|
综述：CT血管造影（CTA）20年的发展之路（连载六）：CT血管造影术对于临床的贡献：冠脉疾病的CT血管造影
作者：Geoffrey D. Rubin, MD 作者单位：Duke Clinical Research Institute, 2400 Pratt St 本文发表于：Radiology: Volume271: Number 3—June 2014 radiology.rsna.org 翻译：张杰；校对：张帅、陆伟；整理：梁军
上期回顾： 本综述从以下两个方面：1）主动脉腔内支架植入术2）经导管主动脉瓣植入术（TAVI），来探讨CT血管造影术对于主动脉腔内修复术方面的临床应用和价值。
本期内容： 短短20年的时间，CT血管造影已从一个新兴的成像方式，演变为一个关键的临床工具，在体内几乎所有血管性疾病的诊断和治疗中起着主导的作用。本期内容着重从冠脉疾病的CT血管造影，从临床价值、对特异性心肌缺血、辐射剂量等方面进行总结和探讨。最后，讲列举CT血管造影（CTA）20年发展之路的系列连载的参考文献。
关注辐射
Concerns for Radiation
对于由CT利用率增加带来的潜在风险，普通出版物和专业文献中对此的关注度也在推进。这些关注主要集中在辐射& #40;112& #41;，特别是对儿童& #40;113& #41;。然而，依然有大量的不确定性存在于医学成像时由辐射所诱发癌症的随机风险。根据现有证据，一个成年人，医学成像的有效剂量在短时间时间内低于50 毫西弗（mSv）单个程序或100毫西弗（mSv）的多个程序，其风险很可能过低而不被流行病学检测发现，或可能是不存在的& #40;114& #41;。 Concerns have been advanced in the lay press and the professional literature regarding potential risks arising from the growthin CT utilization. These concerns have focused onradiation exposure principally & #40;112& #41;, particularly in children & #40;113& #41;. Nevertheless, large uncertainties remain regarding the stochastic risk of cancer induction from radiation at medical imaging. According to current evidence,across an adult population, risks of medical imaging at effective doses below 50 mSv for single procedures or 100 mSv for multiple procedures over short time periods are likely too low to be epidemiologically detectable and may benonexistent & #40;114& #41;.
然而，由于这些不确定性，医学影像必须始终保持警觉以确保医疗成像程序被用于适当的指征和采用最低的辐射剂量，即获得必要的临床信息以至于成像的风险不超过因其而来的好处和在最低允许剂量下扫描（115）。 However, because of these uncertainties, imagers must alwaysremain vigilant to assure that medical imaging procedures are performed forappropriate indications and conducted at the lowest radiation dose thatdelineates the necessary clinical information so that the risks of imaging donot exceed their benefits and scans are performed with the lowest dose allowable & #40;115& #41;.
这些原则的实现是由于CT技术的最新进展，特别是迭代重建算法的重新引入和改良代替了背投影过滤法& #40;116& #41;，这大幅地减少了CT血管造影术的辐射剂量，并将继续做进一步改良和发展& #40;117& #41;。 The realization of these principles is aided by recent advances in CT technology, particularly the reintroduction and refinement of iterative reconstruction as a substitute for filtered back projection & #40;116& #41;, which have reduced the radiation exposure associated with CT angiography substantially and should continue to do so as further refinements evolve & #40;117& #41;.
总结 Summary
在短短的20年里，CT血管造影已从一个新兴的成像方式，无法涵盖大多数血管领域，演变为一个关键的临床工具，在体内几乎所有血管性疾病的诊断和治疗中起着主导的作用。CT的采集和图像处理技术的科技发展促使伟大的创新和重要的发现，没有迹象表明这种趋势会放缓。事实上新的CT扫描仪形态的演变发展，替代性的原始数据重建策略，和成熟的后处理技术为CT血管造影术的进一步发展铺平了道路，在预测心血管病变的临床重要性和指导它们的有效治疗方面提供更多的关联性。 Over a short 20-year span, CT angiography has evolved from a fledgling imaging modality, incapable of encompassing most vascular territories, to a critical clinical tool that plays a dominant role in the diagnosis and management of disease within virtually every arterial bed in the body. While technological developments in CT acquisition and image processing techniques have enabled great innovation and important discovery, there is no sign of this trend slowing。 Indeed the evolution of novel CTscanner geometries, alternative raw data reconstruction strategies, and sophisticated post-processing techniques are paving the way for the further evolution of CT angiography to provide greater relevance in predicting the clinical importance of cardiovascular lesions and facilitating their effective management.
参考文献 References （请点击下方链接，查看本系列连载的所有参考文献） http://edu.gehealthcare.cn/thread/141
|
