發(fā)布時(shí)間：2018-04-20 22:35

  本文選題：先天性心臟病 + 輻射劑量　； 參考：《泰山醫(yī)學(xué)院》2012年碩士論文

【摘要】：目的 探索先天性心臟病雙源CT（Dual-source computed tomography DSCT）掃描的最佳方案，降低雙源CT在先天性心臟病檢查中的輻射劑量，減少射線對(duì)受檢者潛在的危害，遵照循證醫(yī)學(xué)的理念，尋求能滿足診斷前提下的低劑量檢查模式，為臨床提供一種更為安全、可靠的檢查方法。 材料與方法 對(duì)60例超聲檢查診斷為先天性心臟病的患者行雙源CT掃描，將60例患者隨機(jī)連續(xù)分成A、B兩組，每組30例：A組采用傳統(tǒng)的回顧性心電門(mén)控螺旋掃描，B組采用新模式的前瞻性心電門(mén)控大螺距掃描（即Flash模式）。使用德國(guó)SIEMENS公司的SOMATOM Definition Flash雙源CT掃描儀，A組掃描參數(shù)：兩個(gè)球管管電壓均為80～120Kv，管電流實(shí)時(shí)調(diào)控，球管旋轉(zhuǎn)時(shí)間0.28s，螺距（Pitch，P值）值隨心率變化自動(dòng)調(diào)節(jié)：0.2～0.5，層厚0.6mm。造影劑使用劑量、方法及注射速度根據(jù)患兒實(shí)際情況進(jìn)行個(gè)體化計(jì)算，掃描范圍從胸廓入口至左側(cè)膈肌下5cm。B組掃描參數(shù)：兩個(gè)球管管電壓均為80～120kv，管電流實(shí)時(shí)調(diào)控，球管旋轉(zhuǎn)時(shí)間0.28s，螺距固定為3.4，層厚0.6mm，造影劑使用劑量、方法、注射速度及掃描范圍同A組標(biāo)準(zhǔn)。掃描完成采集后，將原始數(shù)據(jù)傳至相應(yīng)工作站進(jìn)行任意方位和層厚的圖像重建，多平面重組（MPR）、最大密度投影（MIP）、容積再現(xiàn)（VR）等后處理技術(shù)，用以顯示復(fù)雜的三維解剖關(guān)系。制定圖像質(zhì)量評(píng)價(jià)標(biāo)準(zhǔn)，由具有豐富心血管影像診斷經(jīng)驗(yàn)的兩名高年資醫(yī)師分別閱片并做出診斷，診斷不一致者共同回顧協(xié)調(diào)得出統(tǒng)一結(jié)論。同時(shí)評(píng)價(jià)其圖像質(zhì)量，記錄并比較兩組輻射劑量，評(píng)價(jià)心內(nèi)外畸形數(shù)目，以手術(shù)或者造影結(jié)果對(duì)照。對(duì)兩組病例的輻射劑量比較做兩獨(dú)立樣本均數(shù)t檢驗(yàn)，兩組圖像診斷準(zhǔn)確率的比較做四格表資料的卡方檢驗(yàn)。 結(jié)果 1.年齡最小的患者僅為4個(gè)月，所有患者均安全、順利完成檢查，無(wú)造影劑過(guò)敏反應(yīng)發(fā)生，檢查前后臨床表現(xiàn)無(wú)差異。 2. A、B兩組各30例圖像平均得分分別為4.3±0.7、4.1±0.8，兩組圖像均能滿足診斷需求。 3. A組病例中心率范圍為72～143bmp，平均掃描長(zhǎng)度為18.6cm，平均輻射劑量為2.03±0.95mSv；B組心率范圍為55～133bmp，平均掃描長(zhǎng)度為17.8cm，平均輻射劑量為0.82±0.33mSv。兩組輻射劑量做兩獨(dú)立樣本均數(shù)t檢驗(yàn)，結(jié)果：t=3.425，p＜0.05，兩樣本均數(shù)差別有統(tǒng)計(jì)學(xué)意義，B組所用輻射劑量低于A組。 4.兩組病例經(jīng)手術(shù)或者造影證實(shí)共計(jì)48例，其中45例為復(fù)雜先天性心臟病。經(jīng)證實(shí)的病例中含單純先天性心臟病，包括房、室間隔缺損、動(dòng)脈導(dǎo)管未閉，復(fù)雜先天性心臟病包括法洛氏四聯(lián)癥、肺動(dòng)脈閉鎖、大血管-心室連接異常、右室雙出口等。統(tǒng)計(jì)所有病例的心血管畸形數(shù)目（包括心內(nèi)畸形、心臟-大血管連接部分、大血管部分、心臟位以及心外并發(fā)畸形），A組有26例經(jīng)手術(shù)證實(shí)，CT診斷心內(nèi)畸形133處，手術(shù)結(jié)果證實(shí)為136處，畸形診斷準(zhǔn)確率為97.8%，其中漏診卵圓孔未閉3例。B組22例經(jīng)手術(shù)證實(shí)，CT診斷畸形101處，手術(shù)結(jié)果證實(shí)為106處，畸形診斷準(zhǔn)確率為95.3%，其中漏診卵圓孔未閉2例、二尖瓣大瓣裂1例、小的膜周部室間隔缺損2例。A、B兩組心血管畸形診斷準(zhǔn)確率做四格表資料的卡方檢驗(yàn)，結(jié)果：x~2=1.175，p＞0.05，差別無(wú)統(tǒng)計(jì)學(xué)意義，兩組圖像在診斷準(zhǔn)確率方面差別無(wú)統(tǒng)計(jì)學(xué)意義。 結(jié)論 前瞻性大螺距掃描模式所用輻射劑量遠(yuǎn)低于回顧性心電門(mén)控螺旋掃描模式所用輻射劑量，而其在圖像質(zhì)量與診斷準(zhǔn)確率方面無(wú)統(tǒng)計(jì)學(xué)差異，，對(duì)先天性心臟病患者而言，是一種更為安全的掃描模式，為降低射線在受檢者的潛在危險(xiǎn)方面具有重大意義。
[Abstract]:objective
To explore the best way to scan the dual source CT (Dual-source computed tomography DSCT) of congenital heart disease, reduce the radiation dose of double source CT in the examination of congenital heart disease, reduce the potential harm of radiation to the subjects, follow the concept of evidence-based medicine, seek the low dose examination model which can meet the diagnosis premise, and provide a more clinical case. A safe, reliable inspection method.
