【摘要】 目的 探讨能谱纯化、自动剂量调制（CARE DOSE 4D）与高级模型迭代重建算法（Advanced Modeled Iterative Reconstruction,ADMIRE）联合在儿童胸部超低剂量CT中的应用价值。方法 收集60例临床诊断肺炎行胸部低剂量CT的患儿，将其分为2组：对照组A组（常规低剂量CT,30例）和实验组B组（超低剂量CT,30例）。B组图像根据ADMIRE等级3、4、5重建获得B₁、B₂、B₃组。由2位医师对A、B₁、B₂、B₃组图像进行主观评价。分别测量、记录并计算每组图像客观数据、辐射剂量数据和图像品质因子（Fiure of Merit,FOM），同时进行统计学分析。结果 主观上，所有组图像主观评分均>1分，可接受度>90%，满足诊断，组间差异有统计学意义（P<0.001），仅A组和B₃组、B₁组和B₂组差异无统计学意义（P>0.05）。客观上，肌肉和肺组织平均CT值各组间差异无统计学意义（P>0.05），肌肉平均SD值、肌肉总平均SD值(SD_肌肉)、信噪比（Signal to Noise Ratio,SNR）、对比噪声比（Contrast to Noise Ratio,CNR）、FOM组间总体差异有统计学意义（P<0.001），仅A组与B₃组在肌肉平均SD值、SD_肌肉、SNR、CNR上差异无统计学意义（P>0.05）。4组FOM值呈递增趋势，B₃组最高。B组剂量长度乘积最低至2.2 mGy·cm、有效辐射剂量最低至0.04 mSv，辐射剂量较A组下降82.4%。结论 能谱纯化、CARE DOSE 4D与ADMIRE联合在优化儿童胸部CT图像质量满足诊断的同时，可显著降低辐射剂量，具有重要临床应用价值。更多还原

【Abstract】 Objective To evaluate the value of combining spectral shaping, automatic tube current modulation（CARE Dose 4D）, and the advanced modeled iterative reconstruction algorithm（ADMIRE） for ultra-low-dose chest CT in children. Methods 60 children clinically diagnosed with pneumonia and undergoing chest low-dose CT were enrolled. They were divided into two groups: control group A（conventional low-dose CT, n=30） and experimental Group B（ultra-low-dose CT, n=30）. Images of group B were reconstructed using ADMIRE levels 3, 4, and 5, yielding subgroups B₁, B₂, and B₃. Two radiologists independently performed subjective evaluations of images from groups A, B₁, B₂, and B₃. Objective image parameters, radiation dose metrics, and the figure of merit（FOM） were measured, recorded, calculated, and statistically analyzed. Results Subjectively, All groups had subjective scores >1, acceptance rate >90%, meeting diagnostic requirements. Inter-group differences were significant（P<0.001）, with no significant difference only between group A and B₃, and between group B₁ and B₂（P>0.05）. Objectively, mean CT values of muscle and lung tissue showed no significant differences among groups（P>0.05）. Significant overall differences existed among groups for muscle mean SD of muscle, overall mean SD of muscle(SD_muscle), signal to noise ratio（SNR）, contrast to noise ratio（CNR）, and FOM（P<0.001）. Pairwise comparisons revealed no significant difference only between group A and B₃ for mean SD of muscle, SD_muscle, SNR, and CNR（P>0.05）. FOM values progressively increased across the four groups, with Group B₃ having the highest. Dose in group B was significantly lower, with dose-length product reaching a minimum of 2.2 mGy·cm and effective dose a minimum of 0.04 mSv, representing an 82.4% reduction compared to group A. Conclusion The combined application of spectral shaping, CARE Dose 4D, and ADMIRE significantly reduces radiation dose while optimizing image quality to meet diagnostic requirements for pediatric chest CT, demonstrating substantial clinical value.更多还原