心率（律）对128层CT冠状动脉成像质量的影响及心电编辑技术的应用研究

发布时间：2018-06-14 00:06

本文选题：冠状动脉成像 + X线计算机　；参考：《辽宁医学院》2012年硕士论文

【摘要】：目的探讨不同心率及心律失常对心脏冠脉成像图像质量的影响及不同心率下最佳重建时相的选择，并进一步探讨心电编辑技术在心律失常患者CT冠状动脉成像中的应用价值。方法收集本院2010年4月至2011年3月间行128层螺旋CT扫描冠状动脉成像检查（MSCTCA）的患者159例，其中男89例，女70例，年龄（32~86）岁，平均年龄（56±12）岁，平均心率为（64±14）bpm。纳入标准：无碘过敏史，无严重的心、肝及肾功能不全，检查前心率大于70次/分（Beat Per Minute，bpm）的患者服用β-受体阻滞剂降低心率。排除标准：孕妇和肝、肾功能不全和不能屏气10s以上者；因患有精神疾病不能按指令屏住呼吸者等。所有患者均签署检查知情同意书。按心律不同分为心律正常组A组及心律失常组B组，其中A组又分为正常心率A1组（HR≤65bpm），临界心率A2组（65＜HR≤75bpm）及高心率A3组（HR＞75bpm），B组进行心电编辑后为B’组。A1组40人，A2组38人，A3组38人，B组43人。所有的冠状动脉图像质量按~IV等级（4分，3分，2分，1分）分段进行由两名中级以上医师进行双盲测评分，当出现争议时由第三名医师中级以上进行判定，记录各支不同时相（10%~90%）的图像质量及其最佳重建重建时相。A组只评价RCA1~3，LAD1~3及LCX1~2，B组则分别评价心电编辑前后全部15段冠状动脉的评分。所有数据采用spss17.0统计软件包分析数据，计量资料用x S表示，采用T检验或单因素方差分析；计数资料用例数或百分数（%）表示，用卡方检验；等级资料采用非参数秩和检验，所有统计学结果均以α=0.05为检验水准，P＜0.05为差异有统计学意义，P＜0.01为差异有显著统计学意义。结果 1．不同心率组最佳重建时相的选择 A1、A2、A3三组各主要分支平均质量评分峰值集中在收缩末期（35%~45%）及舒张中期（65%~80%），成“双峰样”，A组中78例患者(67.24%)选择舒张中期作为最佳时相，21例患者（18.10%）选择收缩末期作为最佳时相，另有17例患者(14.65%）左冠状动脉和右冠状动脉图像质量不能在同一时相达到最佳，需分别采用两个时相评估。 A1组的RCA、LAD、LCX平均图像质量评分分别在75%，75%，70%时相达到最高，A2组的RCA、LAD、LCX平均图像质量评分均在70%时相达到最高。A3组的LAD、LCX平均图像质量评分在70%及60%时达到最高，而RCA则在35%时相时达到最高。 2．不同心率组间各主要冠状动脉图像质量比较 A1组与A2组的主要冠状动脉分支评分的优良率（评分≥3的比例），，分别为96.56%及94.36%，而A3组的优良率仅为86.75%。两两比较三组的图像质量平均分，A1组与A2组各支间无明显统计学差异（P＞0.05），A3组与A1组、A2组各支均有明显统计学差异（P＜0.05） 3．心电编辑后B'组与编辑前B组及正常心率A1组的图像质量比较 B’组所有冠状动脉节段经Wilcoxon配对法检验与编辑前B组比较，其中右主干（RCA1）及左主干（LM）编辑前后图像质量差异无统计学意义（P＞0.05）；其他冠状动脉均有统计学差异（P＜0.01）。 B'组与A1组比较，两组的质量评分经方差分析，LCX的统计学未见明显差异（P＞0.05），RCA与LAD仍有统计学差异（P＜0.05），但两组的RCA，LAD，LCX的优良率经卡方检验并无统计学差异（P＞0.05）。结论第一：心率及心律仍是冠状动脉图像质量的主要影响因素。心率越高图像质量越差，其中RCA最易受心率影响。心律失常患者图像质量普遍偏低，必要时需做心电编辑等后处理补救。第二：MSCTCA最佳时相呈“双峰”样分布。HR＜75bpm时最佳重建时相多为舒张中期，HR≥75bpm时最佳重建时相多为收缩末期。部分心率较快患者需采用多期重建时相，大多数患者LAD最佳时相仍为75%，而LCX及RCA的最佳时相则多为55%~65%及35%~45%。第三：心电编辑技术可明显改善大多数因心律失常而产生的冠状动脉伪影，使图像质量满足诊断要求，扩大了MSCTCA检查的适应症范围，但心电编辑对频发的期前收缩及快速房颤等复杂的心律失常仍有一定局限性，应针对具体情况综合考虑。
[Abstract]:objective
To explore the effect of cardiac arrhythmia and arrhythmia on the image quality of coronary artery imaging and the selection of optimal reconstruction phase under the heart rate, and to further explore the application value of ECG editing technique in coronary artery imaging of CT for arrhythmia patients.
Method
159 cases of 128 slice spiral CT scan coronary angiography (MSCTCA) were collected from April 2010 to March 2011 in our hospital. There were 89 men, 70 women, age (32~86) years, average age (56 + 12) years, and the average heart rate was (64 + 14) bpm..
Inclusion criteria: a history of anaphylaxis without iodine, no serious heart, liver and renal insufficiency, and a patient with a pre test heart rate greater than 70 Beat Per Minute (BPM) taking beta blocker to reduce heart rate.
Exclusion criteria: pregnant women and liver, kidney dysfunction, and inability to hold breath or more than 10s; people who have mental illness can not hold their breath according to instructions. All patients sign informed consent.
According to the different rhythm of the heart rhythm, the A group and the arrhythmia group B group were divided into the normal heart rate group (HR < 65bpm), the critical heart rate A2 group (65 < HR < < 75bpm) and the high heart rate A3 group (HR > 75bpm). The group carried out the electrocardiographic editing group of 40 persons, 38 people, 38 people, 43 people. At the level (4, 3, 2, 1), a double blind score was carried out by two intermediate doctors and above. When there was a dispute, third doctors and above were judged, the image quality of each branch (10%~90%) and the best reconstruction and reconstruction phase.A were evaluated only by RCA1~3, LAD1~3 and LCX1~2, and the B group evaluated the editors before and after editors respectively. All 15 segments of coronary artery score.
