MSCT泌尿系统成像技术减少辐射的研究
发布时间：2019-06-29 14:09
【摘要】：目的：近年来,泌尿系统成像技术不断得到更新,在各种检查中MSCT尿路成像由于其扫描速度快,图像分辨率高,加之强大的后处理功能,使其成为泌尿系统疾病检查中最主要的方法。传统的MSCT尿路成像包括平扫,皮质期、髓质期和排泄期的4期扫描,解决了很多临床实际问题,然而其致命的缺点就是扫描范围大、分期多,患者接受的X线辐射剂量高。本研究旨在通过改进扫描方案,最大限度的减少辐射剂量,探讨其在临床疾病诊断中的应用价值。 方法：本研究分为3个部分： 1.回顾性分析了各个扫描时相在泌尿系统占位性病变中的诊断价值。选取我院2011年1月到2011年9月之间进行传统MSCT泌尿系统成像检查并手术病理证实的患者38例,其中男22例,女18例,年龄15-88岁,中位年龄64岁。通过不同的三期或者二期图像组合对患者进行诊断,并将其结果与病理学结果进行对照。 2.分组研究泌尿系统低剂量扫描技术的价值。选取我院泌尿外科患者20例,按照扫描时Kv值的不同分成4组,对所得图像进行质量评估,并对各组患者所接受的X线的辐射剂量进行统计学比较。 3.改良“分离团注法”研究中,选取我院泌尿外科住院病人10例,扫描的X线参数为160Kv/120mAs,造影剂总量设为90ml,按照第一次团注20ml,第二次团注70m1分配。连续获取平扫-排泄联合图像、皮质-排泄联合期及肾实质-排泄联合期图像并对图像质量进行评估。 4.本研究分为三个部分,其中第一部分和第三部分均为计数资料,差异显著,无需统计学比较。第二部分低剂量MSCT泌尿系统成像部分,其数据为多个独立样本的均数的比较,选择完全随机方差分析法进行统计学比较。数据统计使用安装版的SPSS17.0软件进行统计,检验标准取α=0.05。 结果：1.回顾性分析部分,首先通过(平扫+皮质+实质)三期图像诊断,所纳入26例肾肿瘤患者影像诊断与病理诊断完全符合,4例肾盂癌仅有2例能做出定性诊断,8例输尿管膀胱癌中有2例未能做出明确诊断。第二步通过(平扫期+皮质期+排泄期)三期图像的组合进行诊断,26例肾肿瘤中仅17例可以做出定性诊断,4例肾盂癌、8例输尿管及膀胱癌均明确诊断。第三步通过(皮质+排泄)的两期图像组合诊断,输尿管和膀胱癌8例,全部符合病理,肾盂癌有2例诊断错误,肾实质肿瘤则仅有12例的诊断符合病理。 2.低剂量扫描实验部分。第1组做为常规剂量组,其X线参数为160Kv/120mAs,本组中所纳入的5例患者的图像评分均为5分,患者所接受CTPlvol平均值为11.574±0.36mGy。第2组图像X线参数在120kv/120mAs,所纳入的5例患者的图像中有4例达到4分的标准,仅1例评分为5分,患者所接受CTPlvol平均值为9.392±0.43mGy。第3组图像的参数为80Kv/120mAs,5例患者的图像仅有2例评分达到4分,其他3例均只能达到3分的标准,患者所接受CTPlvol平均值为6.170±0.09mGy。第4组图像X线参数为40Kv/120mAs,其中4例患者图像评分为3分,另有1例患者图像评分仅2分,患者所接受CTPlvol平均值为3.746±0.13mGy。将所得的4组CTPlvol数据输入SPSS17.0软件得P值=0.001,按照α=0.05的检验标准,认为各组均数之间的差别具有统计学意义。 3.改良“分离团注法”研究。本研究共纳入的10例患者,分别对其肾实质及尿路系统图像质量进行评分。10例患者的肾实质图像评分均在2分以上,共有9例患者的尿路系统评分在2分以上,仅有1例患者尿路系统图像评分为1分。改良“分离团注法”减少1期图像的扫描,两次团注所用的造影剂分别为20ml及70ml,总的剂量为90ml。 结论：1.第一部分回顾性研究。对于肾实质疾病,(平扫+皮质+实质)三期图像组合就能做出与病理吻合的诊断,可以考虑减少排泄期的扫描,至少减少X线辐射剂量至少25%。对于排泄系统肿瘤(平扫+皮质+排泄)三期图像已经可以满足临床诊断需求,可以考虑减少肾实质期扫描,至少减少X线辐射剂量至少25%。对于输尿管及膀胱癌甚至可以考虑同时减少平扫及肾实质期,减少X线辐射达50%。 2.通过降低扫描的管电压值,可以大幅度较少患者所接受的X线辐射。本研究结果进行综合评价,临床上推荐使用80Kv的管电压进行MSCT泌尿系统成像的扫描,这个条件下图像质量虽有所下降,但其差别肉眼难以分辨,需要依赖CT值比较。且与常规剂量相比,X线的辐射剂量降低46.7%。 3.改良“分离团注法”其图像质量高,包含的信息全面,并减少1期扫描,降低X线辐射至少25%。
[Abstract]:Objective: In recent years, the imaging technology of urinary system has been continuously updated. In various examinations, MSCT urography is the most important method in the examination of urinary system diseases due to its rapid scanning speed, high image resolution and powerful post-treatment function. The traditional MSCT urography, including the 4-phase scan of the level scan, the cortical phase, the medullary phase and the excretion period, solves many clinical practical problems, but the fatal drawback is that the scan range is large, the stage is large, and the patient's received X-ray radiation dose is high. The purpose of this study is to minimize the radiation dose by improving the scanning protocol and to explore its application value in the diagnosis of clinical disease. Methods: The study was divided into three parts. score:1. A retrospective analysis of the diagnosis of various scanning phases in the diagnosis of urinary system occupying lesions We selected 38 patients with traditional MSCT urinary system imaging and operative pathology from January 2011 to September 2011, of which 22 male,18 female,15-88 years old, median age 64-year-old. The patient was diagnosed by a different three-phase or second-phase image combination and the results were compared with the pathological findings line control.2. Group study of low dose scans in the urinary system The value of the technique was selected.20 cases of urological surgery in our hospital were divided into 4 groups according to the different Kv values at the time of scanning, and the quality of the obtained images was evaluated, and the radiation dose of the X-ray received by each group of patients was measured. Statistical comparison.3. In the modified "separation group injection method" study,10 patients with urological surgery in our hospital were selected. The X-ray parameters of the scan were 160 Kv/120 mAs, and the total amount of the contrast agent was set to 90 ml. The first group was injected with 20 ml and the second group Note 70 m1 distribution. Continuous acquisition of the level-sweep-excretion joint image, the cortical-excretion joint period, and the renal parenchyma-excretion of the combined