双源CT Flash扫描在心血管源性气道狭窄患儿中的应用探讨

发布时间：2018-04-22 13:35

本文选题：双源CT + Flash　；参考：《山东大学》2017年硕士论文

【摘要】：第一部分:小儿先天性心脏病双源CT Flash扫描和前瞻性心电门控序列扫描的多模态对比研究研究目的比较小儿先天性心脏病患儿行双源CT(dual-source CT,DSCT)前瞻性心电门控大螺距扫描模式(即Flash扫描)和前瞻性心电门控序列扫描模式在图像质量、辐射剂量及诊断效能上的差异,探讨双源CT Flash扫描在小儿心脏大血管CTA(CTangiography)检查中的应用价值。资料与方法本研究获得山东省医学影像学研究所伦理委员会审核、批准,并由患儿父母签署知情、同意。对于临床怀疑先天性心脏病的患儿65例,行心脏大血管CTA检查,最终纳入60例患儿作为本研究对象。随机选30名(男13例,女17例)患儿行双源CTFlash扫描,另外30名(男10例,女20例)患儿行前瞻性心电门控序列扫描。以心血管造影检查(conventional cardiac angiography,CCA)或传统手术结果作为标准,计算两组不同扫描方式对先天性心血管畸形的诊断的准确性。由两名放射科医生双盲的情况下采用5分法对所获得的图像质量进行总体评估(5分:图像清晰,没有确切的伪影和明显噪声;4分:图像显示有轻微伪影和噪声,无诊断困难;3分:图像显示模糊,畸形结构可明确诊断,中度的伪影和噪声;2分:图像有严重的伪影及噪声,畸形诊断困难;1分:无法评价。图像的主观评分≥3分才被认定为是合格的图像)。两组患儿有效辐射剂量(effective dose,ED)的获得,根据机器生成的CT容积剂量指数(volume CT dose index,CTDIvol)和剂量长度乘积(dose length produce,DLP)计算。结果两组患儿的年龄(t=0.19,P0.05)、体重(t=0.35,P0.05)、心率(t=0.22,P0.05)无统计学差异。与CCA或手术结果相比较,Flash扫描组发现110种心血管异常,其敏感度、特异度、阳性似然比、阴性似然比及准确率分别为94.55%、99.78%、99.05%、98.71%、98.77%,前瞻性心电门控序列扫描组分别发现117种心血管异常,其以上各诊断参数分别为96.58%、99.56%、98.26%、99.12%、98.95%。图像质量的总体评分均达到了 3分以上,即所获图像均合格,达到诊断要求,且两名医师对图像质量总体评价一致性较高,分别为(4.53±0.73)分、(4.83±0.46)分,组间差异无统计学意义(t=1.90,P0.05)。Flash扫描组和序列扫描组的CTDIvol分别为0.24±0.05mGy和0.96±0.35mGy,差异有统计学意义(t=11.15,P0.01);DLP分别为4.27±1.48mGy·cm和10.50±4.09mG·cm,差异有统计学意义(t=7.85,P0.01);ED分别为0.27±0.06mSv和0.67±0.16mSv,差异有统计学意义(t=12.82,P0.01)。与序列扫描组相比较,Flash扫描组有效剂量降低了 60%。结论双源CT Flash扫描和前瞻性心电门控序列扫描均可以获得较好的准确率。与序列扫描组相比,Flash扫描明显降低患儿辐射剂量,可用于小儿心脏大血管CTA检查。第二部分:探讨双源CT Flash扫描在诊断先心病伴发气道狭窄病变中的应用价值研究目的讨论双源CT Flash扫描在诊断先天性心脏病(先心病)伴发气道狭窄病变中的应用价值。资料与方法纳入2013.01-2015.12年间临床怀疑先天性心脏病合并气道狭窄,并于我科行双源CT低剂量Flash扫描的患儿107例,最终经心脏大血管CTA结果诊断为心脏大血管直接压迫引起的气道狭窄患儿共计99例并纳入本研究。其中,男40例,女59例,平均年龄22月(1月-16岁),平均体重(10±7.7)kg(2.8 kg～45 kg)。由两名放射科医生双盲的情况下采用5分法对所获得的图像质量进行总体评估(5分:图像清晰,没有确切伪影和明显噪声;4分:图像显示有轻微伪影和噪声,无诊断困难;3分:图像显示模糊,畸形结构可明确诊断,中度的伪影和噪声;2分:图像有严重的伪影及噪声,畸形诊断困难;1分:无法评价。图像的主观评分≥3分才被认定为是合格的图像)。气道被分为以下四部分:部位Ⅰ,气管下三分之一;部位Ⅱ,右主支气管;部位Ⅲ,左主支气管;部位Ⅳ,叶支气管。本研究中,气管狭窄的诊断标准是指支气管管腔口径小于正常支气管管腔口径,在MPR/CPR、MinIP或VR图像上测量管腔狭窄程度:(狭窄近端正常管腔直径-最窄处管腔直径)/狭窄近端正常管腔直径× 100%,狭窄程度被分为3度:轻度,狭窄程度≤25%;中度,狭窄程度26%～75%;重度,狭窄程度≥76%。利用 MPR(Multiple planar reconstruction)及 VR(Volume rendering)图像准确显示狭窄段气道周围的解剖结构关系,明确造成气道狭窄的心外大血管畸形的责任病灶。按照引起小儿心血管源性气道狭窄的不同血管畸形类型进行归纳总结。同时,在肺窗和MinIP(Minimum intensity projection)上观察患儿肺内继发病变的特点。结果99例患儿Flash扫描的平均DLP为(7.32±6.19)mGy*cm,平均ED为(0.39±0.20)mSv。所获得的图像均满足诊断要求;两名医师对图像质量的总体评价具有较高的一致性(K=0.754,P0.05)。99例患儿中,共计104处气道狭窄被诊断是心血管源性的气道狭窄,其中,因肺动脉高压引起者38例(36.5%)、主动脉缩窄引起者32例(30.8%)、右位主动脉弓引起者14例(13.5%)、无名动脉压迫12例(11.5%)、肺动脉吊带6例(5.8%)、双主动脉弓1例(1.0%)、左房大1例(1.0%)。同时还可以显示并发的肺内病变,包括36例磨玻璃样变,19例肺实变,7例肺不张及66例肺气肿。不同类型先心病引起的气道狭窄部位不同,P值小于0.0001,差异有统计学意义,其中先心病引起的气道狭窄以发生于Ⅲ段,即左主支气管较多。结论双源CT前瞻性心电门控大螺距扫描(Flash模式)一站式扫描可以同时显示心内外结构畸形、伴发的气道狭窄以及肺内继发病变,为临床诊治提供依据。
[Abstract]:Part one: a multi-modal contrast study of dual source CT Flash scan and prospective ECG gated sequence scan in children with congenital heart disease comparison of children with congenital heart disease with dual source CT (dual-source CT, DSCT) prospective ECG gated large pitch scanning mode (i.e. Flash scan) and prospective ECG gating sequence scanning mode The application value of dual source CT Flash scan in the CTA (CTangiography) examination of the great vessels of the heart of children was discussed in the difference of image quality, radiation dose and diagnostic efficacy. The data and methods were approved by the ethics committee of the medical imaging Institute of Shandong Province, and signed by the parents. 