先天性心脏病合并气道异常的影像学诊断方法研究

发布时间：2018-05-09 10:25

本文选题：儿童 + 低剂量　；参考：《上海交通大学》2015年博士论文

【摘要】：目的通过巴马小型猪计算机体层成像(CT),研究心脏CT低剂量扫描模式和扫描参数,优化低剂量扫描方案,进而探讨低剂量心脏CT在儿童先天性心脏病合并气道异常的应用价值。通过巴马小型猪磁共振(MRI)不同序列的气道成像,选择最佳显示气道MRI序列,进而探讨MRI气道成像及替代CT的可能性。材料与方法1,选取巴马小型猪4头,体重7.5至14.4kg,麻醉后进行心脏CT扫描。采用前门控及后门控扫描模式。在前门控扫描模式下,固定管电压于80KVp,调节管电流在60-180 mA,80%ASIR后重建算法。在后门控扫描模式下,固定管电压80KVp,根据心电图调控管电流模式,设置最大管电流范围80-220 mA,最小管电流范围20-45 mA,80%ASIR后重建算法。选取巴马小型猪2头,体重7.5至10.5kg,麻醉后进行磁共振气道扫描。扫描序列选取CE-MRA、3D-TFE和3D-B-TFE。2,选取323例先天性心脏病患儿行前门控低剂量心脏CT扫描。按体重分三组(0-5kg、6-10kg、11-15kg),连续入组,三个体重组固定管电压、采用二组不同管电流扫描条件,0-5kg组120 mA和300 mA,6-11kg组180 mA和300 mA、11-15kg组200-250 mA和300 mA。相同扫描条件下获取虚拟后门控剂量参数。3,选取357例先天性心脏病患儿行心脏MRI检查。全部病例行三维扰相梯度回波序(3D-TFE)扫描;其中46例患儿同时有CT检查结果做对比;26例病例同时行三维稳态梯度回波(3D-B-TFE)序列扫描,并有CT结果做对比。结果1,CT前门控模式与后门控扫描模式辐射剂量比较显示在相同的扫描参数及图像主观评分无差异的条件下前门控扫描辐射剂量明显低于后门控模式,两头实验猪辐射有效剂量分别下降了81%和77%;前门控心脏ct扫描模式其有效剂量均在亚毫西弗以内。在80kkvp、100ma低剂量扫描条件下大血管图像的主观评分较好(3.8-4.5分)。在显示气道图像质量方面,各扫描参数下主观评分均在4分以上。磁共振三个扫描序列在显示气道方面主观评分显示3d-tfe显示气道评分最高。2,三个体重组在同组扫描参数下(相同管电压和管电流),两位观察者对于大血管及气道图像主观评分均无显著性差异,一致性好(kappa值0.72-0.89;0.59-0.91)。同组不同扫描参数条件下(固定管电压、高低管电流调节),大血管图像观察者主观评分在0-5kg、6-10kg组中有统计学差异,但是低管电流组评分均在3.9-4.5分之间。11-15kg组间没有统计学差异;气道图像主观评分各组均无显示性统计差异。在同组不同扫描剂量条件下,对比噪声比无统计学差异。三个体重组同组高低扫描参数下有效剂量分别下降了64.3%、38.8%和32.9%。与虚拟后门控的辐射剂量比较,三组有效剂量间有显著的统计学差异,有效剂量分别下降了75%、79%和85%。323例先天性心脏病患儿中,非青紫型先天性心脏病与青紫型先天性心脏病的比例为2.3:1;术前病例占88.2%。非青紫型先天性心脏病中主要为简单的左向右分流先天性心脏病;青紫型先天性心脏病为圆锥动脉干畸形系列疾病为主。323例先天性心脏病合并气道异常83例,其中气道狭窄65例,气管性支气管13例,心房异构型支气管4例,气管反位1例。引起气管支气管狭窄的主要为主动脉畸形包括双主动脉弓、右位主动脉弓伴迷走左锁骨下动脉、左弓右降等。323例中214例手术治疗,心外大血管诊断准确率100%,心内缺损诊断准确率94%。3,357例行3d-tfe检查的先天性心脏病患儿中,92%(328/357)例为术前检查,8%(29/347)为术后随访。非青紫型先天性心脏病占71%(253/357),青紫型先天性心脏病占29%(104/357)。在357例检查中,27%(97/357)有气管支气管异常,包括气道狭窄66例,气管性支气管18例,10例心房异构型支气管,3例心房反位。与ct检查结果比较,3d-tfe和3d-b-tfe序列在显示气道上其敏感性、特异性、阳性预测值、阴性预测值、阳性似然比、阴性似然比分比分别为90%、84%、91%、5.6、0.1和80%、62%、71%、2.1、0.3。3D-TFE与CT检查结果一致性极好(Kappa 0.868)结论前门控扫描模式为心脏CT低剂量扫描方案的首选扫描模式,能实现亚毫西弗低剂量扫描,使得CT在儿童先天性心脏病合并气道异常中应用更加广泛。3D-TFE序列为目前MRI显示气道首选序列,MRI可以用来诊断先天性心脏病伴气道异常病变。
[Abstract]:Objective to study the low dose scanning mode and scanning parameters of the low dose of heart CT through the computer tomography (CT) of the Bama miniature pig, and to optimize the low dose scanning scheme, and to explore the application value of low dose cardiac CT in children with congenital heart disease with airway abnormality. Display the MRI sequence of airway, and then discuss the possibility of MRI airway imaging and replacement of CT. Material and method 1, select 4 Bama miniature pigs, weight 7.5 to 14.4kg, and carry out CT scan after anaesthesia. Using front door control and backdoor control scan mode. Under the front gate control mode, the fixed tube electric pressure is 80KVp, the regulating tube current is at 60-180 mA, 80%ASIR back weight. Under the backdoor control scanning mode, the fixed tube voltage was 80KVp, the maximum tube current range was 80-220 mA, the minimum tube current range was 20-45 mA, the 80%ASIR post reconstruction algorithm was set according to the electrocardiogram control tube current mode. The 2 Bama miniature pig was selected, the weight was 7.5 to 10.5kg, and the magnetic resonance airway scan was performed after the anesthesia. The scanning sequence selected CE-MRA, 3D-TFE And 3D-B-TFE.2, 323 children with congenital heart disease were selected in the front door controlled low dose cardiac CT scan. According to the weight of three groups (0-5kg, 6-10kg, 11-15kg), the group of three individuals recombined the fixed tube voltage, two groups of different tube current scanning conditions, 0-5kg group 120 mA and 300 mA, 6-11kg group 180 mA and 300 mA, 11-15kg 200-250, 200-250 and 300 sweeps were the same sweep. The virtual posterior gate controlled dose parameter.3 was obtained under the condition of drawing, and 357 children with congenital heart disease were selected for the cardiac MRI examination. All cases were scanned with three dimensional perturbation gradient echo sequence (3D-TFE); of which 46 cases were compared with the results of CT examination; 26 cases were simultaneously scanned with three dimensional steady ladder echo (3D-B-TFE) sequence and CT results were done. Compared with results 