image and the map 4. The study is divided into three parts, in which the first part and the third part are count data and the difference is significant. No statistical comparison is required. The second part of the low-dose MSCT urinary system imaging section, the data of which is a comparison of the mean number of multiple independent samples, selects a complete random variance score The statistical comparison of the disjunctive method is carried out. The data statistics use the SPSS17.0 software of the installation version to make statistics and test. Standard pick-up = Results:1. The clinical diagnosis and pathological diagnosis of 26 cases of renal tumor were completely in accordance with the three-phase image diagnosis (plain scan + cortex + substance). There were 2 cases of failure to make clear diagnosis. The second step was to make a diagnosis by the combination of the three-phase images (phase-scan + cortex period + drainage period). Only 17 of the 26 cases of renal tumor can make a qualitative diagnosis,4 cases of renal pelvis cancer and 8 cases of loss. In the third step,8 cases of ureter and bladder cancer were diagnosed by two-stage image combination (cortical and excrete), and all of them were in accordance with the pathology. The diagnosis of 12 cases was in accordance with the pathology. 2. The experimental part of low-dose scanning. The first group was the routine dose group, with the X-ray parameter of 160 Kv/120 mAs, and the image score of 5 patients included in this group was 5 points, and the average value of CTPvol accepted by the patient was 1. 1.574-0.36 mGy. The 2-group image X-ray parameter was 120 kv/120 mAs, and 4 of the 5 patients included in the image reached 4-point standard, only one score was 5 points, and the average value of CTPvol accepted by the patient was 9.392 to 0.43 mGy. The parameters of the image in the third group were 80Kv/ 120mAs, only 2 of the 5 patients had a score of 4, and the other 3 cases can only reach the standard of 3 points, and the average value of CTPvol accepted by the patient is as follows: 6.170-0.09 mGy. The 4-group image X-ray parameters were 40 Kv/120 mAs,4 of them had an image score of 3, and one patient had an image score of only 2, and the mean value of CTPvol accepted by the patient was 3.746 to 0.13 mGy. The resulting 4-group CTPvol data was input to the SPSS17.0 software to obtain a P-value of = 0.001, and each group was considered to be The difference between the numbers is of statistical significance. Method " study.10 patients included in this study respectively scored the renal parenchyma and the image quality of the urography system. The scores of the renal parenchymal images in 10 patients were above 2, and there were 9 patients with a urinary tract system score of 2 or more. One patient's urosystem image score was 1 point. The modified "separation group injection method" reduced the scan of the 1-phase image and the contrast media used for the two bolus injections were 20 ml, respectively. 鍙，
本文编号：2507871
[Abstract]:Objective: In recent years, the imaging technology of urinary system has been continuously updated. In various examinations, MSCT urography is the most important method in the examination of urinary system diseases due to its rapid scanning speed, high image resolution and powerful post-treatment function. The traditional MSCT urography, including the 4-phase scan of the level scan, the cortical phase, the medullary phase and the excretion period, solves many clinical practical problems, but the fatal drawback is that the scan range is large, the stage is large, and the patient's received X-ray radiation dose is high. The purpose of this study is to minimize the radiation dose by improving the scanning protocol and to explore its application value in the diagnosis of clinical disease. Methods: The study was divided into three parts. score:1. A retrospective analysis of the diagnosis of various scanning phases in the diagnosis of urinary system occupying lesions We selected 38 patients with traditional MSCT urinary system imaging and operative pathology from January 2011 to September 2011, of which 22 male,18 