采用256层螺旋CT对冠状静脉系统定量研究

发布时间：2018-08-02 17:55

【摘要】：第一部分采用256层螺旋CT对冠状静脉正常解剖结构的评价目的:采用256层螺旋CT定量分析成人正常冠状静脉窦解剖结构及显示率,并分析与性别、年龄的相关性。方法:选择200例怀疑临床冠心病或体检行256层CT螺旋冠状动脉CTA检查的患者,并显示冠状动脉无病变,并符合入组条件的患者,其中男性92例,女受检者108例,平均年龄为(56.35±10.83)岁;对冠脉CTA原始扫描数据进行心脏舒张期78%时相图像重建,观察冠状静脉窦(coronary sinus,CS)、后室间静脉(the Posterior inter—ventricular vein,PIV)、左心室后静脉(Posterior vein of the left ventricle,PVLV)、左边缘静脉(the leftmarginal vein,LMV)、心大静脉(greatcardiac vein,GCV)、前室间静脉(anterior inter—ventricular vein,AIV),心小静脉(small cardiac vein,SCV)、马歇尔静脉(Marshall vein)的走行、解剖结构及显示率,并按照性别分组,分为男性组及女性组;按照年龄分组,分为三组20~40岁,40~60岁,60岁;并观察冠状静脉解剖结构、显示率与性别、年龄的相关性。结果:1心大静脉(GCV)、冠状静脉窦(CS)、后室间静脉(PIV)、前室间静脉(AIV)在所有的病例中100%显示。左心室后静脉(PVLV)显示率为90.5%(181/200),左边缘静脉(LMV)显示率为71.5%(144/200),心小静脉的显示率为19%(38/200)。2左心室后静脉(PVLV)与左边缘静脉(LMV)汇入点变异较大。3各属支显示率与性别无明显相关性(P0.05)。4对不同年龄组20~40岁,40~60岁,60岁冠状静脉解剖及显示率比较,三组间差别无明显统计学意义(P0.05)。结论:采用256层螺旋CT冠状静脉成像可以客观显示冠状静脉走行、解剖及其与周围组织的关系,后者为临床成功实行心脏介入手术提供了重要参考价值。第二部分采用256层螺旋ct对冠状静脉正常值定量分析目的:采用256层螺旋ct定量测量正常成人冠状静脉窦、主要属支径线、截面积,并分析与性别、年龄的相关性。方法:选择81例可疑冠心病或体检行256层螺旋冠状动脉cta检查并显示冠状动脉无病变,并符合入组条件的患者男性37例,女性44例,平均年龄(54.02±13.39)岁;冠脉cta检查结果均未发现冠状动脉病变及其它心脏疾病的患者,对各患者的原始图像进行多期重建,选取心脏舒张中末期图像重建,并定量测量冠状静脉主要属支径线、截面积,并对各测量值与性别、年龄组进行统计学分析。结果:1定量测量心大静脉(gcv)、冠状静脉窦(cs)、后室间静脉(piv)、左心室后静脉(pvlv)、左边缘静脉(lmv),心小静脉径线、截面积,对男女不同性别进行比较,两者差别无统计学意义(p0.05);281例患者按照年龄分组分成三组为a(≤45岁)、b(45岁-65岁)、c(≥65岁)三组,心大静脉(gcv)、冠状静脉窦(cs)、后室间静脉(piv)、左心室后静脉(pvlv)、左边缘静脉(lmv),心小静脉径线、截面积定量测量,不同年龄组间进行比较,三组间冠状静脉及属支径线及截面积无明显差别(p0.05);3冠状静脉窦上下径、面积、直径、前后径,后室间静脉、左室后支静脉、左边缘支直径,后室间静脉、左室后支静脉、左边缘支面积95%参考值范围分别为:11.67~12.84mm,49.82~72.66mm2,7.85~9.30mm,7.90~9.54mm;2.51~3.37mm,2.90~3.56mm,1.92~2.39mm,5.72~10.31mm,6.86~10.72mm,3.12~4.92mm2。结论:采用256层螺旋ct冠状静脉成像可客观定量测量冠状静脉主要属支径线、冠状静脉截面积,为临床成功实行心脏介入手术提供了重要影像参考价值。第三部分采用256层螺旋ct对冠状动脉单支重度狭窄患者冠状静脉定量研究目的:应用256层螺旋ct对冠状动脉单支重度狭窄患者冠状静脉定量测量,并与正常对照组比较,观察冠状动脉疾病与冠状静脉系统关系。方法:回顾性分析在我院进行冠状动脉CTA检查的121例,对照组64例,所选病例冠状动脉均无异常,符合入组标准;单支冠状动脉重度狭窄组57例,将所有患者影像原始数据,进行后处理,采用血管分析软件定量测量心大静脉(GCV)、冠状静脉窦(CS)、后室间静脉(PIV)、心室后静脉(PVLV)、左边缘静脉(LMV)、心小静脉(SMV)入口处的口径与截面积大小,比较冠脉正常组及冠脉狭窄组冠状静脉显示率、冠状静脉CT定量数据,观察两组间有无统计学差别;同时将病变组按照年龄分组分为两组60岁与≤60岁两组,对不同年龄组间进行统计分析。结果:1冠脉正常组与冠脉狭窄组中,心大静脉(GCV)、冠状静脉窦(CS)、后室间静脉(PIV)、前室间静脉(AIV)显示率均为100%。左心室后静脉(PVLV)在冠脉正常组与冠脉狭窄组的显示率分别为93.75%(60/64)、82.46%(47/57);左边缘静脉(LMV)在冠脉正常组与冠脉狭窄组的显示率59.38%(38/64)、63.16%(36/57)。2冠状静脉窦(CS)前后径及上下径、后室间静脉(PIV)、左边缘静脉(PVLV)入口处的径线与截面积测量值在冠状动脉正常组与存在单支冠状动脉狭窄组间比较无明显差别(P0.05)。3冠脉狭窄组中60岁以上年龄组的冠状静脉窦的前后径测量值大于≤60岁的年龄(P=0.017),冠状静脉窦的上下径测量值大于≤60岁的年龄组(P=0.001),在冠状静脉属支的截面积及径线测量中差别无统计学意义(P0.05)。结论:采用256层螺旋CT可以客观显示冠状动脉及冠状静脉,单支冠状动脉狭窄对冠状静脉显示及径线无明显影响,后者对临床冠状静脉相关手术具有重要临床价值。
[Abstract]:The first part was used to evaluate the normal anatomical structure of coronary vein with 256 slice spiral CT. 256 layers of spiral CT were used to quantitatively analyze the anatomical structure and display rate of normal coronary sinus in adults, and to analyze the correlation with sex and age. Methods: 200 patients with suspected clinical coronary heart disease or 256 layer of CT spiral coronary artery CTA examination were selected. There were no lesions in the coronary artery, and the patients were conformed to the conditions of the group, of which 92 were male and 108 in women, with an average age of (56.35 + 10.83) years. The original coronary CTA scan data were reconstructed for 78% hours of cardiac diastolic phase, and the coronary sinus (coronary sinus, CS) and the posterior interventricular vein (the Posterior inter - ventricular VE) were observed. In, PIV), the left ventricular posterior vein (Posterior vein of the left ventricle, PVLV), the