65 children with congenital heart disease were examined by CTA, and 60 children were included in this study. 30 patients (13 males and 17 women) were randomly selected for dual source CTFlash scan, and 30 (10 men and 20 women) were performed prospective ECG gated sequence scanning. Conventional cardiac angiography was performed. CCA) or traditional surgical results as a standard to calculate the accuracy of the diagnosis of congenital cardiovascular malformations in two groups of different scans. A total assessment of the quality of the images obtained by the 5 division of the two radiologists was made by the two radiologists, with a clear image, no false and obvious noise, and 4 points: the image was shown to be slight. Artifact and noise, no difficulty in diagnosis; 3 points: blurred image, abnormal structure diagnosis, moderate artifact and noise; 2 points: serious artifact and noise, malformed diagnosis difficulty; 1 points: inability to evaluate. The subjective score of the image is more than 3 points is identified as a coincidence image). The effective radiation dose (effective dose, ED) of the two groups of children The results were calculated according to the CT volume dose index (volume CT dose index, CTDIvol) and the product of the dose length (dose length produce, DLP). Results there were no statistical differences between the two groups of children (t=0.19, P0.05), body weight, and heart rate. Compared with the results of the surgery, the group found 110 kinds of blood. The sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and accuracy were 94.55%, 99.78%, 99.05%, 98.71%, 98.77%, respectively, and 117 kinds of cardiovascular abnormalities were found in the prospective ECG gated sequence scanning group, and the above diagnostic parameters were 96.58%, 99.56%, 98.26%, 99.12%, respectively, and the overall score of 98.95%. image quality reached 3. The images were all qualified and reached the diagnostic requirements, and the overall evaluation of the image quality was higher in two doctors, respectively (4.53 + 0.73) and (4.83 + 0.46). There was no statistically significant difference between the groups (t=1.90, P0.05).Flash scan group and sequence scanning group (0.24 + 0.05mGy and 0.96 + 0.35mGy respectively), and the difference was statistically significant Significance (t=11.15, P0.01); DLP were 4.27 + 1.48mGy cm and 10.50 + 4.09mG cm respectively. The difference was statistically significant (t=7.85, P0.01), ED was 0.27 + 0.06mSv and 0.67 + 0.16mSv respectively, and the difference was statistically significant. ECG gated sequence scanning can obtain better accuracy. Compared with the sequence scanning group, Flash scan obviously reduces the radiation dose of the children and can be used in the CTA examination of the large blood vessels of the heart. The second part: to discuss the application value of the dual source CT Flash scan in the diagnosis of congenital heart disease accompanied by the stenosis of the airway, and to discuss the dual source CT Flash scan The application value of the diagnosis of congenital heart disease (congenital heart disease) accompanied by airway stenosis. Data and methods were included in clinical suspicion of congenital heart disease combined with airway stenosis in 2013.01-2015.12 during 2013.01-2015.12, and 107 children with low dose of double source CT scan in our department, and the final diagnosis of the large blood vessels