高压电损伤肢体256层螺旋CT灌注成像的应用研究
发布时间：2018-07-29 17:04
【摘要】：目的探索256层螺旋CT灌注成像技术对于高压电后四肢损伤的应用价值。 材料与方法选择高压电损伤患者53例,其中接受四肢灌注检查者48例,常规四肢CTA检查者5例。按照手术后截肢与否,将48例接受四肢灌注检查者分为截肢组14例及未截肢组34例。将MSCTP检查结果(肌肉微循环灌注信息及相应部位血管CTA图像)与手术、病理对照,以及进行自身、双侧对照。将灌注所得图像传入Phillips公司专属EBW工作站,用Functional CT-general模式行灌注图像处理。(1)从灌注扫描结果中,选择最佳时相提取CTA图像,采用MPR、 CPR、VR、MIP及高级血管分析(advantage vessel analysis, AVA)软件进行分析,获得相应部位的血管图像；(2)截肢组及未截肢组中选定兴趣区即得到包含血流灌注(BF),峰值增强(PEI),达峰时间(TTP),血容量(BV)的伪彩图、具体量化数值及时间密度曲线(TDC)。53例均进行血管等形态学分析,截肢组、未截肢组48例进行t检验,其中对截肢组另外进行判别分析,以比较各组肢体各部位灌注参数的差异。 结果1、高压电损伤后肌肉、皮肤及骨骼CT表现患者肌肉损伤在CT平扫、增强图像上一般表现为低密度影；皮肤损伤表现为皮肤局部缺损、皱褶；骨骼破坏后表现为骨皮质不连续、错位。2、高压电损伤后CTA表现CTA对血管显示较为清晰,损伤血管表现为节段性狭窄或血管远端的鼠尾状闭塞、中断。3、高压电损伤后CT灌注表现高灌注、低灌注及无血流灌注表现。各组参数分析如下：(1)截肢组：a、患侧与健侧各部位灌注参数的比较。患侧截肢平面下份与健侧相对应下份层面比较,BF值：前者后者,差异有统计学意义；PEI值：前者后者,差异有统计学意义；TTP、BV值：前者均后者,差异无统计学意义。患侧截肢平面上份与健侧相对应上份层面比较,BF、PEI、BV值：前者均后者,TTP值：前者后者,差异均无统计学意义。患侧截肢平面与患侧相对应平面比较,BF、PEI、TTP、BV值：前者均后者,差异均无统计学意义。截肢组的患侧各部位灌注参数的比较。b、患侧截肢平面上份与截肢平面比较,BF值：前者后者,差异有统计学意义。PEI、TTP、BV值：前者均后者,差异均无统计学意义。c、患侧截肢平面下份与截肢平面参数比较,BF值：前者后者,差异有统计学意义；PEI值：前者后者,差异有统计学意义；BV值：前者后者,差异有统计学意义。TTP值：前者后者,差异无统计学意义。通过判别分析得出,以上三组的kappa值均0.6,一致性比较好。BF、PEI、 TTP、BV值对测量肢体是否需截肢的判定具有实际意义。(2)未截肢组：患者上肢BF、PEI、BV值患侧健侧,TTP值：患侧健侧,差异均无统计学意义。未截肢患者下肢BF、PEI、BV:患侧健侧,未截肢患者下肢TTP值：患侧健侧,差异均无统计学意义。 结论应用256层螺旋CT灌注诊断四肢高电压损伤,能够获得清晰的血管CTA图像及不同损伤部位灌注参数值,并且这些灌注参数对肢体是否需要截肢的判定具有实际意义；MSCTP对区别高压电损伤和电弧损伤有一定的帮助作用。MSCTP是临床诊断、治疗高压电损伤的方便、安全、定性、定量的理想检查方法。
[Abstract]:Objective to explore the application value of 256 slice spiral CT perfusion imaging in limbs injury after high-voltage electricity.
