DSCT在肺静脉解剖及其变异中的应用研究

发布时间：2018-03-22 13:32

本文选题：肺静脉　切入点：左心房　出处：《泰山医学院》2013年硕士论文　论文类型：学位论文

【摘要】：目的综合应用双源Flash CT多种后处理方式，显示肺静脉解剖及其变异类型，并对其进行分析归类，统计不同解剖分型的出现率，为临床提供准确肺静脉的解剖学信息，用于指导房颤导管消融手术的准确定位。方法从临床疑诊冠状动脉粥样硬化性心脏病、主动脉疾病或因体格检查而接受双源Flash CT冠状动脉成像的受检者中，筛除其中存在可能影响肺静脉解剖形态的疾病或既往有心脏、肺部手术史的患者，对300例样本进行回顾性分析，其中男性210例，女性90例，年龄14岁~81岁，平均年龄54.8岁。选取最佳舒张期数据传输至后处理工作站，以原始横断面CT图像为基础，采用容积再现（VR）、最大密度投影（MIP）及多平面重组（MPR）等重组方式，为减少某些局限因素所引起的误差，特别引入CT仿真内窥镜技术（CTVE），由左心房腔内观察肺静脉间嵴的位置、形态。综合应用DSCT多种后处理方法，观察肺静脉解剖及其变异情况，统计各种分型的出现率。结果研究结果表明，300例样本中，共116例患者存在肺静脉解剖变异，总变异率为38.7%。其中左肺静脉变异率为20.3%（61/300），右肺静脉变异率为24%（72/300），经x2检验得出左、右两侧肺静脉变异率无统计学差异。依据肺静脉开口数目的不同、副肺静脉及肺静脉共干出现情况，具体将其分为4种类型：①标准型：最常见，共184例（61.3%）；②肺静脉共干型：共52例（17.3%），根据位置不同又进一步分出左肺静脉共干型41例（13.6%）、右肺静脉共干型10例（3%）、双侧肺静脉共干型1例（0.3%）；③副肺静脉型：共出现48例（16%），其中左副肺静脉型2例（0.67%）、右副肺静脉型37例（12.3%），顶上肺静脉型9例（3%）；④复合变异型共出现16例（5.3%）：均为左肺静脉共干同时合并1条副肺静脉。结论研究结果表明，肺静脉解剖结构变异率较大，最常见的变异类型为肺静脉共干型，其次为副肺静脉型。在肺静脉解剖及其变异研究过程中，双源Flash CT的多种后处理方法各有利弊，综合应用多种后处理方法进行分析，可以对肺静脉解剖结构进行较准确分型。意义综合运用双源Flash CT多种后处理方式，直观、立体的观察肺静脉与左心房解剖结构关系，明确其是否存在解剖变异。对于某些细微解剖结构，特别引入CT仿真内窥镜进行观察，以提高诊断的准确性。通过对肺静脉进行解剖分型，，详细统计各分型的出现率，不仅对肺静脉解剖学研究起到一定的补充，更有助于指导房颤射频消融及心胸外科手术，减少术后并发症的发生。
[Abstract]:Purpose. Multiple post-processing methods of dual-source Flash CT were used to display the anatomy of pulmonary vein and its variation types, and to analyze and classify them, and to calculate the occurrence rate of different anatomical types, so as to provide accurate anatomical information of pulmonary vein in clinic. It is used to guide the accurate localization of catheter ablation for atrial fibrillation. Method. From clinically suspected patients with coronary atherosclerotic heart disease, aortic disease, or double-source Flash CT coronary angiography for physical examination, the presence of a disease that may affect the anatomical morphology of the pulmonary vein or the presence of a previous heart were screened. A retrospective analysis was performed on 300 patients with pulmonary surgery history, including 210 males and 90 females, aged 14 years or 81 years, with an average age of 54.8 years. The best diastolic data were transferred to a post-processing workstation. Based on the original cross-sectional CT images, the methods of volume reconstruction, maximum density projection (MIP) and multiplanar recombination (MPRR) are used to reduce the errors caused by some limited factors. In particular, CT virtual endoscopy was introduced to observe the position and morphology of pulmonary intervenous crest in left atrium, and to observe the anatomy and variation of pulmonary vein by using various post-processing methods of DSCT, and to calculate the occurrence rate of various types. Results. The results showed that 116 out of 300 samples had anatomical variation of pulmonary vein, the total variation rate was 38.7%, in which the variation rate of left pulmonary vein was 20.3 / 300%, and the variation rate of right pulmonary vein was 2472% 300%. The left pulmonary vein was found to be left by x2 test. There was no statistical difference in the variation rate of right and bilateral pulmonary veins. According to the number of pulmonary vein openings, the common trunk of accessory pulmonary vein and pulmonary vein were divided into 4 types: 1 standard type: the most common. A total of 184 cases (61.3 / 2) had common trunk of pulmonary vein: 52 cases (17.3%). According to the position, 41 cases were further divided into left pulmonary vein type and 13.6 trunk type, 10 cases were right pulmonary vein common trunk type, and 1 case was bilateral pulmonary vein common trunk type 1 case was 0.33% accessory pulmonary vein type: there were 48 cases with 16.3 lumen, 48 cases with right pulmonary vein common trunk type, 4 cases with right pulmonary vein common trunk type, 1 case with bilateral pulmonary vein common trunk type, 1 case with bilateral pulmonary vein common trunk type. There were 2 cases with left accessory pulmonary vein, 37 cases with right accessory pulmonary vein, and 9 cases with superior parietal pulmonary vein. Conclusion. The results showed that the variation rate of the anatomical structure of pulmonary vein was large, the most common type of variation was common trunk type of pulmonary vein, and the second type was accessory pulmonary vein type. Multiple post-processing methods of dual-source Flash CT have their own advantages and disadvantages. The anatomical structure of pulmonary vein can be classified accurately by comprehensive analysis of various post-processing methods. Meaning. Multiple post-processing methods of dual-source Flash CT were used to observe the relationship between pulmonary vein and left atrial anatomical structure directly and stereoscopically, and to determine whether there was anatomic variation or not. For some fine anatomical structures, CT virtual endoscopy was introduced to observe them. In order to improve the accuracy of diagnosis, through anatomical classification of pulmonary veins and detailed statistics of the occurrence rate of each type, not only the anatomical study of pulmonary veins is supplemented, but also the radiofrequency ablation of atrial fibrillation and cardiothoracic surgery can be guided. The incidence of postoperative complications was reduced.
【学位授予单位】：泰山医学院
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R541.75;R816.2

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