能谱CT单能量成像在PCI术后随访中的应用研究

发布时间：2018-01-19 12:37

本文关键词： 冠状动脉支架能谱CT 诊断　出处：《宁夏医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的利用宝石能谱CT设备对心脏能谱扫描进行深入研究,在ASIR技术平台上,建立规范优化的冠状动脉评价检查技术方案、图像分析方法、诊断方法。比较分析单能量成像、混合能量成像及CAG对PCI术后冠状动脉评价的结果,验证单能量成像在PCI术后冠状动脉评价的准确性,为PCI术后患者随访提供准确性更高的影像检查新方法。方法收集2015年10月—2016年6月于我院接受宝石CT心脏能谱扫描的PCI术后患者38例(共97枚支架),利用后处理工具重组80-140 keV(80、90、100、110、120、130、140keV)、不同ASIR(20%,50%,80%)的21组单能量图像和140kVp混合能量图像。(1)由三位具有副高以上资历的影像诊断医师对图像进行评估,按照冠状动脉支架图像质量评分方法,选出最佳单能量图像;(2)将97枚支架按真实内径2.0-3.0mm、3.0-3.5mm、3.5-4.0mm分为A、B、C三组,分别在最佳单能量图像及140kVp混合能量图像上对A、B、C三组支架管腔内径进行测量,统计数据,比较两种图像对支架内腔显示能力大小;(3)将有CAG结果的84枚支架分为无狭窄、轻度、中度、重度狭窄四组,重建其最佳单能量图像及混合能量图像,评价支架内管腔狭窄情况,比较两种图像判断支架内腔狭窄程度的准确性。结果经3名诊断医师综合考虑支架内外冠状动脉显示情况盲法评分,得出ASIR比例50%、keV值120keV评分最高,为最佳单能量图像。在最佳单能量图像下测得A、B、C三组支架内平均直径分别为1.57mm、2.04mm、2.59mm,混合能量图像测得该三组支架内平均直径分别为1.30mm、1.64mm、2.05mm,最佳单能量图像较140kVp混合能量图像在三组支架显示内径方面分别提高了20.76%、24.39%、26.34%。对应三组支架,两种成像模式测得的平均直径之间差异均有统计学意义(P0.05)。通过与CAG结果相比较,最佳单能量图像对支架腔内情况评价的准确率为89.28%,140kVp混合能量图像对支架腔内情况评价的准确率为82.14%,采用χ2检验,分别将120keV、ASIR 50%图像、CAG的诊断结果与140kVp图像进行比较分析,结果差异均有统计学意义(p0.05);将120keV、ASIR 50%图像与CAG结果比较分析,两者之间差异均无统计学意义(p0.05)。结论 120keV、ASIR 50%图像为最佳单能量图像,与140kVp混合能量相比,去伪影能力更强,支架内腔的显示更接近真实支架内径,误差更小,并能很好显示支架结构;应用最佳单能量图像行冠状动脉三维重建,可以有效改善支架内冠状动脉成像质量,且在判断再狭窄方面与冠脉造影结果有良好的一致性,较混合能量更为准确,可以为PCI术后患者的冠状动脉评价提供安全无创、准确性高的新方法。
[Abstract]:The purpose of energy spectrum of CT devices on the heart can be studied using scanning spectrum of gem, the technology of ASIR, establish the evaluation of coronary artery examination technique scheme optimization, image analysis method, diagnosis method. Comparative analysis of single energy imaging, mixed energy imaging and CAG of coronary artery after PCI evaluation results, verifying the accuracy of a single energy imaging after PCI in the evaluation of coronary artery, PCI patients were followed up with the accuracy of the new imaging methods higher. Methods from October 2015 to June 2016 in our hospital for heart gem CT spectrum scanning was performed in 38 cases of PCI patients (a total of 97 stents), using recombinant 80-140 (keV postprocessing tool 80,90100110120130140keV ASIR (20%), different, 50%, 80%) of the 21 groups of single energy image and 140kVp mixed energy images. (1) imaging diagnosis by three doctors who have fugaoyishang qualifications assessment of image According to estimates, scores of image quality of coronary artery stent method, select the best single energy image; (2) the 97 stents according to the true inner diameter of 2.0-3.0mm, 3.0-3.5mm, 3.5-4.0mm into A, B, C three groups, respectively in the best single energy image and 140kVp mixed energy images on A, B, C three groups of stent lumen diameter measurement, statistics, comparison of two kinds of image display capability of the stent lumen size; (3) there will be CAG results 84 stents were divided into mild, moderate stenosis, severe stenosis group, four, reconstruction of the optimal monochromaticenergy image and mixed energy images, evaluation of stent lumen stenosis, two image accuracy degree of the stent lumen stenosis. Results after 3 considering the diagnosis of coronary artery stent and physician blinded scoring display that ASIR, the proportion of 50%, the value of keV 120keV highest score is the best single energy image. The measured A in the best single energy image B, C, the average diameter of three stent group were 1.57mm, 2.04mm, 2.59mm, mixed energy images measured in the three groups of average stent diameter were 1.30mm, 1.64mm, 2.05mm, 140kVp is the best single energy image mixed energy images show aspects of diameter were increased by 20.76%, 24.39% in three groups corresponding to the three 26.34%. bracket. The average diameter of stent group between the two imaging mode measured differences were statistically significant (P0.05). By comparing with the CAG results, the accuracy of optimal monochromaticenergy image evaluation of the stent was 89.28%, the accuracy rate of 140kVp mixed energy images of stent evaluation was 82.14%, with 2 test, respectively. 120keV, 50% ASIR images, CAG 140kVp images and the diagnostic results were compared, the differences were statistically significant (P0.05); 120keV, ASIR and CAG 50% image analysis results, the difference between the two there is no unity Statistically significant (P0.05). Conclusion: 120keV and ASIR 50% image is the best single energy image, compared with the 140kVp hybrid energy deghost ability is stronger, the more close to the real display stent lumen diameter of stent, the error is smaller, and can show the support structure; the application of the best single energy images for 3D reconstruction of coronary artery, can improve the quality of in stent coronary angiography, and in the judgment of restenosis and coronary angiography results are in good agreement, with mixed energy is more accurate and can provide safe and noninvasive evaluation of coronary artery in patients after PCI, the new method with high accuracy.

【学位授予单位】：宁夏医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R541.4;R816.2

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