多层螺旋CT在心脏结构和功能评价中的应用研究

发布时间：2018-05-24 05:45

本文选题：自动法 + 手动法　；参考：《河北医科大学》2012年硕士论文

【摘要】：第一部分256iCT和心动超声左心房容积定量测量准确性研究目的：探讨256层螺旋CT对左心房体积测量的准确性。方法：①、手工制作四只不同大小的左心房模型,24小时之内完成256层螺旋CT和心动超声两种检查。对256iCT后处理工作站自动测量法、半自动法、心动超声法与和真实容积之间进行比较；②、选取60例行冠状动脉CTA检查患者并在12小时内进行心脏超声检查,测量左心房容积。将60例患者按性别分组,对总体样本组、男性组及女性组分析256iCT后处理工作站自动测量法和心脏超声法两者之间的差别。结果：1、左心房模型试验结果表明,CT自动算测量法与真实容积之间无明显差别(P0.05),半自动法、超声法与真实容积之间有明显差异(P0.05)。2、60例临床样本组两种测量方法之间差异明显(P0.05),左房体积测量,采用超声法较256iCT自动测量法定量值低约24%,不同性别组分析结果与60例临床样本组基本一致。结论：256层螺旋CT可以用于左心房容积定量测量,其结果客观、准确、可重复性强。该研究具有重要临床价值。第二部分利用256iCT对左心室解剖结构和功能定量研究目的：应用256iCT对正常人左心室结构和功能相关指标进行定量研究,分析各指标与年龄和性别的关系。方法：收集506例行256iCT冠状动脉CTA查体结果正常的患者影像资料；所有患者近6个月无心血管疾病病史。对原始图像进行多期重建,确定左心室舒张末期及收缩末期,分别对左心室舒张末期和收缩末期的室间隔厚度(Septal wall thickness, SWT)、左室后壁厚度(Posterior wall thickness, PWT)、左室宽径(LV inner diameter LVID)、舒张末期容积(end-diastolic volume, EDV)、收缩末期容积(end-systolic volume, ESV)、每搏输出量(stroke volume,SV)和射血分数(ejection fraction, EF)进行测量和计算,并进行相关统计学处理。结果：左心室舒张末期SWT、PWT、LVID95%参考值范围分别为4.4-12.1mm,4.0-14.0rmm,28.1-60.8rmm。左心室收缩末期SWT、PWT、LVID95%参考值分别为：6.2-15.7mm,7.9-20.8mm,18.1-46.3mm。EDV、ESV、SV、EF95%参考值范围分别为：55.9-165.7ml,20.9-75.9ml,25.8-98.6ml,39.8%-78.3%。收缩期LVID和舒张期LVID值不同年龄组之间差异有统计学差异(P0.05),并且随着年龄增长有增大趋势。收缩期SWT、舒张期SWT、收缩期PWT、舒张期PWT以及EF值有随着年龄增长而增大的趋势,同时EDV、ESV、SV值随着年龄增长有减小的趋势,但以上各指标在不同年龄组之间的差异均无统计学意义(P0.05)。不同性别组分析显示除EF值无统计学差异以外,其余各指标均有统计学差异(P0.05),且男性组各指参数均大于女性组。结论：本研究初步制定了左心室形态、功能相关参数的正常参考值,为临床诊断、危险评级及预后判断提供有意义信息。第三部分利用256iCT对正常人左心房相关参数定量研究目的：应用256iCT对左心房结构和功能相关参数定量研究。方法：选择506例行256iCT冠状动脉CTA检查结果正常的患者影像资料,所有患者近6个月之内无心血管疾病病史。确定左心室收缩末期和舒张末期,分别测量左心房最大容积(Left atrial maximal volume LAVmax)、左心房最小容积(Left atrial minimal volume, LAVmin)、左心房最大前后径(Left atrial maximal anterior posterior diameter, LADmax)、左心房最小前后径(Left atrial minimal anterior posterior diameter, LADmin),左心房前壁厚度(Left atrial wall thickness, LAT),并计算出左心房容积指数(Left atrial volume index, LAVI)和左心房射血分数(Left atrial ejection fraction, LAEF),进行相关统计学处理。结果：正常人LAVmax、LAVmin、LADmax、LADmin、LAT、LAVI以及LAEF的95%医学参考值范围分别为：15.64-82.78ml、9.78-51.34ml、25.75-50.87mm、20.99-45.34mm、1.17-3.15mm、18.90-39.32ml/m224.13%-53.11%。不同年龄组之间LAVmax、LAVmin、LADmin有统计学差异(P0.05),40岁以上人群大于40岁以下人群。不同性别之间LAVmax、LAVmin有统计学差异(P0.05),男性大于女性,其余各参数男女之间均无差异(P0.05)。LAVmax、LAVmin与年龄相关,随着年龄增长有增大趋势(P0.05)。LAVI、LAEF在不同年龄、性别之间均无明显差异。结论：本研究初步建立了正常人左心房相关参数的医学参考值,为临床评估左心房解剖结构和功能提供了参考标准。
[Abstract]:Part 1 accuracy of quantitative measurement of left atrial volume by 256iCT and echocardiography
Objective: To investigate the accuracy of 256 slice spiral CT in measuring left atrial volume.
Methods: (1) four different sizes of left atrium models were made by hand, and two kinds of spiral CT and echocardiography were completed within 24 hours. Automatic measurement of 256iCT post processing workstation, semi-automatic method, echocardiography and real volume were compared. (2) 60 cases of coronary artery CTA examination were selected and entered within 12 hours. The volume of left atrium was measured by echocardiography. 60 patients were grouped by sex, and the differences between the 256iCT post processing workstation and the echocardiography were analyzed for the overall sample group, the male group and the female group.
Results: 1, the results of the left atrial model test showed that there was no significant difference between the CT automatic measurement and the real volume (P0.05), the semi-automatic method, the ultrasonic method and the real volume (P0.05), the difference between the two methods of the clinical sample group was obvious (P0.05), the volume measurement of the left atrium, and the ultrasonic method compared with the 256iCT automatic measurement method. The quantitative value was about 24% lower than that of the 60 clinical samples.
Conclusion: the 256 slice spiral CT can be used for quantitative measurement of left atrial volume. The results are objective, accurate and reproducible. This study has important clinical value.
The second part is a quantitative study of left ventricular anatomy and function using 256iCT.
Objective: to quantitatively study the structure and function of left ventricle in normal subjects by 256iCT, and analyze the relationship between each index and age and sex.
