低剂量等渗对比剂在640层容积CT冠状动脉血管成像中的可行性研究

发布时间：2018-04-19 17:41

本文选题：640层容积CT + 冠状动脉　；参考：《河北北方学院》2017年硕士论文

【摘要】：冠状动脉粥样硬化性心脏病(coronary heart disease,CHD)作为一种老年性常见疾病,不仅在全世界范围内较为常见,中国作为人口大国,且人口老龄化趋势逐年升高,CHD事件在中国中老年人群中也愈来愈多,随着生活质量的提高和生活、工作压力的增大,在青壮年人群中也常有发生。能够及时发现早期CHD征象,一种较高端的影像检查设备是必不可少的,日本东芝公司的320排640层容积CT的诞生,其拥有的160 mm的宽探测器,可以一次扫描覆盖整个心脏,目前是筛查CHD价值较高且辐射剂量较低的无创性检查方式。为了进一步降低CHD患者接受冠状动脉(冠脉)CT血管成像(CT angiography,CTA)检查时注射对比剂对患者身体产生的不良影响,降低对比剂碘浓度是至关重要的,其中等渗对比剂碘克沙醇(320mg I/ml)应用于临床以后,给广大CHD患者带来了福音,本文章旨在探讨低剂量等渗对比剂碘克沙醇在640层容积CT冠脉CTA检查中的应用价值。首先,将146例行冠脉CTA检查的患者按照对比剂使用剂量的不同进行A项研究,分为三组:a组:对比剂用量0.6 ml/kg,64例;b组:0.7 ml/kg,45例;c组:0.8 ml/kg,37例,三组管电压均为120k V。然后,又将86例行冠脉CTA检查的患者按照管电压及对比剂使用剂量的不同作为B项研究,分为两组:分别为a组100k V,0.6 ml/kg,41例,b组:120k V,0.7 ml/kg,45例。客观评价:对每个受试者的冠状动脉血管15个节段及主动脉根部CT值及噪声值进行测量,并根据公式计算出各血管节段的信噪比(signal-to-noise,SNR)及对比噪声比(contrast-to-noise,CNR);首先,将扫描后的数据传输至Vitrea后处理工作站,笔者通过数据重建测量各组图像的CT值、噪声,计算出每个测量部位的SNR及CNR,以此结果作为图像质量的客观评价结果。主观评价:以5分评价法为判断依据,由两名影像诊断医师对图像质量进行评分,当两位医师评分结果意见不一致时,再由另一名较高年资诊断医师进行评价,以此结果作为图像质量的主观评分结果;记录每例患者的辐射剂量;最后,应用SPSS17.0软件进行数据输入及统计学分析。研究结果显示,A项研究结果,CT值:a组低于b、c组(P0.05),但a组所有血管节段的CT值均大于250HU,能够满足临床诊断需求。SNR及CNR:a组在RCA_p、RCA_m、RCA_d、PDA、LAD-D1、LAD-D2、LCX-OM1、LCX_m、LCX_d段SNR,CNR明显高于b、c组(P0.05);在LM、LAD_p、LAD_p、LAD_m、LAD_d段CNR明显高于b、c组(P0.05);在AA段SNR、CNR低于B、C组(P0.05);在LAD_p段SNR a组低于b组,而高于c组(P0.05);而在LM、LAD_m、LAD_d、LCX_p段SNR差异无统计学意义(P0.05)。图像质量主观评分及辐射剂量比较,差异无统计学意义(P0.05)。B项研究结果:CT值:与b组比较,a组在AA、LM、LAD-D1、LAD-D2、LCX_p及LCX_d血管节段CT值差异有统计学意义(P0.05),a组明显高于b组,余冠脉节段两组间CT值差异无统计学意义(P0.05),且a组所有血管节段CT值均大于250 HU,能满足诊断要求。SNR及CNR:a组在PDA、LAD-D1、LAD-D2血管节段SNR差异有统计学意义(P0.05),a组明显高于b组,余冠脉节段两组间SNR差异无统计学意义(P0.05);在LAD-D1血管节段CNR差异有统计学意义(P0.05),a组明显高于b组,余冠脉血管节段CNR差异无统计学意义(P0.05)。两组患者辐射剂量差异有统计学意义(P0.05),a组较b组辐射剂量降低了30%。因此,可以得出以下结论:640层容积CT冠脉CTA检查中,管电压采用120k V,根据体质量(0.6 ml/kg)应用碘克沙醇(320 mg I/ml),减少对比剂不良事件的发生率,可得到较好的冠脉图像质量,满足临床诊断需求;640层容积CT冠脉CTA检查中,管电压采用100k V,根据体质量根据体质量(0.6 ml/kg)应用碘克沙醇(320 mg I/ml)能够减少辐射剂量降低对比剂用量,从而减少对比剂肾病不良事件的发生率,减少患者在检查过程中带来的不必要的痛苦。
[Abstract]:Coronary heart disease (CHD), as a common disease of old age, is not only common in the world. China is a big country of population, and the trend of population aging is increasing year by year. The CHD event is becoming more and more among the middle-aged and elderly people in China. With the improvement of life quality and life and work pressure The increase of strength is often occurring among young and young people. It is possible to find early CHD signs. A more advanced image inspection device is essential. The birth of the 320 row 640 layer volume CT of the Japanese Toshiba Co, the 160 mm wide detector, can cover the whole heart at a time, now the value of screening CHD is high and the radiant is very high. In order to further reduce the adverse effects of injection contrast agents on the body of patients with coronary artery (CT angiography, CTA) angiography (CT angiography, CTA), it is essential to reduce the concentration of the contrast agent iodine, in which the isosmonic contrast agent iodide (320mg I/ml) is applied to the clinic. After that, the gospel was brought to the majority of CHD patients. The purpose of this article was to explore the value of low dose isosotic contrast agent iodide in the 640 layer volume CT coronary CTA examination. First, 146 patients with coronary CTA examination were studied according to the different dosage of contrast agent, divided into three groups: a group: contrast agent dosage 0.6 ml/kg, 64 cases; B group: 0.7 Ml/kg, 45 cases, C group: 0.8 ml/kg, 37 