320排CT前瞻性冠状静脉两种延迟采集方法及心动周期对图像质量的影响

发布时间：2018-04-25 19:01

本文选题：CT冠状动脉造影 + CT冠状静脉造影　；参考：《河北北方学院》2017年硕士论文

【摘要】：近年来随着多层螺旋CT的迅速发展,CT对冠状动脉粥样硬化性心脏病(coronary artery atherosclerosis disease,CAD)患者动脉内钙化斑块、软斑块,管腔内狭窄的检查技术趋于成熟,而随着心脏电生理技术(包括导管射频消融、人工起搏、心脏逆行灌注、心脏再同步化治疗)不断发展及普及,冠状静脉成像越来越受到人们的关注。因此一次CT检查能提供冠状动脉及静脉的影像学信息,是如今CT检查的一种趋势,而静脉成像的具体延迟时间尚未明确。本研究目的是通过Toshiba320排CT在前瞻性心电门控扫描模式下分别用两种静脉延迟采集方法对心脏进行一次检查完成冠状动脉、静脉的分别成像,比较两种方法及心脏收缩、舒张期对冠状静脉的显示质量和显示率的影响。从而建立一种可对心脏进行一次检查完成冠状动脉、静脉的分别成像的方法。实验方法是将50例临床需要进行冠状动、静脉CT造影的患者随机分为两组,连续扫描组:22例患者连续扫描5个心动周期,前面3个心动周期用于冠状动脉成像,最后1-2个心动周期用于冠状静脉重建;延迟5s组:28例先扫描1-2个心动周期用于冠状动脉成像,延迟5s后再扫描1-2个心动周期用于冠状静脉重建,静脉重建时相选择代表心脏收缩的时相35%R-R间期及代表心脏舒张时相的75%R-R间期,将重建后的数据传至HP LP3065 Monitor后处理工作站,由两名有经验的放射科医生在双盲下用曲面重建(curved planar reformation,CPR)、容积再现(volume rendering,VR)、多平面重建(multiplanar reformation,MPR)、最大密度投影(maximum intensity projection,MIP)技术测量冠状静脉窦(coronary sinus,CS)、心大静脉(great cardiac vein,GCV)、心中静脉(middle cardiac vein,MCV)、左室后静脉(Left ventricular posterior vein,LPV)管腔的CT值及管径的大小。分别用t检验(95%可信区间)和卡方检验比较两种扫描模式静脉显示质量和显示率,及心脏收缩和舒张期对冠状静脉管径的影响。显示率评分标准:血管对比差,边缘毛糙为小于等于2分;血管对比好,部分区域显示不清或边缘毛糙为3分;冠状静脉窦及一级属支对比度好,管壁光滑为4-5分。评分≥3分者占总数的比例为显示率。运用血管分析法分别于收缩期和舒张期测量冠状窦口(Coronary sinus orifice,CSO)及心大静脉(GCV)、心中静脉(MCV)、及左室后静脉(LPV为多支者选取较粗大一支分析)等属支汇入处的平均管径、横截面积,35%、75%R-R间期管腔内的CT值。评价上述测量值在心脏收缩期与舒张期的变化规律,并计算其变化率[变化率=(收缩期值-舒张期值)/收缩期值×100%]。实验结果显示为延迟5s的扫描方案75%R-R间期静脉窦、心大静脉、心中静脉、左室后静脉CT值分别是(280.23±89.86)HU、(249.77±98.70)HU、(228.86±82.34)HU、(252.36±82.74)HU;35%R-R间期静脉CT值分别为(258.86±81.43)HU、(260.09±91.00)HU、(262.23±90.25)HU、(264.95±65.60HU。连续扫描5个心动周期的扫描方案75%间期静脉窦、心大静脉、心中静脉、左室后静脉CT值分别是(347.38±107.52)HU、(333.39±89.63)HU、(302.07±97.40)HU、(326.46±110.13)HU;35%R-R间期静脉CT值分别为(325.67±100.82)HU、(342.50±89.07)HU、(330.26±102.07)HU、(319.54±101.52)HU。上述数据表明延迟5s的静脉扫描方案较连续扫描5个心动周期的静脉管腔内CT值更高,差异具有统计学意义(P0.05)。静脉窦及其属支管径、面积收缩期均大于舒张期,差异具有统计学意义(P0.05)。静脉窦在舒张期(75%R-R间期)的CT值高于收缩期(35%R-R间期),差异具有显著统计学意义(P0.001)。而心中静脉及左室后静脉在收缩期(35%R-R间期)CT值较高,差异具有显著统计学意义(P0.01)。心中静脉的CT值在收缩期和舒张期之间无明显差异(P0.05)。冠状静脉系统在两种扫描方法的总体显示率为:冠状窦、心大静脉、心中静脉在收缩期及舒张期的显示率均为100%,左室后静脉在收缩期及舒张期的显示率均为90%,数据显示冠状窦、心大静脉、心中静脉、左室后静脉在收缩期及其舒张期的显示率均较高。结论,320排CT前瞻性心电门控冠状动、静脉成像时连续采集方案和延迟5s采集方案冠状静脉总体显示率均较高,但是延迟5s采集方案可以得到更高的冠状静脉显示质量;此外,静脉窦及其属支在收缩期的管径及面积明显大于舒张期。
[Abstract]:In recent years, with the rapid development of multislice spiral CT, CT has tended to mature in coronary atherosclerotic heart disease (coronary artery atherosclerosis disease, CAD) patients with intravascular calcified plaque, soft plaque, and intravascular stenosis, and with cardiac electrophysiological techniques (including catheter radiofrequency ablation, artificial pacing, retrograde perfusion of the heart) Cardiac resynchronization therapy is developing and popularizing, coronary vein imaging is getting more and more attention. Therefore, one CT examination can provide imaging information of coronary artery and vein, which is a trend of CT examination today, and the specific delay time of venous imaging is not clear. The purpose of this study is to look forward to Toshiba320 by CT. Under the ECG gated scanning mode, two kinds of venous delay acquisition methods were used to perform a single examination of the coronary arteries and veins, respectively, to compare the two methods and the effects of cardiac contractions and diastolic phase on the display quality and display rate of the coronary veins. The method of imaging respectively. The experimental method was to divide 50 patients with coronary artery and vein CT angiography into two groups randomly. Continuous scan group: 22 patients scanned 5 cardiac cycles continuously, the first 3 cardiac cycles were used for coronary angiography, the last 1-2 cardiac weeks were used for coronary vein reconstruction, and delayed 5S group: 28 cases first scanned. 