left marginal vein (the leftmarginal vein), the great vein of the heart, the vein of the interventricular vein, the vein of the heart, and the anatomy and display of the Marshall vein. The rates were divided into male and female groups according to gender groups. According to age group, three groups of 20~40 years, 40~60 years old and 60 years old were divided into three groups. The anatomical structure of coronary veins was observed and the correlation between sex and age was observed. Results: 1 heart vein (GCV), coronary sinus (CS), posterior interventricular vein (PIV), and interventricular vein (AIV) in all cases were found in all cases. The rate of left ventricular posterior vein (PVLV) was 90.5% (181/200), the left marginal vein (LMV) showed 71.5% (144/200), and the display rate of the venule of the heart was 19% (38/200).2 left ventricular posterior vein (PVLV) and the left marginal vein (LMV) remittance. There was no significant correlation between the display rate and sex (P0.05).4 (P0.05).4 on the different age groups. There was no significant difference between the three groups at the age of 60 years. There was no significant difference between the three groups (P0.05). Conclusion: the use of 256 slice spiral CT coronary vein imaging can objectively show the coronary vein, dissection and its relationship with the surrounding tissue. The latter provides an important reference value for the successful implementation of cardiac interventional operation. Second parts. Quantitative analysis of the normal coronary vein by 256 slice spiral CT: 256 layers of spiral CT were used to measure the coronary sinus of normal adults, the main branch line, the sectional area, and the correlation with sex and age. Methods: 81 cases of suspected coronary artery disease or physical examination were selected for 256 spiral coronary artery CTA examination and showed no coronary artery disease. There were 37 male patients and 44 women with an average age of (54.02 + 13.39) years of age. No coronary artery lesions and other heart diseases were found in the coronary CTA examination. The original images of the patients were rebuilt, the end diastolic image reconstruction was selected, and the main branch line of the coronary vein was measured. Cross-sectional area, and statistical analysis of the measured values and sex, age group. Results: 1 GCV, CS, posterior interventricular vein (PIV), left ventricular posterior vein (pvlv), left marginal vein (LMV), small vein line of the heart, cross sectional area were compared, and there was no statistical difference between the two sexes (P0.05); (P0.05); The patients were divided into three groups according to age group: a (< 45 years old), B (45 year old -65 years), three groups of C (65 years old), cardiac vein (GCV), coronary sinus (CS), posterior interventricular vein (PIV), left ventricular posterior vein (pvlv), left marginal vein (LMV), small vein diameter of heart, comparison between different age groups, coronary veins and branch diameter between the three groups There was no significant difference between line and section area (P0.05); 3 the upper and lower diameter of coronary sinus, area, diameter, anterior and posterior diameter, posterior interventricular vein, left posterior branch vein, left marginal branch diameter, posterior interventricular vein, left posterior vein, and left marginal branch area of 95% reference range were respectively: 11.67~ 12.84mm, 49.82~72.66mm2,7.85~9.30mm, 7.90~9.54mm; 2.51~3.37mm, 2.90~3.56mm 