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- 探討256切電腦斷層血管攝影於冠狀動脈繞道術後評估之輻射劑量與影像品質研究:比較前瞻性與回顧性心電閘控掃描技術
- 64切與256切電腦斷層血管攝影於冠狀動脈繞道術後評估之輻射劑量與影像品質研究
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題名 | 探討256切電腦斷層血管攝影於冠狀動脈繞道術後評估之輻射劑量與影像品質研究:比較前瞻性與回顧性心電閘控掃描技術=Assessment of Image Quality and Radiation Dose for Following Bypass Surgery with 256-slice Cardiac CT Angiography: Comparison of Retrospective Gating vs. Prospective Triggering Techniques |
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作者 | 邱芳瑜; 楊志明; 陳良光; 蘇誠道; 羅偉業; 李正輝; 李易濰; 呂坤木; Chiu, Fang-yu; Yang, Jhih-ming; Chen, Liang-kuang; Su, Cheng-tau; Law, Wei-yip; Lee, Cheng-hui; Lee, Yi-wei; Lu, Kun-mu; |
期刊 | 中華放射線技術學雜誌 |
出版日期 | 20140600 |
卷期 | 38:2 2014.06[民103.06] |
頁次 | 頁77-86 |
分類號 | 415.3161 |
語文 | chi |
關鍵詞 | 電腦斷層冠狀動脈攝影; 冠狀動脈繞道手術; 回顧性心電閘控; 前瞻性心電閘控; CT coronary angiography; Coronary artery bypass graft; Retrospectively gated helical; Prospectively gated axial; |
中文摘要 | 冠狀動脈繞道手術(coronary artery bypass grafting, CABG)經常用於三條血管阻塞或左主幹冠脈狹窄之重症患者以恢復其心肌灌注。隨著電腦斷層(CT)的進步,電腦斷層冠狀動脈攝影(computed tomography coronary angiography, CTCA)己能非常準確偵測繞道血管的狹窄。而使用256切CT對CABG血管之完整評估,目前極少有文獻討論。我們回顧醫院數據庫,搜尋自2011年1月至2011年6月間曾接受CABG並做CTCA之患者;選定連續29例病患。本研究分析58條繞道血管和269段繞道血管節段;其中18位病人使用回顧性心電閘控技術(retrospectively ECG-gated helical, RGH),其平均心率為66.28次/分鐘;11位病人使用前瞻性心電間控(prospectively ECG-gated axial, PGA)技術,其平均心率為59.45次/分鐘。繞道血管的影像品質使用五等級評分,從1分(最好)到5分(無法診斷)評每節段(近端吻合處、近端區、中端區、遠端區、遠端吻合處);同時也比較兩技術之輻射劑量。依統計分析結果顯示,兩群組之病人特性相似;除了管電流和影像雜訊外,兩群組使用相似CT掃描參數。兩群體的影像品質皆好,且沒有無法評估節段。採行PGA技術之群組其影像品質優於RGH群組,分別是1.51 ± 0.54和1.72 ± 0.63(p = 0.01),且其有效劑量(8.83 ± 1.63 mSv)低於RGH群組(26.65 ± 5.01 mSv)(p < 0.001),可減少約67%劑量。足以顯示,使用256切CT於CABG追蹤,PGA比RGH技術能減少輻射劑量,同時維持好的繞道血管影像品質。 |
英文摘要 | Coronary artery bypass grafting (CABG) is frequently performed in order to restore myocardial perfusion in patients with severe three-vessel disease or left main coronary artery stenosis. With advances in the technology of computed tomography (CT), Computed tomography coronary angiography (CTCA) is highly accurate in the detection of graft stenosis. However, a thorough assessment on the effects of wide-coveraged 256-slice CT for coronary artery bypass grafts has not been well addressed. We reviewed the hospital database for patients with prior coronary bypass surgery who received CTCA from January 2011 to June 2011 and selected 29 consecutive patients. This study included 58 grafts with 269 segments in 29 patients who received CTCA; 18 patients having mean heart rate (HR) of 66.28 were imaged with retrospectively ECG-gated helical (RGH) CTCA and 11 patients having mean HR of 59.45 were imaged with prospectively ECG-gated axial (PGA) CTCA. The image quality of the bypass grafts was assessed by a 5-point scale (1 = excellent to 5 = non-diagnostic) for each segment (proximal anastomosis, proximal, middle, distal course of graft body, and distal anastomosis). Radiation doses of the techniques were also compared. Based on statistical analysis, patient characteristics of the 2 groups were well matched, and the similar CT scan parameters were used for both, except for tube current, and image noise index. In both groups, over 90% of segments received excellent or good imaging scores and none was non-evaluative. Image quality scores for PGA group were better than for RGH group (1.51 ± 0.54 vs 1.72 ± 0.63; p = 0.01), and the effective radiation dose was significantly lower in the prospective (8.83 ± 1.63 mSv) than in the retrospective gating group (26.65 ± 5.01 mSv) (p < 0.001) with a 67% reduction. In conclusion, following bypass surgery, 256-slice CT angiography using PGA technique is superior to RGH technique in limiting the radiation dose and obtaining better image quality of bypass grafts. |
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