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目的探讨阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome,OSAHS)上气道螺旋CT低剂量扫描的临床价值。方法将120例OSAHS患者采用简单随机法均分为实验组和对照组,2组均行上气道平静呼吸、深吸气末、深呼气末、闭口堵鼻深吸气四个呼吸时相扫描。实验组管电流使用低剂量50 m A,对照组常规剂量360 m A。记录2种剂量的容积CT剂量指数(CTDIvol)、剂量长度积(DLP)和有效剂量(effective dose,E)值。在舌体相同位置进行感兴趣区(region of interest,ROI)CT值测量,并记录每组剂量下CT值和标准差(SD)。双盲法主观评价各组图像质量并给予优、良、差分级,相关数据行统计学处理。结果实验组和对照组扫描长度差异无统计学意义(t=7.23,P=0.479),DLP、E值的比较差异有统计学意义(t=108.252,P=0.000),CTDIvol、DLP、E值实验组比对照组降低87.5%。信噪比的比较,实验组SNR值为6.31±1.75,对照组SNR值为10.17±3.13,t=3.19,P=0.006,实验组SNR明显降低。实验组SD值为25.74±2.61,对照组SD值为1.70±0.17,2组噪声比较,实验组噪声明显增大(t=29.022,P<0.001)。主观评判对照组图像质量以优为主,实验组图像质量以良为主,仅3例为差级图像,故基本不影响测量和诊断。结论 OSAHS上气道50 m A低剂量CT扫描能够大幅度降低辐射剂量,且不影响上气道的测量与诊断,具有实际临床应用价值。
Objective To investigate the clinical value of low-dose airway spiral CT in obstructive sleep apnea hypopnea syndrome (OSAHS). Methods 120 cases of OSAHS patients were divided into experimental group and control group by simple randomized method. The two groups were performed the upper airway calm breathing, deep inspiration end, deep expiratory end of breath, scanning. Experimental tube current use low dose 50 m A, control group conventional dose 360 m A. Volumetric CT dose index (CTDIvol), dose length product (DLP) and effective dose (E) values were recorded for 2 doses. The CT value of region of interest (ROI) was measured at the same position of the tongue, and the CT value and standard deviation (SD) of each group were recorded. Double blind method of subjective evaluation of each group of image quality and give excellent, good and bad grades, the relevant data line statistics. Results There was no significant difference in the length of the scan between the experimental group and the control group (t = 7.23, P = 0.479). The differences of DLP and E were statistically significant (t = 108.252, P = 0.000) Experimental group than the control group decreased 87.5%. The SNR of the experimental group was 6.31 ± 1.75, the SNR value of the control group was 10.17 ± 3.13, t = 3.19, P = 0.006, the SNR of the experimental group was significantly reduced. The SD value of the experimental group was 25.74 ± 2.61, the SD value of the control group was 1.70 ± 0.17, the noise of the experimental group was significantly increased (t = 29.022, P <0.001). The quality of the subjective evaluation of the control group was excellent, while that of the experimental group was mainly of good quality. Only 3 cases were differential images, so it did not affect the measurement and diagnosis. Conclusion The 50 m A low-dose CT scan of the upper airway of OSAHS can significantly reduce the radiation dose without affecting the measurement and diagnosis of the upper airway, and has practical clinical value.