1-2 cardiac cycles were used for coronary angiography and 1-2 cardiac cycles after delayed 5S were used for coronary vein reconstruction. The phase selection represented the time phase of the heart contraction and the 75%R-R interval representing the diastolic phase of the heart. The reconstructed data were transmitted to the HP LP3065 Monitor post processing workstation, and two experienced patients were placed. Curved planar reformation (CPR), volume rendering (VR), multiplane reconstruction (multiplanar reformation, MPR), the maximum density projection (maximum intensity), the heart vein (CPR), the heart vein (the heart vein), the heart vein (the heart vein), the heart vein (the vein (the heart vein), the heart vein (the heart vein), the heart vein (the heart vein), the heart vein (the heart vein) Middle cardiac vein, MCV), the CT values and diameter of the left ventricular posterior vein (Left ventricular posterior vein, LPV). Compared with the t test (95% confidence interval) and chi square test, the quality and display rate of the two scanning patterns, and the effect of cardiac contractile and diastolic phase on the diameter of the coronary veins. Contrast poor, the marginal roughness was less than 2 points, the blood vessel contrast was good, the part of the region was unclear or the marginal roughness was 3; the coronary sinus and the first grade branch was well contrasted, the wall of the tube was 4-5. The ratio of the score of the score of the total of 3 points was measured by the blood vessel analysis at the systolic and diastolic phase of the coronary sinus (Coronary sin). Us orifice, CSO) and the cardiac vein (GCV), the heart vein (MCV), and the left ventricular posterior vein (LPV for the larger one selection), the average diameter, the cross section area, the CT in the 35%, 75%R-R interval, and the changes of the measured values in the systolic and diastolic phase of the heart, and calculated the rate of change = (rate of change = ( Systolic value - diastolic value) / systolic value * 100%]. experimental results showed that the 75%R-R interphase venous sinus of the delayed 5S scan, the large vein of the heart, the heart vein, and the CT of the left posterior vein were (280.23 + 89.86) HU, (249.77 + 98.70) HU, (228.86 + 82.34) HU, (252.36 + 82.74) HU, and 35%R-R interval venous CT values were (258.86 + 81.43) HU, respectively (260.09 +). 91) HU, (262.23 + 90.25) HU, (264.95 + 65.60HU. continuous scanning of 5 cardiac cycles, 75% interphase venous sinus, cardiac vein, heart vein, and left ventricle vein, CT value respectively (347.38 + 107.52) HU, (333.39 + 89.63) HU, (302.07 + 97.40) HU, (326.46 +) HU, 35%R-R interval venous CT value respectively 7) HU, (330.26 + 102.07) HU, (319.54 + 101.52) HU., the above data showed that the venous scanning scheme of delayed 5S was higher than that in the venous catheter of 5 consecutive cardiac cycles. The difference was statistically significant (P0.05). The venous sinus and its branch diameter were larger than the diastole, and the difference was statistically significant (P0.05). Venous Dou Zaishu. The CT value of the 75%R-R interval (35%R-R interval) was higher than that of the systole (35%R-R interval). The difference was statistically significant (P0.001), but the CT value of the heart vein and the left posterior vein in the systole (35%R-R interval) was higher (P0.01). The CT value of the heart vein was not significantly different between the systolic and diastolic phase (P0.05). The overall display rate of the two scanning methods was: the coronary sinus, the great heart vein, the display rate of the heart vein in systolic and diastolic time were 100%, the display rate of the left posterior vein in systolic and diastolic phase were 90%. The data showed that the coronary sinus, the great heart vein, the heart vein, the left posterior vein were displayed in the systolic and diastolic period. Conclusion: 320 rows of CT prospective cardiac valve controlled coronary movement, continuous acquisition and delayed 5S acquisition were all higher in the coronary vein, but delayed 5S acquisition could obtain higher quality of coronary vein display; in addition, the diameter and area of venous sinus and its branch in systole were obviously greater than diastolic phase.

【学位授予单位】：河北北方学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R541.4;R816.2

【参考文献】