female,15-88 years old, median age 64-year-old. The patient was diagnosed by a different three-phase or second-phase image combination and the results were compared with the pathological findings line control.2. Group study of low dose scans in the urinary system The value of the technique was selected.20 cases of urological surgery in our hospital were divided into 4 groups according to the different Kv values at the time of scanning, and the quality of the obtained images was evaluated, and the radiation dose of the X-ray received by each group of patients was measured. Statistical comparison.3. In the modified "separation group injection method" study,10 patients with urological surgery in our hospital were selected. The X-ray parameters of the scan were 160 Kv/120 mAs, and the total amount of the contrast agent was set to 90 ml. The first group was injected with 20 ml and the second group Note 70 m1 distribution. Continuous acquisition of the level-sweep-excretion joint image, the cortical-excretion joint period, and the renal parenchyma-excretion of the combined image and the map 4. The study is divided into three parts, in which the first part and the third part are count data and the difference is significant. No statistical comparison is required. The second part of the low-dose MSCT urinary system imaging section, the data of which is a comparison of the mean number of multiple independent samples, selects a complete random variance score The statistical comparison of the disjunctive method is carried out. The data statistics use the SPSS17.0 software of the installation version to make statistics and test. Standard pick-up = Results:1. The clinical diagnosis and pathological diagnosis of 26 cases of renal tumor were completely in accordance with the three-phase image diagnosis (plain scan + cortex + substance). There were 2 cases of failure to make clear diagnosis. The second step was to make a diagnosis by the combination of the three-phase images (phase-scan + cortex period + drainage period). Only 17 of the 26 cases of renal tumor can make a qualitative diagnosis,4 cases of renal pelvis cancer and 8 cases of loss. In the third step,8 cases of ureter and bladder cancer were diagnosed by two-stage image combination (cortical and excrete), and all of them were in accordance with the pathology. The diagnosis of 12 cases was in accordance with the pathology. 2. The experimental part of low-dose scanning. The first group was the routine dose group, with the X-ray parameter of 160 Kv/120 mAs, and the image score of 5 patients included in this group was 5 points, and the average value of CTPvol accepted by the patient was 1. 1.574-0.36 mGy. The 2-group image X-ray parameter was 120 kv/120 mAs, and 4 of the 5 patients included in the image reached 4-point standard, only one score was 5 points, and the average value of CTPvol accepted by the patient was 9.392 to 0.43 mGy. The parameters of the image in the third group were 80Kv/ 120mAs, only 2 of the 5 patients had a score of 4, and the other 3 cases can only reach the standard of 3 points, and the average value of CTPvol accepted by the patient is as follows: 6.170-0.09 mGy. The 4-group image X-ray parameters were 40 Kv/120 mAs,4 of them had an image score of 3, and one patient had an image score of only 2, and the mean value of CTPvol accepted by the patient was 3.746 to 0.13 mGy. The resulting 4-group CTPvol data was input to the SPSS17.0 software to obtain a P-value of = 0.001, and each group was considered to be The difference between the numbers is of statistical significance. Method " study.10 patients included in this study respectively scored the renal parenchyma and the image quality of the urography system. The scores of the renal parenchymal images in 10 patients were above 2, and there were 9 patients with a urinary tract system score of 2 or more. One patient's urosystem image score was 1 point. The modified "separation group injection method" reduced the scan of the 1-phase image and the contrast media used for the two bolus injections were 20 ml, respectively. 鍙，
本文编号：2507871
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