1.92~2.39mm, 5.72~10.31mm, 6.86~10.72mm, 3.12~4.92mm2. conclusion: 256 slice spiral CT coronary vein imaging can be used to objectively and quantitatively measure the main branch line of the coronary vein, the coronary vein section area, and provide the important image reference value for the successful implementation of cardiac interventional operation. The third part uses 256 slice spiral CT to single coronary artery. Coronary vein quantitative study in severe stenosis patients: quantitative coronary vein measurement with 256 slice spiral CT for patients with severe coronary artery stenosis, and compared with normal control group, the relationship between coronary artery disease and coronary vein system was observed. Methods: retrospective analysis of 121 cases of coronary artery CTA examination in our hospital and 64 cases in control group. There were no abnormal coronary arteries in the selected cases, which were in line with the standard of entry group; 57 cases of single coronary artery stenosis group were treated with the original data of all the patients. The large vein (GCV), the coronary sinus (CS), the posterior interventricular vein (PIV), the posterior ventricular vein (PVLV), the left marginal vein (LMV), and the venule (SMV) were measured by the software of blood vessel analysis. The diameter of the entrance and the size of the sectional area were compared with the coronary venous display rate of the normal coronary artery and the coronary stenosis group and the quantitative data of the coronary vein CT. There were no statistical differences between the two groups. At the same time, the group was divided into two groups, 60 and 60 years old and two groups according to the age group, and the results were statistically analyzed between the groups of different age groups. Results 1 the normal coronary artery group and the normal group were analyzed. In the coronary stenosis group, the cardiac vein (GCV), the coronary sinus (CS), the posterior interventricular vein (PIV) and the interventricular vein (AIV) showed the 100%. left ventricular posterior vein (PVLV) in the normal coronary and coronary stenosis groups, respectively, 93.75% (60/64), 82.46% (47/57), and the left marginal vein (LMV) was 59.3 in the normal coronary and coronary stenosis group. 8% (38/64), 63.16% (36/57).2 (36/57).2 coronary sinus (CS) diameter and upper and lower diameter, posterior interventricular vein (PIV), left marginal vein (PVLV) at the entrance of the diameter and cut area measured between the normal coronary artery group and the existence of single coronary stenosis group no significant difference (P0.05).3 coronary stenosis group in the group of 60 years of age over 60 years of age group coronary sinus The measured values of the anterior and posterior diameter were greater than the age of 60 years (P=0.017). The measurements of the upper and lower diameters of the coronary sinus were greater than those of the age group of 60 years (P=0.001). There was no significant difference in the measurement of the sectional area and diameter of the coronary vein branch (P0.05). Conclusion: the 256 slice spiral CT can be used to objectively display the coronary and coronary veins and single coronary artery. Stenosis has no significant effect on coronary vein display and diameter, and the latter has important clinical value for clinical coronary vein related surgery.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R816.2

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