of the heart and the large blood vessels of the heart was direct to the large blood vessels of the heart. A total of 99 children with airway stenosis caused by compression were included in this study, including 40 males and 59 females, with an average age of 22 months (January -16 years) and an average weight of (10 + 7.7) kg (2.8 kg to 45 kg). The image quality obtained by 5 scores was evaluated by two radiologists in the case of 5 (5 points: clear image, no exact artifact and no exact artifact. Obvious noise; 4 points: the image showed slight artifact and noise, no difficulty in diagnosis; 3 points: blurred image, malformed structure clearly diagnosed, moderate artifact and noise; 2 points: serious artifact and noise, malformation difficulty; 1 points: no evaluation. The subjective score of the image was more than 3 points was identified as a qualified image). Airway was divided. The following four parts: site I, sub trachea 1/3; Part II, right main bronchus; Part III, left main bronchus; Part IV, lobar bronchus. In this study, the diagnostic criteria for tracheal stenosis are that the bronchial tube diameter is less than the normal bronchial tube diameter, and the degree of stenosis is measured on MPR/ CPR, MinIP, or VR images: (narrow near correct) Ordinary lumen diameter - the narrowest canal diameter) / narrow proximal normal lumen diameter * 100%, the degree of stenosis was divided into 3 degrees: mild, narrow degree less than 25%; moderate, stenosis degree 26% ~ 75%; severe, stenosis degree more than 76%. using MPR (Multiple planar reconstruction) and VR (Volume rendering) images to accurately display the anatomy around the narrow segment of the airway Structural relationship, clearly responsible for the tracheal stenosis of the large vascular malformation. According to the different types of vascular malformation causing cardiovascular stenosis in children, the characteristics of the pulmonary lesions in the lungs were observed on the lung window and MinIP (Minimum intensity projection). Results the Flash scan of 99 children was flat. The average DLP was (7.32 + 6.19) mGy*cm and the average ED was (0.39 + 0.20) mSv. to meet the diagnostic requirements; two doctors in the overall evaluation of image quality had high consistency (K=0.754, P0.05) in.99 cases, and 104 airway strictures were diagnosed as tracheobronchial stenosis, of which 38 cases were caused by pulmonary hypertension ( 36.5%) 32 cases (30.8%) were caused by coarctation of the aorta, 14 cases of right aortic arch (13.5%), 12 cases of innominate artery compression (11.5%), 6 cases of pulmonary artery sling (5.8%), 1 cases (1%) of double aortic arch and 1 cases (1%) in left atrium. Different types of congenital heart disease caused by different types of congenital heart disease, the P value is less than 0.0001, the difference is statistically significant, in which the stenosis of the airway caused by the congenital heart disease occurs in the third segment, that is, the left main bronchus is more. Conclusion the double source CT prospective ECG gated large pitch scan (Flash mode) scan can simultaneously display the abnormal structure and the malformation of the heart and the heart. Airway stenosis and secondary pulmonary lesions can provide evidence for clinical diagnosis and treatment.

【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R725.4;R816.92

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