双源CT MinDose技术在主动脉瓣病变术前评估中的临床应用研究

发布时间：2018-05-09 02:45

本文选题：双源CT + 主动脉瓣环直径　；参考：《山东大学》2014年博士论文

【摘要】：目的：采用双源CT (Dual-source CT, DSCT)的MinDose技术(MinDose-DSCT)一站式评价主动脉瓣病变病人的冠状动脉、瓣叶形态、瓣环直径及心功能,并与二维超声心动图(Two-dimensional transthoracic echocardiography,2D-TTE)、实时三维超声心动图(Real-time three-dimensional transthoracic echocardiography, RT-3DE)进行比较,探讨Mindose-DSCT对主动脉瓣病变病人的术前评估价值。方法：回顾性分析2010年3月～2013年1月间于本研究中心就诊的68例主动脉瓣膜病变需行主动脉瓣置换术病人。上述病人或因年龄≥60岁可疑冠状动脉粥样硬化性心脏病(CAD),或因年龄60岁但2D-TTE提示左室射血分数(Left ventricular ejection, LVEF)降低(55%)需要接受DSCT检查以明确冠脉病变。排除标准为体重85Kg,有明显心律失常或心率较快70次／分且不能降至70次／分以下及MinDose-DSCT或RT-3DE扫查获取图像失败排除28例病人,共有40例病人(28名男性,12名女性；28名主动脉瓣狭窄病人,7名主动脉瓣关闭不全病人,5名主动脉瓣狭窄合并轻度以上关闭不全病人；平均年龄,61.3±13.6岁)纳入研究。上述病人均在1星期内接受TTE及DSCT检查。所有病人均采用DSCT后处理工作站及改良二维双平面法(Simpson's法)、四维自动左室定量分析(four-dimensional automatic left ventricular quantification,4D AUTO LVQ)分别计算LVEF。所有病人Mindose-DSCT于70%心动周期多平面重组图像测量主动脉瓣环直径,TTE于胸骨旁左室长轴切面测量主动脉瓣环直径(aortic valve annulus diameter, AVAD)。 DSCT于不同轴位图像观察主动脉瓣叶数目、钙化及脱垂情况,并可进而观察并测量瓣周结构。本研究经医院伦理委员会批准并签署相关CT检查知情同意书。结果：40例病人检查期间均无明显心律失常,均成功接受MinDose-DSCT及TTE检查并均获得满意图像,均未发生明显并发症。所有患者行TTE及MinDose-DSCT检查时的图像质量均可满足心功能分析要求。 1.冠状动脉及主动脉瓣观察结果：MinDose-DSCT除可以比较清晰的显示冠状动脉情况,冠状面、横断面以及矢状面MPR图像可以清晰的显示主动脉瓣病变情况,特别是横断面观察主动脉瓣与超声心动图相比具有显著优势。瓣环、瓣叶数目、钙化情况以及瓣叶脱垂情况一目了然。TTE观察冠状动脉非常受限,仅有部分病人(15/40例)可以比较清晰的显示冠状动脉开口,远端走行及管腔情况无法显示。2D-TTE仅可于大动脉短轴切面单平面观察主动脉三个瓣叶,无法立体连续评估瓣叶详细病变情况。RT-3DE虽然可以从不同角度进行切割多平面观察主动脉瓣,但受图像质量影响真正能清楚显示瓣叶结构的仅为少数病人。 2. MinDose-DSCT,2D-TTE及4D AUTO LVQ评价LVEF的对照研究：40例主动脉瓣病变病人经MinDose-DSCT检查的LVEF测值与2D-TTE测值具有良好的相关性(r=0.87,P0.01)。MinDose-DSCT检查的LVEF测值与RT-3DE测值具有更好的相关性(r=0.90,P0.01)。 3. MinDose-DSCT及2D-TTE评价AVAD的对照研究：MinDose-DSCT测值与2D-TTE测值相比偏大,但也具有很好的相关性(r=0.90,P0.01)。结论：DSCT的MinDose技术可以在明显降低辐射剂量、保证图像诊断质量的前提下一站式完成对主动脉瓣病变病人的冠状动脉、AVAD及LVEF和主动脉瓣膜及瓣周解剖结构的全面评价,具有较高的临床应用价值。目的：探讨二代双源CT MinDose技术与回顾性心电门控在评估主动脉瓣病变患者时的辐射剂量及图像质量。方法：回顾性分析40例行MinDose-DSCT检查的主动脉瓣病变患者及33例疑诊CAD行常规后门控检查体检人员的影像学资料。主观评价方法：将两组图像在隐匿患者信息和扫描参数的情况下由两位有十年以上心血管影像诊断经验的医师采用盲法分别独立评价所有图像。按照图像的整体质量及阶梯状伪影,血管增强一致性及冠状动脉显示情况等多个方面按照4分或3分的评分标准进行评价。客观评价方法：由一位有十年以上心血管影像诊断经验的医师评价图像噪声,计算信号-噪声比率(signal-to-noise ratio, SNR)和对比-噪声比率(contrast-to-noise ratio, CNR).综合统计每一位检查者接受检查的辐射剂量。将两组不同扫描方式检查图像质量的平均得分及辐射剂量进行对比分析。两位医师之间的的诊断一致性采用kappa检验。P0.05有统计学意义。本研究经医院伦理委员会批准并签署相关CT检查知情同意书。结果：所有病人均获得满意图像质量,MinDose-DSCT组与常规后门控两组整体图像评分(3-4分)均达到诊断标准,两种方式之间无统计学差异(P0.05)。MinDose-DSCT组冠状动脉节段评分为1.8±0.2,常规后门控组为1.64±0.3,两种方式之间无统计学差异；阶梯状伪影评分在MinDose-DSCT组与常规后门控两组之间无统计学差异；心血管强化的一致性评分MinDose-DSCT组与常规后门控两组之间无统计学差异(P均0.05)。MinDose-DSCT组与常规后门控组图像噪声分别为19.3±2.1、17.5±1.8,两组之间无统计学差异(P0.05)。MinDose-DSCT组平均有效辐射剂量明显低于常规后门控组(3.2±0.4mSv vs.8.7m±0.3mSv, P=.000)。结论：DSCT的MinDose技术可以在保证较好的图像质量前提下明显降低受检人员的辐射剂量。
[Abstract]:Objective : To evaluate the preoperative evaluation value of Mindose - DSCT ( MinDose - DSCT ) in patients with aortic valve disease by MinDose - DSCT .
28 aortic stenosis patients , 7 aortic valve insufficiency patients , 5 aortic stenosis with mild or more closed patients ;
The average age , 61.3 卤 13.6 years were included in the study . All patients were examined by TTE and DSCT within 1 week . All patients were treated with DSCT post - treatment workstation and modified two - dimensional double - plane method ( Simpson ' s method ) , and four - dimensional automatic left ventricular quantification ( 4D AUTO LVQ ) was used to measure LVEF . All patients with Mindose - DSCT measured aortic annulus diameter at 70 % cardiac cycle multi - plane reconstructed image , and the aortic valve annulus diameter ( AVAD ) was measured by TTE in the long axis of left ventricular chamber . DSCT observed the number of aortic valve leaflets , calcification and prolapse in different axial images , and then observed and measured the perivalvular structure . This study was approved by the Ethics Committee of the Hospital and signed the relevant CT examination informed consent form .

