利用对比剂追踪SMV技术进行CTE扫描的应用研究

发布时间：2018-06-27 04:59

本文选题：小肠CT造影 + 肠系膜上静脉　；参考：《天津医科大学》2017年硕士论文

【摘要】：目的:研究在增强CT检查中SMV与小肠肠壁增强效应的关系,探索新型的对比剂追踪SMV技术完成增强CTE扫描的可行性,并将其与传统的主动脉上对比剂追踪技术的三期CTE图像做对比。方法:通过对无小肠病变的患者进行增强CT扫描,监测SMV与小肠肠壁的CT值以得到二者增强效应强度-时间的关系,确定扫描阈值,并对比剂追踪SMV自动触发扫描技术完成单期CTE增强检查,同时回顾分析行传统三期CTE增强检查的无小肠病变的患者的图像,并将这两种方法所得图像进行比较。内容:(1)选择无小肠病变者对其进行上腹部单期增强CT检查,在检查过程中,由经验丰富的放射科技师选定一个能显示十二指肠肠壁及肠系膜上静脉的层面,并设置ROI分别置于十二指肠肠壁及SMV内作为监测点,在注射对比剂后35s~55s对此层面进行连续扫描,平均间隔时间为1s,得出各个时间点上十二指肠肠壁与SMV的CT值,得出二者增强效应强度-时间的关系,并根据此关系得出肠壁增强效应最强时所对应的SMV的CT值,确定扫描阈值。(2)选择多名无消化道出血症状者对其进行增强CTE检查,不同于传统增强CT扫描将ROI置于主动脉中,而是将其置于SMV内,设定相应阈值并利用自动触发技术,完成CTE增强扫描并获取图像,将图像数据传至后处理工作站完成图像的重建并测量、记录各组段肠壁的CT值以评价其增强效应的强弱。(3)回顾分析多名曾行三期增强CTE且诊断阴性者,其扫描技术为利用传统的主动脉追踪技术,将ROI置于膈下1cm的腹主动脉内,设定相应阈值,利用自动触发扫描技术完成动脉期、肠道期及门脉期三期增强CTE扫描并获取图像,将图像数据传至后处理工作站完成图像的重建并分别测量、记录动脉期、肠道期及门脉期三个期相下各组段肠壁的CT值以评价其增强效应的强弱,并与(2)中单期增强CTE所得图像数据进行统计学分析,同时由两名以上有多年腹部CT诊断经验的副主任(或以上职称)医师对(2)及(3)中所得图像的诊断效能进行双盲对比。结果:(1)CTE受检者的SMV到达峰值的平均时间为注射对比剂后45.83±6.037s,十二指肠肠壁到达峰值平均时间为注射对比剂后40.24±8.907s,二者时间上的差异无统计学意义(P0.05)。十二指肠肠壁CT值到达峰值的时间点前4s(GE Lightspeed VCT 64排螺旋CT扫描机从触发到开始扫描所用反应时间为4s)所对应的SMV的CT值平均为65.87±8.246HU。(2)CTE诊断为阴性的受检者使用SMV上对比剂追踪技术进行单期增强扫描所得各组段肠管肠壁平均CT值分别为:十二指肠115.63±15.38HU、空肠108.57±12.82HU、回肠90.35±13.34HU,各组段肠道CT值差异无统计学意义(P0.05)。(3)CTE诊断为阴性受检者使用主动脉上对比剂追踪技术进行三期增强扫描所得十二指肠、空肠、回肠肠壁平均CT值于动脉期分别为65.68±15.36HU、64.61±20.23HU、60.18±12.25HU;肠道期分别为为117.66±29.87HU、110.37±24.92HU、87.54±18.19HU;门脉期分别为85.76±30.09HU,、78.03±15.43HU、68.56±14.42HU。十二指肠、空肠及回肠肠壁的CT值均是肠道期高于动脉期和门脉期,且差异有统计学意义(P0.05),而动脉期和门脉期差异无统计学意义(P0.05);SMV法所得各组段肠壁CT值与主动脉法所得的肠道期的肠壁CT值间的差异无统计学意义(P0.05),且由两名经验丰富的放射科诊断医师用双盲法比较这二者图像质量无差异。结论:使用对比剂追踪SMV技术进行CTE单期增强扫描是可行的,而且此方法所得图像质量与传统三期CTE中对比度最好的肠道期图像一样好。
[Abstract]:Objective: To investigate the relationship between SMV and intestinal wall enhancement in enhanced CT, and explore the feasibility of a new contrast agent tracking SMV technique to enhance the CTE scan, and compare it with the three phase CTE images of the traditional aorta contrast agent tracking technique. Method: enhanced CT scan for patients with non intestinal lesions and SMV monitoring SMV The relationship between the CT value of the intestinal wall and the intestinal wall of the small intestine was obtained to obtain the relationship between the two enhancement effect intensity time, the scanning threshold was determined, and the contrast agent tracking SMV automatic trigger scanning technique was used to complete the single phase CTE enhancement examination. Meanwhile, the images of the patients with the traditional three phase CTE enhanced examination of the non intestinal lesions were analyzed, and the images obtained by the two methods were compared. (1) a single phase enhanced CT examination of the upper abdomen was performed on the patients without small intestinal lesions. During the examination, an experienced radiologist selected a level that could display the duodenum and the superior mesenteric vein, and set the ROI in the duodenum wall and SMV as the monitoring point, and after the injection of contrast agent, the 35s~55s layer was taken. Continuous scanning, the average interval time is 1s, the CT value of the duodenum wall and SMV at each time point is obtained, and the relationship between the two enhancement effect intensity time is obtained. According to this relationship, the CT value of the corresponding SMV when the strongest intestinal wall enhancement effect is strongest and the scanning threshold is determined. (2) select multiple symptoms of no digestive tract bleeding to them. The enhanced CTE examination, unlike the traditional enhanced CT