Methods: the imaging data of 506 patients with normal coronary artery CTA findings in 256iCT were collected; all patients had no history of cardiovascular disease for nearly 6 months. Multiphase reconstruction of the original images was carried out to determine the end diastolic and end systolic stage of left ventricular diastolic and end systolic thickness (Septal wall thickness, S) WT), the thickness of the left ventricular posterior wall (Posterior wall thickness, PWT), the width of the left ventricle (LV inner diameter LVID), the end diastolic volume (end-diastolic volume, EDV), the end systolic volume, and the measurement and calculation of the per stroke output and the ejection fraction, and related statistics. Handle.
Results: the reference ranges of left ventricular end diastolic SWT, PWT, and LVID95% were 4.4-12.1mm, 4.0-14.0rmm, 28.1-60.8rmm. left ventricular end systolic SWT, PWT, and LVID95% reference values respectively: 6.2-15.7mm, 7.9-20.8mm, 18.1-46.3mm.EDV. There was a statistical difference between ID and diastolic LVID values in different age groups (P0.05), and increased with age. Systolic SWT, diastolic SWT, systolic PWT, diastolic PWT and EF value increased with age, while EDV, ESV, SV values decreased with age, but the above indexes were different There was no statistical difference between the age groups (P0.05). The analysis of different sex groups showed that there were statistical differences except the EF value (P0.05), and the parameters of each finger in the male group were all larger than those of the female group.
Conclusion: the normal reference value of left ventricular shape and function related parameters is preliminarily established in this study, which provides meaningful information for clinical diagnosis, risk rating and prognosis judgment.
The third part is a quantitative study of left atrial related parameters in normal subjects using 256iCT.
Objective: to quantitatively study the parameters related to the structure and function of left atrium by 256iCT.
Methods: the imaging data of 506 patients with normal 256iCT coronary artery CTA examination were selected. All patients had no history of cardiovascular disease within nearly 6 months. The left ventricular end systolic and terminal diastolic volume (Left atrial maximal volume LAVmax) and the minimum volume of left atrium (Left atrial minimal volume) were measured respectively. The maximum left atrium diameter (Left atrial maximal anterior posterior diameter, LADmax), the minimum left atrium anterior and posterior diameter (Left atrial minimal anterior), left atrial anterior wall thickness, and left atrium volume index (LAVmin), and left atrium volume index (left atrial volume index), and left atrium volume index (left atrium volume index), and left atrium volume index (left atrium volume index), and left atrium volume index (left atrium volume index), and left atrium volume index (left atrium volume index) were calculated. Left atrial ejection fraction (LAEF) was used for statistical analysis.
Results: the 95% medical reference values of normal people LAVmax, LAVmin, LADmax, LADmin, LAT, LAVI and LAEF are respectively 15.64-82.78ml, 9.78-51.34ml, 25.75-50.87mm, 20.99-45.34mm, 1.17-3.15mm, and there are statistical differences. The population over 40 years old is more than 40 years old. There were statistical differences in LAVmax and LAVmin (P0.05) between male and female (P0.05). There was no difference between male and female in male and female (P0.05).LAVmax, LAVmin was associated with age, and increased with age (P0.05).LAVI, and there was no significant difference between sex and sex at different ages.
Conclusion: This study preliminarily establishes the medical reference values of left atrial related parameters in normal people, and provides a reference standard for clinical assessment of the anatomical structure and function of left atrium.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R816.2

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