能谱CT分次团注对于肝硬化患者门静脉系统成像：评估辐射剂量及门静脉系统显示

发布时间：2018-05-16 15:04

本文选题：能谱CT + 门静脉成像　；参考：《吉林大学》2017年硕士论文

【摘要】：目的:研究肝硬化患者,能谱CT分次团注单期成像对门静脉成像质量及辐射剂量的影响。材料和方法:收集2014年9月至2016年3月入院,并患有肝炎、肝硬化等肝功能A/B/C级受患者共149例,将所有患者随机分成两个组别,即能谱CT分团门静脉单期增强组和常规螺旋CT门静脉多期扫描组,能谱CT分团单期扫描组为实验组,共有75例患者纳入实验,排除其他因素所致扫描不佳6例患者,男性33例,女性36例。常规螺旋CT多期扫描组为对照组,共有74例患者纳入实验,排除其他因素所致扫描不佳10例患者,男性29例,女性35例。两个实验组患者再按肝功能CHILD分级标准,划分为A/B/C三个次级组,实验组CHILD A级34例,CHILD B级19例,CHILD C级16例;对照组CHILD A级33例,CHILD B级18例,CHILD C级13例。实验组采用能谱CT,利用分次团注单期成像的方法;对照组采用常规螺旋CT,利用Smart智能触发延迟10s连续三期扫描的方法。对两组病例所得的CTPV图像进行主、客观评估;同时记录每次检查辐射剂量。所得实验数据中,符合正态分布的计量资料以x±s表示,采用独立样本t检验;计数资料比较采用x2检验,P值0.05差异具有统计学意义。结果:在性别、年龄及身高体重指数(BMI)等基础数据方面,实验组75例患者和对照组74例患者间数据无明显统计学差异。在单能量为60kev时,能谱ct门静脉成像获得门静脉显示的最佳单能量图像。在单能量60kev下重建图像,门静脉强化程度定量评估:一、1、门静脉系统各分支ct值比较:肝内门静脉ct值组间比较:实验组a/b/c组明显高于对照组(p0.001)。2、肝外门静脉ct值组间比较:实验组a/b组优于对照组a/b组,有统计学差异(p0.001);实验组c组优于对照组c组,p值为0.002,有统计学差异。3、门静脉属支ct值组间比较:实验组a/b组优于对照组a/b组,肝外门静脉ct值有统计学差异(p0.001);实验组c组均优于对照组c组,有统计学差异(p值为0.003)。二、门静脉cnr及snr:实验组a/b/c三组肝内、外门静脉及门静脉主干cnr、snr略高于对照组a/b/c三组,两组组间比较均无统计学差异。三、门静脉主观评分分析:实验组与对照组组间比较:实验组a/b组主观评分高于对照组a/b组,差异有明显统计学意义(p0.01),实验组c组略高于对照组c组,有统计学差异(p值=0.031)。四、门静脉辐射剂量分析:实验组a/b/c各组辐射剂量均远低于对照组,差异有统计学意义(p0.01)。结论:1、能谱ct门静脉成像与分团注射结合,在肝硬化患者能获得较好的门静脉及分支、病变显示情况,并同时降低了扫描过程中患者所受的辐射剂量,降幅达53%。2、能谱ct分团注射单期成像的扫描方法,在肝硬化不同肝功能CHILD分级下,均获得良好的成像效果。
[Abstract]:Objective: to study the effect of energy dispersive CT single phase imaging on the imaging quality and radiation dose of portal vein in patients with liver cirrhosis. Materials and methods: a total of 149 patients with A/B/C grade of liver function such as hepatitis, cirrhosis and other liver function were collected from September 2014 to March 2016. All patients were randomly divided into two groups. There were 75 patients in the experimental group, including 75 patients who were included in the experiment, and 6 patients (33 males) who were excluded from other factors, and the group of single phase enhancement of portal vein and conventional spiral CT of portal vein were divided into experimental group and conventional spiral CT group, and 75 patients were included in the experiment. 36 cases were female. The conventional spiral CT multi-phase scanning group was used as the control group, 74 patients were included in the experiment, 10 cases were excluded from other factors, 29 cases were males and 35 cases were females. The patients in two experimental groups were divided into three sub-groups according to the CHILD grading standard of liver function. The experimental group included 34 cases of CHILD A grade B and 19 cases of CHILD B grade C, and the control group of 33 cases with CHILD A grade B grade 18 cases with child C grade 13 cases. The experimental group was performed with energy dispersive CTs, and the control group with conventional spiral CTs, and the control group with Smart intelligent trigger delay of 10 s for three consecutive phases. The CTPV images of the two groups were evaluated objectively and objectively, and the dose of radiation was recorded at the same time. In the experimental data, the measured data according to normal distribution are expressed as x 卤s, and the independent sample t test is used, and the statistical significance is found in the comparison of counting data with x 2 test (P 0.05). Results: there was no significant difference between 75 patients in the experimental group and 74 patients in the control group in terms of basic data such as sex, age, height and body mass index (BMI). When the single energy is 60kev, the best single energy image of portal vein can be obtained by energy spectrum CT portography. The image is reconstructed under a single energy 60kev. Quantitative evaluation of portal vein enhancement: comparison of ct value of portal vein system: comparison between groups of portal vein ct value: a/b/c group in experimental group was significantly higher than that in control group (p0.001), and portal vein ct value in extrahepatic portal vein group was better than that in control group (a / b group). There was statistical difference between group C and control group (P = 0.002, P = 0.002, respectively), and there was statistical difference between group C and control group (P = 0.002). The comparison of ct value of portal vein branch between group A / b and group A / b was better than that of group A / b of control group. The ct value of extrahepatic portal vein was significantly different (p 0.001), and that of experimental group C was better than that of control group (P = 0.003). Second, portal cnr and snr: the SNR of a/b/c group was slightly higher than that of control group (a/b/c group). There was no significant difference between the two groups. 3. Analysis of portal vein subjective score: the subjective score of experimental group a / b group was higher than that of control group a / b group, the difference was significant (p 0.01), the experimental group C group was slightly higher than the control group C group, there was statistical difference between group A / b group and control group (P < 0. 031). 4. Portal vein radiation dose analysis: the dose of a/b/c in experimental group was much lower than that in control group, the difference was statistically significant (P 0.01). Conclusion in the patients with liver cirrhosis, the portal vein and branches can be obtained by the combination of spectral CT portal vein imaging and mass injection, and the lesions can be shown well, and the radiation dose of the patients during the scanning process can be reduced at the same time. The scanning method of single phase imaging with energy dispersive ct subgroup injection can obtain good imaging effect under different liver function CHILD grade of liver cirrhosis.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R575.2;R816.5

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