64排螺旋CT下肢动脉血管成像个体化技术的临床研究

发布时间：2018-07-01 14:52

本文选题：示踪法技术 + 预实验注射技术　；参考：《延边大学》2012年硕士论文

【摘要】：目的：探讨改良后的2次小剂量对比剂预试验技术在64层螺旋CT下肢动脉血管成像的可行性。方法：选择40例临床怀疑下肢动脉性疾病的患者,随机分成两组：个体化组和对照组。对照组20例,采用示踪法技术(Bolus-tracking),用64层CT行CTA；个体化组20例,应用预实验注射技术(Test-bolus),即采用2次小剂量(对比剂各15ml,生理盐水各30m1)团注预试验法行CTA,根据腹主动脉(L3/4水平)及双侧胫前动脉或胫后动脉(踝关节水平)的动态扫描达峰时间确定CTA的扫描延迟时间及扫描持续时间。每组CTA图像由2名有经验的高年资主治医师对下列4个方面独立进行评价：(1)显示血管的最远分支级别；(2)动脉边缘光滑度；(3)静脉干扰情况；(4)4个动脉节段(腹主动脉-髂动脉段、股动脉-胭动脉段、小腿动脉段、足背或足底动脉段)的CT值,比较2组患者的CTA图像质量。对2组患者的动脉分支级别、血管边缘、静脉干扰评分和测量的CT值应用t检验。结果：个体化组2次小剂量对比剂预试验显示,20例患者腹主动脉小剂量对比剂预试验成功率100%(20/20),对比剂到达腹主动脉(L3/4水平)的峰值间(TAo)差异较大,时间范围和平均时间为18.0-34.0(24.3±5.3)s。20例患者中获取胫前／后动脉(踝关节水平)小剂量对比剂预试验成功率98%(76/80),双侧胫前动脉达峰时间(TTI)差异较大,时间范围和平均时间为28.0-60.0(49.1±7.9)s,16例左右胫前动脉达峰时间不一致。腹主动脉-胫前动脉的通过时间(Tt)为10.0-31.0s,平均(18.84±5.5)s,Tt的个体间差异大,对比剂通过时间最长与最短者相差2-3倍。个体化组小腿部动脉的最远分支级别,动脉边缘光滑度,静脉干扰及动脉段CT值分别为3.4±0.8,2.7±0.5,0.2±0.4,219.5±10.638；对照组小腿部动脉的最远分支级别,动脉边缘光滑度,静脉干扰及动脉段CT值分别为2.9±1.0,2.4±0.8,0.8±0.5,187.9±14.027；个体化组足背部动脉的最远分支级别,动脉边缘光滑度,静脉干扰及动脉段CT值分别为3.2±0.8,2.6±0.5,0.3±0.4,187.9±14.027；对照组足背部动脉的最远分支级别,动脉边缘光滑度,静脉干扰及动脉段CT值分别为2.3±1.1,2.3±0.8,0.7±0.5,166.3±17.480；分别对两组评分进行比较,个体化组均优于对照组,P值均小于0.05,具有统计学意义。腹主动脉-髂动脉阶段及股动脉-胭动脉阶段两组患者的静脉干扰评分分别为,个体化组为0.0±0.0,0.0±0.0；对照组为0.3±0.3,0.4±0.3；个体化组均优于对照组,P值小于0.05,有统计学意义。结论：1.个体化组腹主动脉峰值时间(TAo)、胫前/后动脉峰值时间(TTI)及腹主动脉-胫前/后动脉通过时间(Tt)存在明显个体差异。2.应用两次预实验注射技术可以准确把握扫描时间,从而获得比示踪法技术更好的血管成像质量,对临床提供术前评估和指导治疗有极其重要的意义。
[Abstract]:Objective: to investigate the feasibility of the modified low-dose contrast agent pretest in 64-slice spiral CT angiography of lower extremity artery. Methods: 40 patients with suspected lower extremity arterial disease were randomly divided into two groups: individualized group and control group. 20 cases in the control group were treated with Bolus-tracking and 20 cases in the individualized group were treated with 64-slice CT. Using the method of pre-experimental injection (Test-bolus), two small doses (15 ml each of contrast agent, 15 ml of normal saline) were used to perform the pre-injection test. The dynamic changes of abdominal aorta (L3 / 4 level) and bilateral anterior tibial artery or posterior tibial artery (ankle level) were measured. Scan peak time to determine CTA scan delay time and scan duration. Each group of CTA images was independently evaluated by two experienced senior attending physicians in the following four areas: (1) showing the furthest branch of the vessel; (2) the smoothness of the artery edge; (3) the venous interference; (4) CT values of 4 arterial segments (abdominal aorta-iliac artery segment, femoral artery-popliteal artery segment, leg artery segment, dorsal foot or plantar artery segment) were compared between the two groups. T-test was used to evaluate arterial branch grade, vascular edge, venous interference score and measured CT value in both groups. Results: in the individualized group, the success rate was 100% (20 / 20) in 20 patients (20 / 20) with low dose contrast agent pretest, and there was a great difference in the peak value (TAO) of the contrast agent to the abdominal aorta (L 3 / 4 level). The time range and mean time were 18.0-34.0 (24.3 卤5.3) s.20 cases. The success rate of low-dose contrast agent pretest of anterior tibial / posterior tibial artery (ankle level) was 98% (76 / 80), and the time of reaching peak of bilateral anterior tibial artery (TTI) was significantly different. The time range and mean time were 28.0-60.0 (49.1 卤7.9) sm in 16 cases, the peak time of left and right anterior tibial artery was not consistent. The transit time (T _ t) of the abdominal aorta to anterior tibial artery was 10.0-31.0 s, with a mean of (18.84 卤5.5) sTt. The difference was 2-3 times between the longest transit time and the shortest transit time. In the individualized group, the furthest branch grade of the leg artery, the degree of smooth margin of the artery, the venous interference and the CT value of the artery segment were 3.4 卤0.82 卤0.52 卤0.42 19.5 卤10.638, respectively, while in the control group, the furthest branch grade of the leg artery, the degree of smooth margin of the artery, and the CT value of the artery segment were 3.4 卤0.88 卤0.52 卤0.42 卤10.638, respectively. The CT values of venous interference and arterial segment were 2.9 卤1.0 卤2.4 卤0.8 卤0.5187.9 卤14.027, respectively. The furthest branches of dorsal artery of foot, the smoothness of artery edge, the CT value of venous interference and arterial segment in individualized group were 3.2 卤0.82.6 卤0.50.50 卤0.4187.9 卤14.027, respectively, and the furthest branch grade of dorsal artery of foot in the control group. The arterial margin smoothness, venous interference and CT value of arterial segment were 2.3 卤1.1 ~ 2.3 卤0.80.87 卤0.5166.3 卤17.480 respectively, the scores of individualized group were better than that of control group (P < 0.05), which had statistical significance. The scores of venous interference in the abdominal aorta-iliac artery stage and the femoral artery-popliteal stage were 0.0 卤0.00.0 卤0.00.in the individualized group and 0.3 卤0.3in the control group, respectively. The scores of venous interference in the individualized group were higher than those in the control group (P < 0.05). Conclusion 1. In individualized group, there were significant differences in the peak time of abdominal aorta (TAO), peak time of anterior tibial / posterior tibial artery (TTI) and transit time of abdominal aorta to anterior tibial artery (Tt). The application of two-time pre-experimental injection technique can accurately grasp the scanning time and obtain better vascular imaging quality than the tracer technique. It is of great significance to provide preoperative evaluation and guidance for clinical treatment.
【学位授予单位】：延边大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R816.2

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