Materials and methods 53 cases of high voltage electrical injury were selected, including 48 cases of extremities and 5 cases of conventional extremities CTA. 48 cases were divided into 14 cases of amputation group and 34 cases of non amputation group according to the amputation after operation. The results of MSCTP examination (the information of microcirculation perfusion of muscles and the CTA image of blood vessels in the corresponding parts) were examined. The images were introduced into the EBW workstation of Phillips company, and the perfusion images were processed by Functional CT-general mode. (1) from the results of the perfusion scan, the optimum phase was selected to extract the CTA image, using MPR, CPR, VR, MIP and advanced vascular analysis (advantage vessel analysis,). AVA) the software was analyzed and the vascular images of the corresponding parts were obtained; (2) the selected interest areas in the amputation group and the amputated group were selected to include blood flow perfusion (BF), peak enhancement (PEI), peak time (TTP), blood volume (BV) pseudo color map, specific quantitative numerical time density curve (TDC).53 cases performed vascular morphology analysis, amputation group, not cut. T test was performed in 48 cases of limb group, and discriminant analysis was performed in amputation group to compare the difference of perfusion parameters in different parts of limbs.
Results 1, the muscle, skin and bone CT manifestations of the muscle, skin and bone in the patients with high voltage electrical injury were performed on CT plain scan, and the enhanced image was generally low density. The skin injury showed local defect and wrinkle, after the destruction of the bone, the bone cortical discontinuity was discontinuous, the.2 was misplaced, and the CTA displayed CTA to the blood vessels clearly and damaged blood after the high voltage electrical injury. The tube showed a segmental stenosis or a rat caudate occlusion of the distal part of the vessel, interrupting.3. High perfusion, low perfusion and no blood flow perfusion after high voltage electrical injury. The parameters of each group were as follows: (1) the amputation group: A, the comparison of the perfusion parameters between the affected side and the healthy side. The lower part of the affected side amputation plane was compared with the healthy side, BF Value: the former, the difference has statistical significance; PEI value: the former and the latter, the difference has statistical significance; TTP, BV value: the former is the latter, the difference is not statistically significant. The upper limb of the amputated plane should be compared with the healthy side at the upper level, BF, PEI, BV value: the former is both the latter, the former is the latter, the difference is not statistically significant. The affected side section is not statistically significant. BF, PEI, TTP, BV value: the former was the latter, the difference was not statistically significant. The comparison of the perfusion parameters of the affected side of the amputation group was.B, the upper part of the amputated limb was compared with the amputation plane, BF value: the former, the difference was statistically significant.PEI, TTP, BV value: the former were all the latter, and the difference was not statistically significant. Significance.C, the lower part of the affected side of the amputation plane compared with the amputation plane parameters, BF value: the former, the difference has statistical significance; PEI value: the former and the latter, the difference has statistical significance; the former is the former and the former, the difference has a statistically significant.TTP value: the former is the latter, the difference is not statistically significant. By discriminant analysis, the above three groups of kappa values All 0.6, the consistency of.BF, PEI, TTP, BV value for the determination of limb amputation is of practical significance. (2) unamputated group: the upper limb BF, PEI, BV value of the side healthy side, TTP value: the side of the affected side, the difference is not statistically significant. The lower limb BF, PEI, BV: affected side, the lower limb TTP values of the lower extremity patients: the side health side, difference of the affected side, the side health, difference of the affected side There was no statistical significance.
Conclusion 256 layers of spiral CT is used to diagnose the high voltage injury of extremities, which can obtain clear blood vessel CTA image and the perfusion parameters of different injury sites. And these perfusion parameters are of practical significance to the determination of limb amputation, and MSCTP can help to distinguish high voltage electrical injury and arc injury..MSCTP is clinical It is a convenient, safe, qualitative and quantitative method for diagnosis and treatment of high voltage electrical injury.
【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R318.51
本文编号：2153381
[Abstract]:Objective to explore the application value of 256 slice spiral CT perfusion imaging in limbs injury after high-voltage electricity.
