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目的探讨具有自适应统计迭代重建(ASiR)平台的动态500排扫描技术(VHS)在婴幼儿先天性心脏病诊断中的应用价值。方法对于2012年8月至2013年1月期间临床疑为先天性心脏病的80例患儿进行MSCT增强扫描,其中,男48例,女32例,年龄5天~12个月,中位年龄4.3个月。按照每组40例随机分成研究组与对照组。检查设备采用GE Healthcare Optima CT660扫描仪。研究组扫描参数为VHS扫描模式,Pass为5,80 kVp、自动毫安(范围40~400 mA),噪声指数16,0.5 s/r、螺距1.375∶1、视野32 cm,层厚5.0 mm、对5个序列扫描图像进行薄层0.625 mm,60%ASiR重建。对照组采用常规参数扫描:120 kVp,200 mA,0.5 s/r,螺距1.375∶1,层厚5.0 mm,薄层0.625 mm,采用传统滤波反投影法(FBP)进行图像重建;增强扫描采用人工智能触发扫描技术,阈值100 HU。使用非离子型对比剂优维显300,药量按1.5~2.0 ml/kg体重计算、注射流率0.4~1.0 ml/s,采用单筒高压注射器。MSCT扫描范围从胸廓入口至膈肌水平。记录每例患儿曝光剂量。所有图像传到GE AW 4.5工作站进行后处理重组;图像质量评估采用Likert 5分制(5分最好,1分最差,≥3分被认为临床可以接受)。结果两组图像质量评分达到诊断标准的比例为:研究组95%,对照组92.5%,两组比较无统计学差异(P均>0.05),但有效剂量分别为研究组(1.57±0.78)mSv,对照组(6.73±0.82)mSv,两组比较有明显统计学差异(P<0.01)。结论与常规扫描方法比较,基于ASiR平台的500排(VHS)扫描技术可以满足婴幼儿先天性心脏病的MSCT影像学诊断要求,同时可以大幅度降低辐射剂量达77%,值得临床推广应用。
Objective To investigate the application value of dynamic 500-row scanning technology (VHS) with adaptive statistical iterative reconstruction (ASiR) platform in the diagnosis of congenital heart disease in infants. Methods Eighty patients with suspected clinical congenital heart disease from August 2012 to January 2013 underwent MSCT enhanced scanning, including 48 males and 32 females, aged from 5 days to 12 months. The median age 4.3 months. According to each group of 40 cases were randomly divided into study group and control group. The inspection equipment uses a GE Healthcare Optima CT660 scanner. The scanning parameters of the study group were VHS scanning mode, Pass was 5,80 kVp, automatic milliampere (range 40 ~ 400 mA), noise figure 16,0.5 s / r, pitch of 1.375:1, field of vision 32 cm, Thin layer 0.625 mm, 60% ASiR reconstructions were performed on five sequential scan images. The control group was scanned with conventional parameters: 120 kVp, 200 mA, 0.5 s / r, pitch of 1.375:1, layer thickness of 5.0 mm and thin layer of 0.625 mm. The images were reconstructed by traditional filter backprojection (FBP) Smart trigger scanning technology, threshold 100 HU. The use of non-ionic contrast agent Wei significant 300, according to the amount of 1.5 ~ 2.0 ml / kg body weight, the injection rate of 0.4 ~ 1.0 ml / s, single cylinder high pressure syringe. The MSCT scan ranged from the thoracic inlet to the diaphragmatic level. Record each child exposure dose. All images were sent to the GE AW 4.5 workstation for post-processing recombination; image quality was assessed using Likert 5-point scale (5 is the best, 1 is the worst, and 3 is considered clinically acceptable). Results The proportions of the two groups were 95% in the study group and 92.5% in the control group. There was no significant difference between the two groups (P> 0.05), but the effective dose was 1.57 ± 0.78 mSv, the control group (6.73 ± 0.82) mSv, there was significant difference between the two groups (P <0.01). Conclusion Compared with the conventional scanning method, 500 rows (VHS) scanning technology based on ASiR platform can meet the requirements of MSCT imaging diagnosis of congenital heart disease in infants and young children, and can significantly reduce the radiation dose to 77%, which is worthy of clinical application.