256层螺旋CT灌注成像高压电损伤对肢体保存的应用研究

发布时间：2019-05-31 17:12

【摘要】：目的探索256层螺旋CT灌注成像技术对于高压电后对四肢损伤保存肢体的应用价值材料与方法选择高压电损伤患者72例,其中接受四肢灌注检查者67例,常规四肢CTA检查者5例。按照手术后截肢与否,将67例接受四肢灌注检查者分为截肢组22例及未截肢组45例。将MSCTP检查结果(肌肉微循环灌注信息及相应部位血管CTA图像)与手术、病理对照,以及进行自身、双侧对照。将灌注所得图像传入Phillips公司专属EBW工作站,用Functional CT-general模式行灌注图像处理。(1)从灌注扫描结果中,选择最佳时相提取CTA图像,采用MPR、CPR、VR、MIP及高级血管分析(advantage vessel analysis, AVA)软件进行分析,获得相应部位的血管图像；(2)截肢组及未截肢组中选定兴趣区即得到包含血流灌注(BF),峰值增强(PEI),达峰时间(TTP),血容量(BV)的伪彩图、具体量化数值及时间密度曲线(TDC)。72例均进行血管等形态学分析,截肢组、未截肢组67例进行t检验,其中对截肢组另外进行判别分析,以比较各组肢体各部位灌注参数的差异。结果1、高压电损伤后肌肉、皮肤、骨骼CT影像表现：患者肌肉损伤在CT平扫、增强图像上一般表现为低密度影；皮肤损伤表现为皮肤局部缺损、皱褶；骨骼破坏后表现为骨皮质不连续、错位。2、高压电损伤后CTA表现：CTA对血管显示较为清晰,损伤血管表现为节段性狭窄、跳跃显影或血管远端呈鼠尾状闭塞、中断。3、高压电损伤后CT灌注表现：高灌注、低灌注及无血流灌注表现。各组参数分析如下：1)截肢组：a、患侧截肢平面下份与健侧相对应下份层面比较,BF值：前者后者,差异有统计学意义；PEI值：前者后者,差异有统计学意义;BV值：前者后者,差异无统计学意义；TTP：前者后者,差异无统计学意义。患侧截肢平面上份与健侧相对应上份层面比较,BF、PEI、BV、TTP值：前者均后者,差异均无统计学意义。患侧截肢平面与健侧相对应平面比较,TTP值：前者后者,差异有统计学意义；BF、PEI、BV值：前者均后者,差异均无统计学意义。b、患侧截肢平面上份与患侧截肢平面比较,BF、PEI、TTP值：前者均后者,差异无统计学意义,BV值：前者后者,异无统计学意义。c、患侧截肢平面下份与患侧截肢平面参数比较,BF、PEI值前者后者,差异无统计学意义；BV值：前者后者,差异有统计学意义。a组数据kappa值均0.4,一致性较差。所以，，采用BF、PEI、TTP、BV值对于是否为患侧截肢各平面与健侧相对应各层面的预测的实际意义不大。b组kappa值为0.390.4,一致性较差。所以,采用BF、PEI、TTP、BV值对于是否为患侧截肢平面上份与患侧截肢层面的预测的实际意义不大。c组kappa值为0.420.4,一致性尚可。所以BF、PEI、TTP、BV值对于患侧平面下份与患侧平面的预测有一定的实际意义。2)未截肢组：未截肢患者BF、PEI、BV值：患侧健侧,差异均无统计学意义。TTP患侧健侧,差异无统计学意义。结论应用256层螺旋CT灌注诊断四肢高电压损伤,能够获得清晰的血管CTA图像及不同损伤部位灌注参数值,并且这些灌注参数对皮瓣修复的预后具有评判价值;MSCTP对区别高压电损伤截肢与否一定的帮助作用。MSCTP能够为临床提供诊断、治疗高压电损伤的方便和安全、定性、定量的检查方法。
[Abstract]:Objective To explore the application value of 256-slice spiral CT perfusion imaging in the preservation of limbs after high voltage Methods:72 patients with high-voltage injury were selected from the materials and methods, of which 67 subjects were treated with 4-limb perfusion and 5 cases of conventional four-limb CTA. Example.67 patients with four-limb perfusion were divided into the amputation group (22 cases) and the non-amputation group (45) according to the post-operation amputation. Example: MSCTP examination results (muscle microcirculation perfusion information and corresponding site vessel CTA images) were compared with the procedure, the pathology control, and the self, bilateral pair In accordance with. Transfer the resulting image to the dedicated EBW workstation of the Phillips company and fill the image with the Functional CT-general mode. (1) From the results of perfusion scanning, the best time phase was selected to extract the CTA image, and the software of MPR, CPR, VR, MIP and advanced blood vessel analysis (AVA) was used for analysis to obtain the blood vessel map of the corresponding site. (2) The selected areas of interest in the amputation group and the non-amputee group were pseudo-color images including blood flow perfusion (BF), peak enhancement (PEI), peak time (TTP), blood volume (BV), specific quantification values and time density curves (TDC). The t-test was performed in 67 cases of the non-amputated group, in which the amputation group was further analyzed to compare the difference of the perfusion parameters of each part of the limb. Results 1. The image of the muscle, skin and bone after high-voltage injury showed that the muscle injury of the patient was on the CT level, and the enhancement of the image was generally low-density shadow; the skin injury was manifested as the local defect of the skin, the fold, and the bone cortex was not continuous and wrong after the bone destruction. 