Materials and methods 53 cases of high voltage electrical injury were selected, including 48 cases of extremities and 5 cases of conventional extremities CTA. 48 cases were divided into 14 cases of amputation group and 34 cases of non amputation group according to the amputation after operation. The results of MSCTP examination (the information of microcirculation perfusion of muscles and the CTA image of blood vessels in the corresponding parts) were examined. The images were introduced into the EBW workstation of Phillips company, and the perfusion images were processed by Functional CT-general mode. (1) from the results of the perfusion scan, the optimum phase was selected to extract the CTA image, using MPR, CPR, VR, MIP and advanced vascular analysis (advantage vessel analysis,). AVA) the software was analyzed and the vascular images of the corresponding parts were obtained; (2) the selected interest areas in the amputation group and the amputated group were selected to include blood flow perfusion (BF), peak enhancement (PEI), peak time (TTP), blood volume (BV) pseudo color map, specific quantitative numerical time density curve (TDC).53 cases performed vascular morphology analysis, amputation group, not cut. T test was performed in 48 cases of limb group, and discriminant analysis was performed in amputation group to compare the difference of perfusion parameters in different parts of limbs.
Results 1, the muscle, skin and bone CT manifestations of the muscle, skin and bone in the patients with high voltage electrical injury were performed on CT plain scan, and the enhanced image was generally low density. The skin injury showed local defect and wrinkle, after the destruction of the bone, the bone cortical discontinuity was discontinuous, the.2 was misplaced, and the CTA displayed CTA to the blood vessels clearly and damaged blood after the high voltage electrical injury. The tube showed a segmental stenosis or a rat caudate occlusion of the distal part of the vessel, interrupting.3. High perfusion, low perfusion and no blood flow perfusion after high voltage electrical injury. The parameters of each group were as follows: (1) the amputation group: A, the comparison of the perfusion parameters between the affected side and the healthy side. The lower part of the affected side amputation plane was compared with the healthy side, BF Value: the former, the difference has statistical significance; PEI value: the former and the latter, the difference has statistical significance; TTP, BV value: the former is the latter, the difference is not statistically significant. The upper limb of the amputated plane should be compared with the healthy side at the upper level, BF, PEI, BV value: the former is both the latter, the former is the latter, the difference is not statistically significant. The affected side section is not statistically significant. BF, PEI, TTP, BV value: the former was the latter, the difference was not statistically significant. The comparison of the perfusion parameters of the affected side of the amputation group was.B, the upper part of the amputated limb was compared with the amputation plane, BF value: the former, the difference was statistically significant.PEI, TTP, BV value: the former were all the latter, and the difference was not statistically significant. Significance.C, the lower part of the affected side of the amputation plane compared with the amputation plane parameters, BF value: the former, the difference has statistical significance; PEI value: the former and the latter, the difference has statistical significance; the former is the former and the former, the difference has a statistically significant.TTP value: the former is the latter, the difference is not statistically significant. By discriminant analysis, the above three groups of kappa values All 0.6, the consistency of.BF, PEI, TTP, BV value for the determination of limb amputation is of practical significance. (2) unamputated group: the upper limb BF, PEI, BV value of the side healthy side, TTP value: the side of the affected side, the difference is not statistically significant. The lower limb BF, PEI, BV: affected side, the lower limb TTP values of the lower extremity patients: the side health side, difference of the affected side, the side health, difference of the affected side There was no statistical significance.
Conclusion 256 layers of spiral CT is used to diagnose the high voltage injury of extremities, which can obtain clear blood vessel CTA image and the perfusion parameters of different injury sites. And these perfusion parameters are of practical significance to the determination of limb amputation, and MSCTP can help to distinguish high voltage electrical injury and arc injury..MSCTP is clinical It is a convenient, safe, qualitative and quantitative method for diagnosis and treatment of high voltage electrical injury.
【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R318.51
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