1, the CT front gate control mode and the backdoor control scan mode radiate dose show that under the same scanning parameters and the subjective score of the image, the front gated radiation dose is obviously lower than the back door control mode, and the effective dose of the two experimental pigs decreased by 81% and 77% respectively, and the front door controlled heart CT scan mode is the effective agent. The subjective score of the images of the large vessels was better (3.8-4.5) under the condition of 80kkvp, 100mA low dose scanning. The subjective scores of the scanning parameters were more than 4 in the image quality of the airway. The subjective score of the three scan sequences in the display of the airway showed that the score of the airway was the highest.2, three of the airway score, three Under the same group of scanning parameters (the same tube voltage and tube current), there was no significant difference between the two observer on the subjective score of the large vessels and the airway images (kappa value 0.72-0.89; 0.59-0.91). The subjective score of the large blood vessel image observer under the same group of scanning parameters (fixed tube voltage, high and low tube current regulation) was subjective score There were statistical differences in group 0-5kg and 6-10kg, but there was no statistical difference between the low tube current group and the.11-15kg group in the 3.9-4.5 score. There was no statistical difference in the subjective score of the airway image. The comparison of the contrast noise ratio under the same group of different scanning doses was not statistically different. The three individuals were effective under the high and low scanning parameters of the same group. The dose decreased by 64.3%, 38.8% and 32.9%., compared with the radiation dose of virtual backdoor control. There were significant differences in the effective dose between the three groups. The effective dose decreased by 75%. 79% and 85%.323 cases with congenital heart disease, the proportion of non blue purple congenital heart disease and purple congenital heart disease was 2.3:1; the preoperative cases accounted for 8. 8.2%. non blue purple congenital heart disease is mainly a simple left to right shunt congenital heart disease; purple congenital heart disease is mainly conical artery stem malformation disease series disease mainly.323 congenital heart disease combined with airway abnormality in 83 cases, including 65 cases of airway stenosis, 13 cases of tracheal tracheal tracheal tube, 4 cases of atrium isomer bronchus, and 1 tracheal reverse. Cases of tracheobronchial stenosis were mainly aortic malformation, including double aortic arch, right aortic arch with left subclavian artery, left arch and right subclavicular artery, 214 cases of.323 cases, 100% of the diagnosis of great vessels in the heart, and 92% of children with congenital heart disease with the accuracy of 94%.3357 routine 3d-tfe examination (328/3 57) preoperative examination, 8% (29/347) for postoperative follow-up. Non blue purplish congenital heart disease accounted for 71% (253/357), and purple congenital heart disease accounted for 29% (104/357). 27% (97/357) had tracheobronchial abnormality in 357 cases, including 66 cases of airway stenosis, 18 cases of tracheobronchial tube, 10 atrium isomer, 3 atrium reverse. And CT examination. The results were compared. The sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, negative likelihood ratio of 3d-tfe and 3d-b-tfe sequences were 90%, 84%, 91%, 5.6,0.1 and 80%, 62%, 71%, and 2.1,0.3.3D-TFE and CT were excellent conconformance (Kappa 0.868). Conclusion the front door controlled scan mode was low dose of cardiac CT scan. The preferred scanning mode of the drawing scheme can achieve low dose scans of submilsever, making CT more extensive.3D-TFE sequence used in children with congenital heart disease associated with airway abnormalities as the current MRI display of the first choice of the airway, and MRI can be used to diagnose congenital heart disease associated with abnormal airway disease.

【学位授予单位】：上海交通大学
【学位级别】：博士
【学位授予年份】：2015
【分类号】：R725.4

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