自然呼吸下高螺距双源CT肺动脉造影方法的临床应用研究

发布时间：2018-02-24 11:00

本文关键词： 高螺距双源CT 肺动脉造影自然呼吸辐射剂量碘负荷　出处：《浙江大学》2013年硕士论文　论文类型：学位论文

【摘要】：目的：评价自然呼吸状态下、高螺距双源CT肺血管造影(CTPA)的成像质量,探讨该技术在可疑肺栓塞患者中应用的可行性。方法：对110例临床疑似肺动脉栓塞的患者采用第二代双源CT行CT肺血管造影(CTPA),患者随机分为2组：高螺距组(n=55)患者在自然呼吸状态下行螺距(pitch)为3.0、管电压100Kv、管电流100mAs的扫描,注射对比剂40ml。常规组(n=55)行常规CTPA检查,螺距(pitch)为0.8、管电压120Kv、管电流100mAs,注射对比剂80ml,深吸气后屏气扫描。统计比较两组肺动脉主干、尖段(S1)和后基底段(S10)肺动脉的强化程度、图像噪声、信噪比(SNR)、 CT容积剂量指数(CTDIvol)、剂量长度乘积(DLP)、有效剂量(ED)及图像的主观质量评级。采用SPSS19.0软件,进行Student t检验、四格表卡方检验、非参数秩和检验、Kappa一致性检验进行统计学分析。结果：肺动脉主干平均CT值高螺距组(421±107)高于常规组(375±113)p0.05)；高螺距组SNRs1(41.63±9.26)和SNRs10(41.31±9.13)明显高于常规组的平均SNRs1、 SNRs1o(33.24+10.23、35.20±11.11),两组之间差异具有显著统计学意义(p0.01)；平均图像噪声(10.05±1.53)、平均检查时间(0.76±0.07)明显低于常规组；高螺距组的平均辐射剂量CTDIvol、DLP及ED分别为2.88±0.44mGy、88±14mGy*cm和1.50±0.23mSv,均显著低于常规组(5.61±0.98mGy、144±30mGy*cm和2.45±0.52mSv),两组之间差异具有显著统计学意义(p0.01)；高螺距组主观图像质量评分高于常规组(p0.05)。高螺距组中,所有患者没有出现呼吸及心脏运动伪影,没有出现对比剂充盈不均或缺损,所有病例达到诊断要求。结论：自然呼吸下高螺距双源CTPA检查能得到没有呼吸和心脏运动伪影的优质CTPA图像,能满足肺栓塞诊断的要求,对危重、呼吸急促及不能屏气患者的CTPA检查特别有价值。而且这种技术明显降低辐射剂量及减少碘对比剂的用量。
[Abstract]:Objective:. To evaluate the imaging quality of high pitch dual source CT pulmonary angiography (CTPA) under natural breathing, and to explore the feasibility of using this technique in patients with suspected pulmonary embolism. Methods:. 110 patients with suspected pulmonary embolism were randomly divided into two groups: high pitch group (n = 55) with a pitch of 3.0, tube voltage of 100 KV and tube current of 100 Mas. 40 ml. Routine CTPA was performed in the control group. Pitch pitch was 0.8, tube voltage was 120 KV, tube current was 100 mAs, contrast agent was 80 ml, breath-holding scanning after deep inspiratory. The enhancement degree of pulmonary artery in the two groups was compared and compared, such as the main pulmonary artery, the apical segment S1) and the posterior basal segment S10). Image noise, signal-to-noise ratio (SNR), CT volumetric dose index (CTDIvoll), dose length product (DLPX), effective dose (EDV) and subjective quality rating of image were evaluated by SPSS19.0 software, Student t test and four-grid chart chi-square test. Nonparametric rank sum test (RSR) and Kappa consistency test were used for statistical analysis. Results:. The mean CT value of pulmonary artery trunk in the high pitch group (421 卤107) was higher than that in the routine group (375 卤113), the SNRs1(41.63 卤9.26) and the SNRs10(41.31 卤9.13 in the high pitch group were significantly higher than those in the routine group (SNRs1, SNRs1o(33.24 10.23 ~ 35.20 卤11.11). The difference between the two groups was significant (p0.01), the mean image noise was 10.05 卤1.53 and the mean time of examination was 10.05 卤1.53. 0.76 卤0.07) was significantly lower than that in the routine group. The average radiation doses of CTDIvoll DLP and Ed in the high pitch group were 2.88 卤0.44 mGy / cm and 1.50 卤0.23 mGy / cm, respectively, which were significantly lower than those in the normal group (5.61 卤0.98mGy) 144 卤30mGy / cm and 2.45 卤0.52mSv.The subjective image quality score of the high pitch group was significantly higher than that of the normal group (p0.05). There were no respiratory and cardiac motion artifacts, no uneven filling or defect of contrast medium, and all patients met the diagnostic requirements. Conclusion:. High pitch dual-source CTPA under natural respiration can obtain high quality CTPA images without respiratory and cardiac motion artifacts, which can meet the requirements of pulmonary embolism diagnosis. CTPA is of particular value in patients with shortness of breath and breath-holding, and this technique significantly reduces the dose of radiation and the dosage of iodine contrast agents.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R816.41

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