宝石能谱CT在手足肌腱病变中的初步应用

发布时间：2018-05-07 06:59

  本文选题：能谱CT + 手足肌腱　； 参考：《山东大学》2012年硕士论文

【摘要】：目的： 1、运用宝石能谱CT寻求显示手足部肌腱的最佳keV单能量。 2、探讨宝石能谱CT对正常手足肌腱解剖的显示价值。 3、探讨宝石能谱CT在手足肌腱病变中的初步应用。 资料与方法： 对从2010年10月至今因临床怀疑肌腱病变而来山东省千佛山医院影像科检查的61例患者行手足部能谱CT扫描,采用GE宝石能谱(CT Discovery CT750HD, HDCT)扫描机,能谱扫描模式。扫描层厚5.0mm,间隔5.0mm,扫描模式：Helical full0.6sec GSI-18,最大管电流：640mA,管电压：140/80KV,螺距：0.531：1,床速：10.62mm/rot,准直：20.0mm。平均容积CT剂量指数(CT Dose Index volume, CTDIvol):45.97mGy。扫描范围：手部包括腕关节,足部包括踝关节,必要时加扫前臂和小腿,所有受检者均行双侧对比扫描。 将5.0mm层厚的混合能量图像重建为0.625mm层厚的单能量图像后,传至AW4.4工作站,在GSI Viewer视图下,通过能谱分析软件,以肌腱及周围肌肉为感兴趣区,选取3个不同层面进行测量,分别记录每一层面具有最佳对比噪声比(contrast-to-noise ratio, CNR)的keV单能量值,对三个结果求取其算数平均值。随机抽取30例正常手或足肌腱,用SAS软件对keV算数平均值进行统计处理。对该30例样本,选取其显示肌腱的最佳keV单能量图像与常规混合能量图像,用4分法分别对肌腱显示的图像质量进行评分,采用SPSS17.0统计学软件分析比较两者间差异有无统计学意义。 选取具有最佳CNR的相应单能量系列图像,分别综合运用容积再现技术(Volume Rendering, VR)及多平面重组技术(Multiplannar Reformation, MPR),必要时辅以曲面重组技术(Curved Plannar Reformation, CPR),对体内植入金属固定物着,同时加以MARS处理。以目标肌腱为中心,将图像任意转动、切割并调节窗宽窗位以达到显示肌腱的最佳平面、角度和效果,观察并记录每条肌腱的密度、走行、止点、外形及周围组织情况。 结果： 1、显示肌腱的最佳单能量数据统计：样本量30,介于[30,50],行正态性W检验,P0.05有统计学意义。经SAS软件计算得W=0.956727,P=0.2549a=0.05所以,该样本来自符合正态分布的总体。均值：65.07833,标准偏差：2.99701,95%可信区间：(63.96,66.20)。所以在均值65keV时,能获得最高的CNR。 最佳keV单能量图像与常规混合能量图像质量的评价：两者评分分别为3.33±0.48、2.87±0.73,采用SPSS17.0统计学软件分析,t值2.93,P值0.0050.05,差异有统计学意义。 2、正常肌腱54例,手24例,足30例。CT表现为位置正常,密度均匀,约87-96Hu,边界清楚、光滑、锐利,走行连续、自然。除受检者指浅屈肌腱、示指伸肌腱、小指伸肌腱末端及部分受检者桡侧腕屈肌腱、腓骨长肌腱、第三腓骨肌、胫骨后肌腱止点显示欠佳外,余所有主要手足部肌腱均能清晰显示。 3、损伤肌腱68例：肿瘤、肌腱缝合或骨折术后23例,慢性损伤19例,骨折或关节脱位13例,骨肿瘤或周围软组织肿瘤10例,肌腱断裂2例,先天畸形1例。诊断准确率为89.71%(61/68),除肌腱慢性损伤诊断准确率较低外(12/19),其余病变诊断准确率达100%。 结论： 1、65keV单能量是显示肌腱的最佳单能量。 2、宝石能谱CT能清晰显示手足部主要肌腱,且与解剖学高度一致,但指趾远端肌腱显示欠佳。 3、宝石能谱CT能清晰显示手足肌腱断裂、缝合术后、畸形等,但对肌腱慢性炎性改变显示欠佳。
[Abstract]:Objective:
1, use gemstone energy spectrum CT to find the best keV single energy of hand and foot tendon.
2, to explore the value of gemstone spectral CT in the anatomy of normal hand and foot tendons.
3, to explore the preliminary application of gemstone spectral CT in hand foot tendon disease.
Information and methods:
61 patients who had been examined by clinical suspicion of tendons from October 2010 to Qianfo Hill hospital in Shandong province were examined by hand foot spectrum CT scan, using GE gemstone spectrum (CT Discovery CT750HD, HDCT) scanner, energy spectrum scanning mode. Scanning layer thickness 5.0mm, interval 5.0mm, scanning mode: Helical full0.6sec GSI-18, maximum tube electricity Flow: 640mA, tube voltage: 140/80KV, spiral distance: 0.531:1, bed speed: 10.62mm/rot, collimation: 20.0mm. average volume CT dose index (CT Dose Index volume, CTDIvol): 45.97mGy. scan range: hand including wrist, foot including ankle joint, if necessary, forearm and calf, all subjects have bilateral contrast scan.
After reconstructing the 5.0mm layer thick mixed energy image into a single energy image with 0.625mm layer thickness, it was passed to the AW4.4 workstation. Under the GSI Viewer view, 3 different layers were selected to measure the best contrast noise ratio (contrast-to-noise ratio, respectively) by using the spectrum analysis software and using the tendon and the surrounding muscles as the region of interest. CNR keV single energy value, the average value of the number of the three results was calculated. 30 cases of normal hand or foot tendon were randomly selected, and the average value of the keV arithmetic was processed by SAS software. The best keV single energy image of the tendon and the conventional mixed energy image were selected for the 30 samples, and the image quality of the tendon displayed by the 4 method was respectively. The SPSS17.0 score was used to analyze and compare the differences between the two groups.
Select the corresponding single energy series with the best CNR, use the volume rendering technique (Volume Rendering, VR) and the multiplane recombination technology (Multiplannar Reformation, MPR). When necessary, the technique of surface recombination (Curved Plannar Reformation, CPR) is used, and the metal fixtures are implanted in the body. At the same time, the MARS is treated with the target. The tendon is the center, the image is rotated at any time, cutting and adjusting the window wide window to show the best plane, angle and effect of the tendon, and observe and record the density of each tendon, walk, stop, shape and surrounding tissue.
Result锛，

本文编号：1855880