cases, three group of tube voltages were 120K V., and 86 cases of coronary CTA examination were divided into two groups according to the difference of the tube voltage and the dosage of contrast agent, divided into two groups: a group 100k V, 0.6 ml/kg, 41 cases, 0.7, 45 cases. Objective evaluation: coronary blood blood for each subject. The 15 segments and the CT values and noise values of the root of the aorta are measured, and the signal-to-noise ratio (signal-to-noise, SNR) and the contrast noise ratio (contrast-to-noise, CNR) are calculated according to the formula. First, the data after the scanning are transferred to the Vitrea post processing station. The author reconstructs the CT value of each group of images, noise, and meter through the data reconstruction. The results of SNR and CNR of each measurement area were calculated as the objective evaluation results of image quality. Subjective evaluation: Based on the 5 score evaluation method, the image quality was evaluated by two image diagnostics. When the scores of two doctors were different, the results were evaluated by a higher seniority physician. As a result of the subjective score of the image quality, the radiation dose of each patient was recorded. Finally, the SPSS17.0 software was used for data input and statistical analysis. The results showed that the results of A study, CT value: a group was lower than B and C group (P0.05), but all the CT values of all vascular segments in a group were greater than 250HU, and could satisfy the clinical diagnostic requirement.SNR and CNR:a group. In RCA_p, RCA_m, RCA_d, PDA, LAD-D1, LAD-D2, LCX-OM1, LCX_m, and LCX_d SNR, CNR obviously higher than B. 0.05) the subjective score of image quality and the comparison of radiation dose, there was no significant difference (P0.05).B research results: CT value: compared with group B, the difference of CT values of a group in AA, LM, LAD-D1, LAD-D2, LCX_p and LCX_d vascular segments was significantly higher than that in the group, and there was no significant difference between the groups of the remaining coronary segments. The CT value of all vascular segments was greater than 250 HU, which could meet the diagnostic requirements of.SNR and CNR:a group in PDA, LAD-D1, LAD-D2 segment SNR differences (P0.05), a group was significantly higher than the B group, and there was no statistical significance between the two groups of the residual coronary segments. There was no significant difference in the CNR difference between the remaining coronary artery segments (P0.05). The radiation dose difference between the two groups was statistically significant (P0.05), and the radiation dose in the group A was lower than that of the B group, so the following conclusion could be concluded: in the 640 layer volume CT coronary CTA examination, the tube voltage was used as 120K V, and the volume mass (0.6 ml/kg) used iodipol (320 mg), and decreased. Compared with the incidence of adverse events, a better quality of coronary images can be obtained to meet the needs of clinical diagnosis. In the 640 layer volume CT coronary CTA examination, the tube voltage is 100k V, and the use of iodik (320 mg I/ml) according to body mass (0.6 ml/kg) can reduce the dose of the contrast agent and reduce the contrast agent kidney disease. The incidence of good events reduces the unnecessary suffering of patients during the examination.

【学位授予单位】：河北北方学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R816.2;R541.4

【参考文献】