pulmonary tuberculosis

收稿日期: 2021-01-20

ZTFLH:

R814.42

基金资助:广东省医学科学技术研究基金(B2018197)

通讯作者: 李龙,E-mail:radiolilong@hotmail.com

作者简介: 陈艳琼,本科学历,主管技师。

引用本文:

陈艳琼, 吴斌, 王耀彬, 张春平, 周毅方, 李龙. 低剂量恒流控制CT扫描在初治继发性肺结核随访中的价值[J]. 武警医学, 2021, 32(5): 411-415. CHEN Yanqiong, WU Bin, WANG Yaobin, ZHANG Chunping, ZHOU Yifang, LI Long. Value of low-dose constant current control scanning in chest CT for the follow-up of secondary pulmonary tuberculosis in the primary therapy. Med. J. Chin. Peop. Armed Poli. Forc., 2021, 32(5): 411-415.

链接本文:

http://journal08.magtechjournal.com/Jwk_wjyx/CN/ 或 http://journal08.magtechjournal.com/Jwk_wjyx/CN/Y2021/V32/I5/411

[1]	Nachiappan A C, Rahbar K, Shi X, et al. Pulmonary Tuberculosis: Role of Radiology in Diagnosis and Management [J]. Radiographics, 2017, 37(1): 52-72.
[2]	中华医学会放射学分会心胸学组. 低剂量螺旋CT肺癌筛查专家共识[J]. 中华放射学杂志, 2015, 49(5): 328-335.
[3]	周清华, 范亚光, 王颖, 等. 中国肺癌低剂量螺旋CT筛查指南(2018年版)[J]. 中国肺癌杂志, 2018, 21(2): 67-75.
[4]	Ohno Y, Koyama H, Seki S, et al. Radiation dose reduction techniques for chest CT: Principles and clinical results[J]. Eur J Radiol, 2019, 111: 93-103.
[5]	中华人民共和国国家卫生和计划生育委员会. 肺结核诊断标准(WS 288—2017)[J]. 新发传染病电子杂志, 2018, 3(1): 59-61.
[6]	American Association of Physicists in Medicine. The Alliance for Quality Computed Tomography: Adult Routine Chest CT Protocols Version 2.1[EB/OL].[2016-05-04]. https://www.aapm.org/pubs/CTProtocols/documents/AdultRoutineChestCT.pdf.
[7]	Boone J, Strauss K, Cody D et al. AAPM Report No. 204: Size-specific dose estimates (SSDE) in pediatric and adult body CT exams[R/OL].
	[2011]. https://aapm.org/pubs/reports/RPT_204.pdf.
[8]	Deak P D, Smal Y, Kalender W A. Multisection CT protocols: sex- and age-specific conversion factors used to determine effective dose from dose-length product[J]. Radiology, 2010, 257(1): 158-166.
[9]	中华人民共和国国家卫生健康委员会. 中华人民共和国卫生行业标准 WS 519—2019: X射线计算机体层摄影质量控制检测规范[S/OL].[2019-10-22]. http://www.nhc.gov.cn/wjw/pcrb/201902/70480b80952846e6905bc291921f10cd/files/c9a12afa2ba6443fb99facc3d1bf54aa.pdf.
[10]	Yel I, Martin S S, Wichmann J L, et al. Evaluation of Radiation Dose and Image Quality using High-Pitch 70-kV Chest CT in Immunosuppressed Patients[J]. Rofo, 2019, 191(2): 122-129.
[11]	Yan C, Liang C, Xu J, et al. Ultralow-dose CT with knowledge-based iterative model reconstruction (IMR) in evaluation of pulmonary tuberculosis: comparison of radiation dose and image quality[J]. Eur Radiol, 2019, 29(10): 5358-5366.
[12]	朱艳艳, 张旭, 柳澄, 等. 成人初治继发性活动性肺结核的计算机断层成像特征分析[J]. 中华传染病杂志, 2020, 38(6): 359-363.
[13]	中华医学会放射分会传染病放射学专业委员会. 肺结核影像学及分级诊断专家共识[J]. 新发传染病电子杂志, 2018, 3(2): 118-127.
[14]	Damilakis J. CT Dosimetry: What Has Been Achieved and What Remains to Be Done [J]. Invest Radiol, 2021, 56(1): 62-68.
[15]	Cross N M, Zamora D A, Moirano J M, et al. Practical CT Dose Monitoring: Current Tools and the Clinical Relevance [J]. Semin Roentgenol, 2018, 53(2): 115-123.
[16]	McCollough C H, Leng S, Yu L, et al. CT dose index and patient dose: they are not the same thing[J]. Radiology, 2011, 259(2): 311-316.
[17]	吴柯薇, 钟朝辉, 王振常, 等. 宽体探测器CT不同扫描方式对胸部低剂量CT图像质量及辐射剂量的影响[J]. 中国医疗设备, 2019, 34(8): 93-96.
[18]	吕蓉, 陈晨, 胡维娟, 等. CT值与管电流、管电压的关系以及图像噪声与辐射剂量的相关性研究[J]. 实用放射学杂志, 2020, 36(1): 123-127.