颅内结核MSCT成像方法与诊断研究

发布时间：2018-04-04 22:39

本文选题：MSCT　切入点：颅内结核　出处：《山东大学》2014年博士论文

【摘要】：目的探讨多层面CT (multi-slice computed tomography, MSCT)双期扫描技术,比较5分钟延迟期扫描与注射对比剂后立即扫描在颅内结核病灶的显示上的优势。材料一般资料收集本院经临床资料证实的颅内结核患者30例,其中男19例,女11例,年龄10-58岁,平均年龄29.3岁。临床以发热、头痛、恶心伴呕吐为主要症状就诊,所有病例均符合颅内结核的临床诊断标准。本研究所有患者都签署了知情同意书,并通过医院医学伦理委员会医学伦理学审查批准。方法采用多层螺旋CT先常规平扫后行双期扫描,即动脉期注入对比剂后25秒行扫描,延迟期注入对比剂5分钟后扫描。对两期图像在显示颅内结核病灶的能力进行评价。结果30例患者526个病灶中,各类型病灶延迟期图像显示颅内结核灶的能力均优于动脉期图像,在病灶与邻近血管断面的区分上延迟期也明显优于动脉期。结论MSCT双期扫描对颅内结核病灶的显示具有优势,尤其是延迟期扫描。CT双期增强扫描既可以在动脉期通过CTA图像评价血管的病理改变,又能更好通过延期期图像早期发现并评价结核性脑膜炎和颅内结核瘤的情况,为临床治疗提供帮助,可以显著改善颅内结核患者的预后。目的探讨迭代重建(Iterative Reconstruction, IR)算法在头颈部CT血管成像(CT angiography,CTA)中的临床应用价值。材料与方法行头颈部CTA检查的患者100例,随机分为A、B两组,每组50例。A组为常规剂量扫描(管电压120kV、管电流300mAs),用滤过反投影法(filtered back projection, FBP)进行重建；B组为低剂量扫描(管电压100kV、自适应动态管电流(199～399mAs),用IR进行重建。由2名经验丰富的放射医生采用双盲法对两组图像质量进行评分,并比较单次扫描的CT剂量指数容积(CT dose index volume, CTDIvol)和剂量长度乘积(dose-length product, DLP)。结果A、B两组的辐射剂量及图像质量的差异均有统计学意义(P0.001),B组的辐射剂量明显低于A组,而B组的图像质量明显优于A组。结论在头颈部CTA应用中,与常规FBP比较,采用IR算法可以降低辐射剂量,同时提高图像质量。
[Abstract]:Objective to investigate the advantages of multi-slice computed tomographic (MSCT) dual-phase scanning technique in the diagnosis of intracranial tuberculosis (TB) in patients with intracranial tuberculosis after 5 minutes delayed phase scan and immediately after injection of contrast agent.Materials General data were collected from 30 patients with intracranial tuberculosis confirmed by clinical data including 19 males and 11 females aged 10-58 years with an average age of 29.3 years.Fever, headache, nausea and vomiting were the main symptoms.Informed consent was signed and approved by the Medical Ethics Committee of the Hospital.Methods Multi-slice spiral CT was performed with conventional plain scan and then double-phase scanning, that is, 25 seconds after arterial phase injection of contrast agent, and 5 minutes after delayed phase injection of contrast agent.The ability of two-phase images to display intracranial tuberculosis foci was evaluated.Results among the 526 lesions in 30 patients, the ability of each type of lesions to display intracranial tuberculous foci was superior to that of arterial phase images, and the delayed phase was also superior to the arterial phase in differentiating the lesions from the adjacent vascular sections.Conclusion Dual-phase MSCT scan has advantages in displaying intracranial tuberculosis foci, especially in delayed phase scanning. Dual phase enhanced CT scan can be used to evaluate the pathological changes of blood vessels in arterial phase by CTA images.It can also be better to detect and evaluate the situation of tuberculous meningitis and intracranial tuberculoma in the early stage by delayed image, and to provide help for clinical treatment, which can significantly improve the prognosis of patients with intracranial tuberculosis.Objective to evaluate the clinical value of iterative reconstruction (IRI) algorithm in head and neck CT angiography (CTAA).Materials and methods 100 patients with head and neck CTA were randomly divided into two groups.Each group consisted of 50 cases. Group A was scanned with conventional dose (voltage 120kV, current 300mAs1). Group B was scanned with low dose (voltage 100kV, self-adaptive dynamic current 199399mAs1) by filter back projection (FBP), and was reconstructed by IR.Two experienced radiologists scored the image quality of the two groups by double blind method, and compared CT dose index volume (CTDIvoll) and dose length product (DLPX) with single scan.Results the difference of radiation dose and image quality between group A and group B was statistically significant. The radiation dose of group B was significantly lower than that of group A, but the image quality of group B was significantly better than that of group A.Conclusion in the application of head and neck CTA, compared with conventional FBP, IR algorithm can reduce radiation dose and improve image quality.
【学位授予单位】：山东大学
【学位级别】：博士
【学位授予年份】：2014
【分类号】：R529.0;R816.1

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