scan, placed the ROI in the aorta, but placed it in the SMV, set the corresponding threshold and use the automatic trigger technique to complete the CTE enhancement scan and obtain the image. The image data was passed to the post processing workstation to complete the reconstruction and measurement of the image, and the CT value of the intestinal wall of each segment was recorded to evaluate its enhancement effect. (3) review and analyze a retrospective analysis of a number of three phase enhanced CTE and negative diagnosis. The scanning technique was used to use the traditional aorta tracking technique to place ROI in the abdominal aorta of the 1cm under the diaphragm, set the corresponding threshold, complete the arterial phase by automatic trigger scanning technique, and enhance the CTE scan and obtain the image in the three stage of the intestinal phase and portal period. Like data to the post processing workstation, the images were reconstructed and measured respectively. The CT values of the intestinal wall of each group in the three phases of the arterial phase and the portal phase were recorded to evaluate the strength of the enhancement effect, and the data were statistically analyzed with the single phase enhanced CTE in the (2) period, and the diagnostic experience of the abdominal CT in the abdomen of more than two years was also made. The assistant director (or above title) doctors compared the diagnostic efficiency of the images obtained in (2) and (3). Results: (1) the average time of the SMV reaching the peak of the CTE subjects was 45.83 + 6.037s after the injection contrast, the average time of the peak of duodenal wall was 40.24 + 8.907s after the injection contrast agent, and the difference in the two time was not statistically significant. P0.05. The CT value of the duodenum wall of the duodenum reached the peak time point before 4S (GE Lightspeed VCT 64 spiral CT scanner from the trigger to the beginning of the scan the reaction time is 4S), the average of CT values of SMV (2) CTE diagnosed as negative with the contrast agent tracking technique for single phase enhanced scan The average CT value of intestinal intestinal wall was 115.63 + 15.38HU in duodenum, 108.57 12.82HU in jejunum and 90.35 in ileum. There was no significant difference in CT value of intestinal tract in each group (P0.05). (3) CTE diagnosed as negative subjects using aorta contrast agent tracking technique for three phase enhanced scan of duodenum, jejunum, ileum wall average The value of CT was 65.68 + 15.36HU, 64.61 + 20.23HU and 60.18 + 12.25HU in the arterial phase, and the intestinal period was 117.66 + 29.87HU, 110.37 + 24.92HU, 87.54 + 18.19HU, respectively, 85.76 + 30.09HU, 78.03 + 15.43HU, 68.56 + 14.42HU. duodenum, and the intestinal and ileum intestinal wall was higher than that of the arterial and portal phases. There was statistical significance (P0.05), but there was no significant difference between the arterial phase and the portal phase (P0.05). There was no significant difference between the CT value of the intestinal wall of each segment of the SMV method and the CT value of the intestinal wall in the enteric stage of the aorta (P0.05), and the two experienced radiologists compared the quality of the images with the double blind method. Theory: it is feasible to use contrast agent tracking SMV technique for CTE single phase enhanced scan, and the image quality obtained by this method is as good as the best enteric phase image in the traditional three phase CTE.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R816.5

【参考文献】