Results : There was no significant arrhythmia during the examination of 40 patients . All patients were successfully treated with MinDose - DSCT and TTE to obtain satisfactory images without significant complications . All patients underwent TTE and MinDose - DSCT examination to meet the requirement of cardiac function analysis .

1 . The observation of coronary artery and aortic valve : MinDose - DSCT can clearly show the condition of coronary artery disease , coronal plane , cross section and sagittal MPR image .

2.MinDose - DSCT , 2D - TTE and 4D AUTO LVQ were used to evaluate LVEF . The LVEF measured by MinDose - DSCT in 40 patients with aortic valvular disease had good correlation with 2D - TTE values ( r = 0.87 , P0.01 ) . The value of LVEF measured by MinDose - DSCT was better correlated with RT - 3DE ( r = 0.90 , P0.01 ) .

3 . MinDose - DSCT and 2D - TTE were used to evaluate AVAD : MinDose - DSCT value was larger than that of 2D - TTE , but also had good correlation ( r = 0.90 , P0.01 ) .

Conclusion : The MinDose technique of DSCT can significantly reduce the radiation dose , ensure the quality of image diagnosis , complete the comprehensive evaluation of coronary artery , AVAD and LVEF , aortic valve membrane and perivalvular anatomy of patients with aortic valve disease on the premise of image diagnosis quality , and has high clinical application value .

Objective : To study the radiation dose and image quality of the two - generation dual - source CT MinDose technique and the retrospective ECG gating in the assessment of patients with aortic valve disease .

Methods : The imaging data of 40 patients with aortic valvular disease and 33 suspected cases of suspected CAD were analyzed retrospectively . The subjective evaluation method was as follows : the two groups of images were evaluated by using blind method in the case of concealed patient information and scanning parameters . The objective evaluation method was as follows : 1 - bit more than ten years of cardiovascular image diagnosis experience in the evaluation of image noise , the signal - to - noise ratio ( SNR ) and contrast - to - noise ratio ( CNR ) . The average score of the image quality and the radiation dose were analyzed by combining two groups of different scanning methods . The diagnostic consistency between the two physicians was statistically significant . The study was approved by the hospital ethics committee and signed the relevant CT examination informed consent form .

Results : All patients had satisfactory image quality , MinDose - DSCT group had no statistical difference between the two groups ( P0.05 ) . The coronary segmental score of MinDose - DSCT group was 1.8 卤 0.2 , and the normal control group was 1.64 卤 0.3 . There was no statistical difference between the two methods .
There was no statistical difference between the MinDose - DSCT group and the conventional post - gated group .
There was no statistical difference between the MinDose - DSCT group ( 19.3 卤 2.1 , 17.5 卤 1.8 , P = 0.000 ) .

Conclusion : The MinDose technique of DSCT can significantly reduce the radiation dose of the subject under the precondition of ensuring better 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】：R816.2;R654.2

【参考文献】