All data were analyzed by SPSS17.0 statistical software package, and the measurement data were expressed in X S, using T test or single factor variance analysis, the number of use cases or percent (%) was expressed with the chi square test. The grade data were tested with non parametric rank and test, all statistical results were tested with alpha =0.05, P < 0.05 was statistically significant. Significance, P < 0.01 was significant statistically significant.
Result
The selection of the best reconstruction phase in 1. non concentric rate groups
The average mass score of A1, A2 and A3 three groups was concentrated at the end of systolic (35%~45%) and medium-term diastolic (65%~80%), "Shuangfeng like". In group A, 78 patients (67.24%) chose the middle diastolic phase as the best phase, 21 patients (18.10%) selected the end systolic phase as the best phase, and 17 patients (14.65%) left coronary artery and right coronal coronary artery. The quality of arterial images can not be optimal at the same time, and two time phases should be used respectively.
The average image quality score of RCA, LAD, and LCX in group A1 reached the highest level at 75%, 75% and 70% respectively. The average image quality score of RCA, LAD and LCX in A2 group reached the highest.A3 group of LAD, the LCX average image quality score reached the highest at 70% and 60%, while RCA then reached the highest when 35% phase.
2. comparison of image quality of main coronary arteries between different heart rate groups
The good rate of the main coronary artery branch score in group A1 and group A2 (the proportion of score above 3) was 96.56% and 94.36% respectively, and the good rate of group A3 was only the average score of image quality in the three groups of 86.75%. 22. There was no significant difference between the A1 group and the A2 group (P > 0.05), A3 and A1 groups and A2 groups had significant statistical differences (P < 0.05).
Comparison of image quality between B'group and pre edit B group and normal heart rate A1 group after 3. ECG editing
All coronary artery segments in B 'group were tested by Wilcoxon matching and before edited B group, and there was no statistical difference between the right main trunk (RCA1) and left main trunk (LM) before and after editing (P > 0.05), and the other coronary arteries were statistically different (P < 0.01).
Compared with group A1, the quality score of the two groups was not significantly different between the two groups by analysis of variance (P > 0.05), and there was still statistical difference between RCA and LAD (P < 0.05), but there was no statistical difference between the two groups of RCA, LAD, LCX (P > 0.05).
conclusion
First: heart rate and heart rhythm are still the main factors affecting the image quality of coronary artery. The higher the heart rate is, the worse the image quality is, and the RCA is the most susceptible to the heart rate. The image quality of the arrhythmia patients is generally low, and the post-processing remedies should be done when necessary.
Second: when the best phase of MSCTCA is "Shuangfeng" like.HR < 75bpm, the best reconstruction phase is mostly mid diastolic phase, and the best reconstruction phase is the end systolic phase when HR is more than 75bpm. Some patients with relatively fast heart rate need to adopt multiphase reconstruction phase, most of the patients with the best phase of LAD are still 75%, while the best phase of LCX and RCA is mostly 55%~65% and 35%~45%..
Third: electrocardiogram editing technology can obviously improve most of the coronary artifacts caused by arrhythmia, make the image quality meet the diagnostic requirements and expand the range of indications for MSCTCA examination. However, ECG editors still have some limitations on the complicated arrhythmia, such as frequent premature contraction and rapid atrial fibrillation, and should be integrated with specific conditions. Consider.
【学位授予单位】：辽宁医学院
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R816.2

【参考文献】