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目的对儿童肺结核患者行低剂量螺旋CT扫描,并对图像质量进行评价。方法收集2006年4月1日至2011年4月30日确诊新发初治0～15岁的肺结核患者150例,所有患儿按年龄分为3组(Ⅰ组0～岁,Ⅱ组6～岁,Ⅲ组11～15岁),每组均按完全随机方式纳入,达50例终止,分别采用常规剂量[自动曝光控制技术(AECT)]和低剂量[恒定性管电流控制技术(CCCT)]方案扫描,作自身性前后图像对比,采取双盲法对图像质量作量化评价,验证各组肺结核患儿的低剂量CT图像质量[每项图像质量控制(简称“质控”)内容为五级,采用5分制,图像质量很好为5分,较好为4分,一般为3分,稍差为2分,差为1分]。恒定式管电压120kV,Ⅰ组AECT100mA,CCCT 20mA;Ⅱ组AECT 150mA,CCCT 30mA;Ⅲ组AECT 150mA,CCCT 40mA。结果 150例肺结核患儿不同低剂量方案螺旋CT扫描后评价结果:(1)肺窗显示的病灶范围、病灶密度、病灶清晰度、病灶中的细节、噪声大小5项质控内容:Ⅰ组CCCT 20mA平均得88.8(22.2±1.5)分,AECT 100mA平均得95.1(23.7±0.8)分,差异有显著统计学意义(t=7.9,P<0.001);Ⅱ组CCCT 30mA平均得97.2(24.2±0.9)分,AECT 150mA平均得98.2(24.7±0.5)分,差异无统计学意义(t=2.9,P>0.05);Ⅲ组CCCT 40mA平均得98.3(24.6±0.6)分,AECT 150mA平均得99.0(24.7±0.5)分,差异无统计学意义(t=1.7,P>0.05)。(2)纵隔窗显示的肌肉肋骨脂肪、肺门大血管、纵隔内食管与周围组织对比度、心房心室、下腔静脉5项图像质控内容:Ⅰ组CCCT 20mA平均得87.8(21.9±1.5)分,AECT 100mA平均得95.4(23.8±1.1)分,差异有显著统计学意义(t=7.2,P<0.001);Ⅱ组CCCT 30mA平均得97.0(24.2±0.8)分,AECT 150mA平均得98.7(24.5±0.5)分,差异无统计学意义(t=2.2,P>0.05);Ⅲ组CCCT 40mA平均得97.6(24.4±0.7)分,AECT 150mA平均得98.9(24.7±0.4)分,差异无统计学意义(t=2.7,P>0.05)。(3)肺结核病灶图像质量Ⅰ组CCCT 20mA平均得85.6(3.72±0.73)分,AECT 100mA平均得95.3(4.66±0.66)分,差异有显著统计学意义(t=9.34,P<0.001);Ⅱ组CCCT 30mA平均得96.0(4.56±0.54)分,AECT 150mA平均得98.8(4.74±0.44)分,差异无统计学意义(t=1.99,P>0.05);Ⅲ组CCCT 40mA平均得97.6(4.72±0.45)分,AECT 150mA平均得99.2(4.84±0.37)分,差异无统计学意义(t=1.66,P>0.05)。结论恒定式管电压120kV不变,使用0～岁组CCCT 20mA、6～岁组CCCT 30mA、11～15岁CCCT 40mA等不同低剂量螺旋CT扫描均能较好地诊断儿童肺结核。
Objective To perform low-dose spiral CT scan on children with pulmonary tuberculosis and evaluate the image quality. Methods A total of 150 newly diagnosed tuberculosis patients with newly diagnosed onset of 0 ~ 15 years old were collected from April 1, 2006 to April 30, 2011. All patients were divided into 3 groups according to their age (group Ⅰ 0 ~ year, group Ⅱ 6 ~ Year old, and 11 to 15 years old in group Ⅲ). Each group was enrolled in a completely randomized manner and 50 patients were terminated. The patients were divided into two groups by conventional dose (AECT) and low dose (CCCT) ] Program scan for self-contrast before and after the image, using double-blind method for quantitative evaluation of image quality to verify the low-dose CT images of children with tuberculosis in each group [for each image quality control (referred to as For the five, with 5 points system, the image quality is good for 5 points, preferably 4 points, usually 3 points, slightly less than 2 points, the difference is 1 point]. Constant tube voltage 120kV, group AECT 100mA, CCCT 20mA; group AECT 150mA, CCCT 30mA; group AECT 150mA, CCCT 40mA. Results The results of spiral CT scans of different low-dose regimens in 150 cases of tuberculosis patients were evaluated: (1) The range of lesion, lesion density, lesion definition, focal lesion detail and noise level in lung window showed that: 20mA averaged 88.8 (22.2 ± 1.5), AECT 100mA averaged 95.1 (23.7 ± 0.8), the difference was statistically significant (t = 7.9, P <0.001) ), AECT 150mA averaged 98.2 (24.7 ± 0.5) points, the difference was not statistically significant (t = 2.9, P> 0.05); Ⅲ CCCT 40mA average 98.3 (24.6 ± 0.6) points, AECT 150mA an average of 99.0 24.7 ± 0.5) points, the difference was not statistically significant (t = 1.7, P> 0.05). (2) 5 cases of muscle rib fat, hilar large vessels, contrast media of the mediastinum and surrounding tissues, atrial ventricle and inferior vena cava in mediastinum window. Contents of CCCT 20mA in group Ⅰ averaged 87.8 (21.9 ± 1.5) points , AECT100mA averaged 95.4 (23.8 ± 1.1), the difference was statistically significant (t = 7.2, P <0.001); CCCT 30mA in group Ⅱ averaged 97.0 (24.2 ± 0.8) points, AECT 150mA averaged 98.7 (24.5 ± 0.5), the difference was not statistically significant (t = 2.2, P> 0.05); CCCT 40mA in group Ⅲ averaged 97.6 (24.4 ± 0.7) points, and AECT 150mA averaged 98.9 (24.7 ± 0.4) points, with no statistical difference Significance (t = 2.7, P> 0.05). (3) The CTCT 20mA averaged 85.6 (3.72 ± 0.73) points and the AECT 100mA average 95.3 (4.66 ± 0.66) points in group Ⅰ, the difference was statistically significant (t = 9.34, P <0.001) The CCCT 30mA averaged 96.0 (4.56 ± 0.54) points and the AECT 150mA averaged 98.8 (4.74 ± 0.44) points, the difference was not statistically significant (t = 1.99, P> 0.05) 0.45), AECT 150mA averaged 99.2 (4.84 ± 0.37) points, the difference was not statistically significant (t = 1.66, P> 0.05). CONCLUSIONS: The constant tube voltage of 120 kV is constant. CTCT of 20mA in 0 ~ group, CCCT of 30mA in 6 ~ group and CCCT 40mA of 11 ~ 15 years old can all be used to diagnose pediatric pulmonary tuberculosis.