256层螺旋CT脾动脉成像低剂量高浓度对比剂的应用及对脾动脉解剖分析

发布时间：2018-01-17 00:18

本文关键词：256层螺旋CT脾动脉成像低剂量高浓度对比剂的应用及对脾动脉解剖分析　出处：《河北联合大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的将低剂量高浓度对比剂应用于256层螺旋CT脾动脉成像，分析其可行性；通过256层螺旋CT脾动脉成像观察脾动脉解剖及变异，并探讨256层螺旋CT脾动脉成像的临床应用价值。方法1将100例接受256层螺旋CT脾动脉成像的患者随机分为两组：研究组50例，注射高浓度对比剂碘普罗胺（370mgI/mL）50ml+生理盐水20ml；对照组50例，注射70ml常规浓度对比剂碘海醇（300mgI/mL）。两组注射速率均为4.0ml/s。两组均为在膈顶水平腹主动脉内设定感兴趣区，设定阈值为150Hu，采用自动跟踪技术，感兴趣区内CT值达阈值后自动激发扫描。分别测量两组的腹主动脉腹腔干水平、脾动脉中段及脾叶动脉管腔内对比剂CT值，比较两组的对比剂增强水平，对两组的脾动脉各级分支显示率进行比较，对两组的图像质量进行评分并比较。2选择经临床及其他检查未发现脾脏或脾血管疾病而行256层螺旋CT腹部动脉成像的患者100例作为研究对象，将原始图像重建为0.625mm薄层后传至工作站，应用多种后处理技术对图像进行处理，如容积再现（VR）、多平面重组（MPR）、最大密度投影（MIP）、曲面重组（CPR）等，观察脾动脉正常解剖及变异，探讨脾动脉256层螺旋CT成像在腹腔镜脾切除术前检查及部分脾栓塞术前检查的应用价值，并分析256层螺旋CT在脾动脉成像中的优势。3统计学方法：所有数据用SPSS17.0统计学软件进行统计。用均数±标准差表示计量数据；用χ2检验对分类资料及率进行比较；用独立样本t检验比较不同组间的差异；利用双变量相关分析来分析变量之间的相关性。若P 0.05，则差异具有统计学意义。结果1研究组与对照组腹主动脉腹腔干水平、脾动脉中段及脾叶动脉内对比剂浓度比较，分别为：研究组347.7±46.6Hu，321.1±49.9Hu，293.5±50.2Hu，平均320.81±47.43Hu；对照组276.4±47.2Hu，221.7±44.4Hu，175.9±44.0Hu，平均224.67±39.01Hu，各组数据研究组均高于对照组，两组比较差异具有统计学意义（P 0.01）；两组脾动脉各级分支显示率比较存在统计学差异（P0.01），研究组Ⅲ级血管分支显示率高于对照组；脾动脉图像质量评分比较，两组间无统计学差异（P0.05）。2脾动脉起源为正常型者为85例（占85%），起源变异15例，变异率为15%，不同性别间变异率差异无统计学意义（χ2=1.050，P0.05）。脾动脉末端分支为集中型的35例，，分散型的62例。3例脾叶动脉为一支型，83例为二支型，14例为三支型。显示脾上极动脉10例，脾下极动脉15例。脾动脉起始管径为3.42～8.32mm，平均（5.86±1.08）mm；脾动脉末端管径为1.92～6.41mm，平均（4.24±0.87） mm；脾叶动脉管径为1.20～5.86mm，平均（3.35±0.87）mm；脾动脉主干长度为7.20～19.30mm，平均（12.22±2.09）mm；脾指数113.4～884.0cm3，平均（390.65±151.48）cm3。不同性别间脾动脉起始管径、脾动脉末端管径、脾叶动脉管径及脾动脉主干长度比较具有统计学差异（P 0.05）；不同年龄组脾动脉起始管径、脾动脉末端管径、脾叶动脉管径及脾动脉主干长度比较，无统计学差异（P0.05）。不同性别间脾指数比较具有统计学差异（P 0.05）；不同年龄组脾指数比较，不存在统计学差异（P0.05）。脾动脉起始管径、脾动脉末端管径及脾叶动脉管径与脾指数具有相关性（P 0.05），且呈正相关。脾动脉主干长度与脾指数无相关性（P0.05）。脾动脉在胰尾上方走行65例，在胰尾后方走行24例，在胰尾前方走行11例。结论1256层螺旋CT脾动脉成像中，应用低剂量高浓度对比剂可以降低发生对比剂不良反应的可能性，且得到的脾动脉图像完全能够满足临床诊断要求，值得临床应用。2256层螺旋CT脾动脉成像能清晰显示活体状态下脾动脉的正常解剖及变异，可以为腹腔镜脾切除术的术式选择提供依据，并可为部分脾栓塞术提供解剖学参考及相关数据，从而可以准确控制栓塞程度并选择合适的导管导丝。3256层螺旋CT技术上的先进性及强大的血管后处理分析软件，用于脾动脉血管成像优势明显。
[Abstract]:Objective to apply low-dose high-density contrast agent to 256 slice spiral CT splenic artery imaging, analyze its feasibility, observe the anatomy and variation of splenic artery by 256 slice spiral CT splenic artery imaging, and discuss the clinical application value of 256 slice spiral CT splenic artery imaging.
Methods: 100 patients were randomly divided into 1 underwent 256 slice spiral CT imaging of the splenic artery into two groups: study group 50 cases, injection of high concentration of contrast medium iopromide (370mgI/mL) 50ml+ 20ml normal saline; 50 cases in the control group, 70ml injection of conventional concentration of contrast agent iohexol (300mgI/mL) injection rate of two. The two group is 4.0ml/s. group were set in the top level of abdominal aorta in the region of interest in the diaphragm, set the threshold for 150Hu, automatic tracking technology using ROI automatic CT scanning of excitation threshold. The two groups were measured by abdominal aorta and celiac trunk, splenic artery and splenic artery lumen in middle lobe comparison the value of contrast agent CT, compared with two groups of enhanced level of splenic artery branches in two groups showed rate comparison, image quality scores were performed in two groups and compared.2 by clinical and other examination found no spleen or splenic vascular disease underwent 256 slice spiral CT Abdominal angiography in 100 patients as the research object, the original image reconstruction for 0.625mm layer and transferred to the workstation, application of various postprocessing technique of image processing, such as volume rendering (VR), multi planar reconstruction (MPR), maximum intensity projection (MIP), heavy surface (CPR), the observation group of splenic artery the normal anatomy and variants, investigate the application value of 256 slice spiral CT imaging in examination before laparoscopic splenectomy and partial splenic embolization of splenic artery before examination, and analyze the advantages of.3 statistical method of 256 slice spiral CT in splenic artery imaging: all data using SPSS17.0 statistical software for statistical data. The measurement standard deviation; 2 test was used to compare the classification and data rate; independent sample t test was used to compare the different differences between groups; correlation analysis with two variables to analyze the correlation between variables. If P is 0.05, the difference is the The significance of learning.