2. CTA in high-voltage injury: CTA is clear in the display of blood vessel, and the damage to the blood vessel is a section of the section of the section, the jumping development or the distal end of the vessel is in the shape of a tail-like occlusion, and the interruption.3. CT perfusion after high-voltage injury: high perfusion, low perfusion and no blood flow irrigation. Note: The parameters of each group are as follows:1) amputation group: a. The lower part of the amputation plane of the affected side is compared with the healthy side at the lower part level, and the BF value: the former is the latter and the difference is of statistical significance; the value of the PEI: the former is the latter, the difference is of statistical significance; the value of BV: the former is the latter, and the difference is not statistical Significance of learning; TTP: The former is the latter and there is no statistical difference between the latter and the latter. The value of BF, PEI, BV, and TTP: The former was the latter and the difference was not statistically significant. The value of TTP: The former is the latter, the difference is of statistical significance, and the value of BF, PEI, and BV: The former is the latter, and the difference is no statistics. The value of BF, PEI and TTP: The former is the latter, the difference is no statistical significance, the value of BV: The former is the latter, and the difference is non-statistical. Study significance. c. The lower part of the amputation plane of the affected side is compared with the plane parameter of the amputation plane at the affected side, the value of BF and PEI is the latter, and the difference is not significant; the value of BV: the former is the latter, and the difference is statistics study significance. A group data kappa value of 0.4, consistent Poor sex. Therefore, the value of BF, PEI, TTP, and BV is used to determine the actual meaning of the prediction of each plane and the healthy side of the amputee for the affected side. The value of kappa number in group b was 0.390.4, and the value of kappa value was 0.390.4. Poor sex. Therefore, the value of BF, PEI, TTP, and BV is used to determine the actual meaning of the prediction of the amputated plane on the affected side and the amputation level on the affected side. The value of kappa value in group c was 0.420.4, and the value of kappa value was 0.420.4. The values of BF, PEI, TTP and BV have a certain practical significance for the prediction of the plane of the affected side and the plane of the affected side.2) No amputee: BF, PEI and BV in the non-amputated patient: no statistics on the side-to-side and the difference of the affected side. Significance of learning. There was no statistical difference between the side and the side of the affected side of the TTP. Conclusion Using 256-slice spiral CT perfusion in the diagnosis of high voltage injury of four limbs, it is possible to obtain clear blood vessel CTA images and different lesion site perfusion parameter values, and these perfusion parameters can be used for the prognosis of skin flap repair. Evaluated value; MSCTP is certain to distinguish the amputation of high-voltage electric injury. The MSCTP can be used for clinical diagnosis, convenience and safety for treating high-voltage damage, and qualitative and quantitative analysis.
【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R816.8;R647

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