Tesis

Perbandingan Kualitas Gambar Antara Rekonstruksi Monoenergi dan Rekonstruksi Standar Spectral CT dalam Menilai Stenosis Arteri Ekstremitas Bawah pada Pasien Peripheral Arterial Disease Di RSUPN Cipto Mangunkusumo.

Latar Belakang: Peripheral Arterial Disease (PAD) merupakan penyakit vaskular tersering ketiga. Penilaian derajat stenosis penting untuk menentukan tatalaksana. CTA dengan Spectral CT dan rekonstruksi monoenergi (VMI) berpotensi meningkatkan kualitas citra dibandingkan rekonstruksi standar. Tujuan: Membandingkan kualitas citra (SNR, CNR) dan penilaian derajat stenosis arteri ekstremitas bawah antara rekonstruksi standar dan VMI. Metode: Studi potong lintang berpasangan pada 31 pasien PAD yang menjalani Spectral CT di RSUPN Dr. Cipto Mangunkusumo. Dilakukan pengukuran SNR, CNR, dan derajat stenosis pada arteri iliaka, femoral, dan tibial. Analisis dengan uji Wilcoxon rank (p < 0,05). Hasil: VMI meningkatkan signifikan nilai SNR dan CNR pada semua segmen arteri (p=0,000). Tidak ada perbedaan bermakna derajat stenosis (p > 0,05). Skor subjektif radiolog lebih tinggi pada VMI (Likert 4,6–4,8) dibanding standar (Likert 4,1–4,2). Kesimpulan: Rekonstruksi monoenergi Spectral CT meningkatkan kualitas citra CTA ekstremitas bawah tanpa memengaruhi pengukuran stenosis, sehingga berpotensi menjadi metode tambahan evaluasi PAD.
Kata kunci: PAD, CTA, Spectral CT, monoenergi, SNR, CNR, stenosis


Background: Peripheral Arterial Disease (PAD) is the third most common vascular disease. Stenosis assessment is essential for management. Computed Tomography Angiography (CTA) with Spectral CT and virtual monoenergetic imaging (VMI) may improve image quality compared to standard reconstruction. Objective: To compare image quality (SNR, CNR) and agreement of stenosis assessment between standard reconstruction and VMI in lower extremity CTA. Methods: A paired cross-sectional study was conducted on 31 PAD patients who underwent Spectral CT at Dr. Cipto Mangunkusumo National Hospital. SNR, CNR, and stenosis degree were measured in iliac, femoral, and tibial arteries. Data were analyzed using Wilcoxon rank test (p < 0.05). Results: VMI significantly improved SNR and CNR in all arterial segments (p=0.000). No significant difference was found in stenosis degree (p > 0.05). Subjective radiologist scores were higher for VMI (Likert 4.6–4.8) than standard (Likert 4.1–4.2). Conclusion: Spectral CT VMI significantly enhances lower extremity CTA image quality without affecting stenosis measurement and may be considered as an additional non-invasive method in PAD evaluation.
Keywords: PAD, CTA, Spectral CT, monoenergetic reconstruction, SNR, CNR, stenosis.