Results of the 1 study group and control group, abdominal aorta, celiac, comparison, contrast agent concentration of splenic artery and splenic artery in the middle respectively: the study group was 347.7 + 46.6Hu, 321.1 + 49.9Hu, 293.5 + 50.2Hu, average 320.81 + 47.43Hu; the control group was 276.4 + 47.2Hu, 221.7 + 44.4Hu, 175.9 + 44.0Hu, an average of 224.67 + 39.01Hu, each data in study group were higher than the control group, with significant differences between the two groups (P 0.01); the two group of splenic artery branches showed there is statistical difference rate (P0.01), the study group III vascular branches display rate is higher than that of the control group; comparison of splenic artery image quality score, no significant difference between the two between the groups (P0.05) origin of.2 into normal splenic artery in 85 cases (85%), 15 cases of the origin of variation, the variation rate was 15%, the variation rate between different gender difference was not statistically significant (2=1.050, P0.05). 35 cases of splenic artery terminal branch centralized, divided 62 cases of.3 patients with splenic artery is a discrete type, 83 cases of the two branch type, 14 cases of type three. Display superior splenic artery in 10 cases, splenic artery in 15 cases. The spleen artery diameter is 3.42 ~ 8.32mm, the average (5.86 + 1.08) mm; the end of the splenic artery the diameter is 1.92 ~ 6.41mm, the average (4.24 + 0.87) mm; splenic lobe artery diameter is 1.20 ~ 5.86mm, the average (3.35 + 0.87) mm; splenic artery length is 7.20 ~ 19.30mm, the average (12.22 + 2.09) mm; spleen index of 113.4 ~ 884.0cm3, the average (390.65 + 151.48) cm3. between different gender splenic artery diameter, the end of the splenic artery diameter, compare the splenic artery diameter and splenic artery length have significant difference (P 0.05); different age groups of spleen artery diameter, the end of the splenic artery diameter, compare the spleen artery diameter and splenic artery trunk and leaf length, no significant difference (P0.05). The spleen index of different gender the difference statistically significant ( P 0.05); comparison of different age groups of spleen index, there were no statistical differences (P0.05). The spleen artery diameter, associated with the end of the splenic artery diameter and splenic artery diameter and spleen index (P 0.05), and were positively correlated. No correlation between splenic artery length and spleen index (P0.05) of splenic artery. 65 cases of pancreatic tail in 24 cases above, walking in the tail of the pancreas in 11 cases in the rear, walking in front of the tail of the pancreas.
Conclusion 1256 slice spiral CT imaging of splenic artery, application of low dose and high concentration of contrast agent can reduce the possibility of the occurrence of adverse reaction of contrast medium, the splenic artery and the obtained image can fully meet the requirements of clinical diagnosis, worthy of clinical application of splenic artery imaging.2256 slice spiral CT can clearly display the living condition of the splenic artery anatomic variants can provide the basis for selection of surgical laparoscopic splenectomy, and provide anatomical reference and related data for partial splenic embolization, which can accurately control the degree of embolism analysis software and choose the appropriate catheter.3256 advanced slice spiral CT technology and powerful vessels for postprocessing, splenic artery angiography have obvious advantages.

【学位授予单位】：河北联合大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R816.5

【参考文献】