Head DE-CTA Technology And Its Preliminary Study Of The Clinical Application

Objective:To investigate the advantage and disadvantage of dual energy with dual-source CT in cerebral angiography through study of its technologic application and compared with Neuro-DSA.The value of clinical application of dual energy CTA was also explored by comparing with DSA.Material and Methods:From March,2008 to January,2009,250 patients(146 Males and 104 Females,ranged from 18 to 82 years old,mean age was 48 years old) enrolled in the First Affiliated Hospital of Kunming Medical College were performed dual energy scan(Group A,200 patients) and Neuro-DSA scan(Group B,50 patients) using DSCT.The patients were randomly divided into Group A and Group B.Regarding to the justification of scan protocol,100 patients in Group A were selected as sub-group to explore the scan protocol.The image quality Was analyzed both in four categories(4.0/60,4.5/60,4.0/70,4.5/70) of flow rate and total amount of contrast-enhanced material and in three categories(100—150HU,150—200HU,200-250HU) of CT value of left common carotid artery.The comparison of two scan approach was based on image quality,radiation does, postprocessing methods,time of scanning and subtraction and data storage amount.To validate the diagnostic capability of DE-CTA virtual unenhanced images,100 patients in Group A were undergoing head scan both in routine non-contrast program and DE-CTA virtual unenhanced program.Mean CT values,signal-to-noise ratio,image quality,sensitivity of lesion identification,and radiation does were applied to comparison.According to diagnostic results of dual energy of cerebral arterial angiography,62 patients out of 200 patients in Group A were confirmed with cerebral vessel lesions,the results were complied with DSA findings(the time between the two methods were within 1 week).Specifically,24 Aneurysm patients were further explored in location,numbers,shape,neck of Aneurysm, body of Aneurysm.Results:1.Image Qualities were not significantly different within four categories of contrast-enhanced material(P>0.05).The 60-70 ml total amounts of contrast-enhanced material in 4.0-4.5ml/S flow rate were acceptable.2.Within three categories of CT values of left common carotid artery,there was statistically significant difference(P<0.05) in three trigger CT value of left common carotid artery at Centrum 4's lower level.High image qualities were acquired in 100-200 HU categories.3.The image qualities of Group A were not significantly different from Group B's(P>0.05).In four grades, the number of cases having GradeⅠimage quality was higher than other three grades.4. Radiation does,time consume,data storage were statistically significant different between Group A and Group B(P<0.05),particularly,The time of enhanced scan in DE-CTA was longer than Neuro-DSA and the data storage were larger.However,the radiation does of DE-CTA was lower than Neuro-DSA's.the time of whole exam process and subtraction in DE-CTA were shorter than Neuro-DSA.5.Mean CT values,signal-to-noise ratio,image quality were statistically significant different between routine non-contrast program and DE-CTA virtual unenhanced program(P<0.05).Mean CT values,signal-to-noise ratio in routine non-contrast program were higer than DE-CTA virtual unenhanced program.As well as image quality.Therefore,all patients's image quality grades were upwards 3 score,it could meet the diagnosing requirement.However,the radiation does of DE-CTA was lower than routine non-contrast program's.6.sensitivity of lesion identification was no significant difference between routine non-contrast program and DE-CTA virtual unenhanced program. Only regarding to the calcify lesion,DE-CTA may not be emerging.7.62 patients's diagnostic results of DSA were not significantly different from DE-CTA's(P>0.05).8.The location,numbers,shape,neck of Aneurysm,body of Aneurysm of 24 Aneurysm patients were no significant difference between two examination(P>0.05).Conclusion:1.High image quality can be obtained 60-70ml total amount of contrast-enhanced materials in 4.0-4.5ml/s flow rate.2.Bolus tracking and manual trigger in region of interest(Centrum 4's lower level) can improve the high quality of image.3.There were no significant difference of image quality between DE-CTA and Neuro-DSA.Main cerebral vessels and details can clearly displayed in DE-CTA and Neuro-DSA.4.For patient's benefits,DE-CTA was recommended due to lower radiation does(about low 26.3%) employed.Since the shorter time of substraction and once scan enough in DE-CTA,moving-fake was omitted and the stability of examination was guaranteed.5.Multiple postprocessing methods ensured the image of DE-CTA to be clear,visible,direct,with splendid information for diagnosing.6.Virtual unenhanced image in DE-CTA could meet the diagnosing requirement.7.The capability of DE-CTA for diagnosing cerebral vessel lesions was not statistically different for DSA.Since there was no statistically difference between DE-CTA and DSA,DE-CTA can fulfill it's advantages in displaying location,numbers,shape,neck of Aneurysm,body of Aneurysm. DE-CTA can meet clinical diagnostic,interventional or surgical treatment requirements. 8.DE-CTA image can obtain the Cerebral angiography and the changes of brain tissue with once scan,it is superior to DSA.