Materials and methods
A double source CT scan was performed in 60 patients with congenital heart disease diagnosed by ultrasound. 60 patients were randomly divided into A, B two, 30 cases in each group. The A group adopted traditional retrospective ECG gated spiral scan, and the B group adopted a new mode of prospective ECG gated large pitch scan (i.e. Flash mode). The SOMATOM Defin of German SIEMENS company was used. Ition Flash dual source CT scanner, A group scanning parameters: two ball tube voltage is 80 to 120Kv, tube current real-time control, tube rotation time 0.28s, pitch (Pitch, P value) value changes automatically with the change of heart rate: 0.2 ~ 0.5, layer thickness 0.6mm. contrast agent use dose, method and injection speed according to the actual situation of children to carry out individual calculation, sweep The scanning range from the chest entrance to the left diaphragm 5cm.B group scanning parameters: two ball tube voltage is 80 ~ 120kv, the tube current is real-time control, the tube rotation time 0.28s, the pitch fixed 3.4, the thickness of 0.6mm, the use dose of contrast agent, the method, the injection speed and the scanning range are the same as the A group standard. After the scan completes the collection, the original data passes the corresponding data to corresponding On the workstation, the image reconstruction of any direction and thickness, the MPR, the maximum density projection (MIP), the volume reproduction (VR) and other post-processing techniques were used to display the complex three-dimensional anatomical relationship. The image quality evaluation standard was set up, and the two senior doctors with rich cardiovascular imaging diagnosis experience were read and diagnosed respectively. The patients with inconsistent diagnosis were reviewed and coordinated to draw a unified conclusion. At the same time, the image quality was evaluated, two groups of radiation doses were recorded and compared, and the number of internal and external malformations was evaluated by operation or contrast results. The radiation dose comparison of the two groups was compared with two independent samples t test, and the comparison of the accuracy rate of the two groups in the image diagnosis was four. The card inspection of the material.
Result
1. the youngest patients were only 4 months. All patients were safe and completed the examination without any allergic reaction. There was no difference in the clinical performance before and after the examination.
2. A, B two groups of 30 cases, the average image scores were 4.3 + 0.7,4.1 + 0.8, two groups of images can meet the diagnostic needs.
The case center rate of the 3. A group was 72 ~ 143bmp, the average scanning length was 18.6cm, the average radiation dose was 2.03 + 0.95mSv, the heart rate range of B group was 55 ~ 133bmp, the average scanning length was 17.8cm, the average radiation dose was 0.82 + 0.33mSv. two, and two independent samples were tested with t test. The results were t=3.425, P < 0.05, two samples were the difference. The radiation dose in group B was lower than that in group A.
4. a total of two cases were confirmed by surgery or angiography, of which 45 were complicated congenital heart disease. The confirmed cases included simple congenital heart disease, including atrial, ventricular septal defect, patent ductus arteriosus, complex congenital heart disease including tetralogy of Fallot, pulmonary artery atresia, large vascular ventricular connection abnormality, right ventricular double exit, and so on. The number of cardiovascular deformities in all cases (including intracardiac malformation, heart - large vascular connection part, large vessel part, heart position, and cardiac concurrency malformation), in group A, 26 cases were confirmed by surgery, and 133 were diagnosed by CT, 136 of the surgical results were confirmed, and the accuracy rate of malformation was 97.8%. 3 cases in group.B with missed diagnosis of oval foramen were 22 cases. It was confirmed by the operation that 101 malformations were diagnosed by CT, 106 were confirmed by operation, and the accuracy rate of malformation was 95.3%, including 2 cases of missed oval foramen, 1 cases of mitral valve cleft, 2 case of small circumference septal defect, and 2 diagnosis accuracy of B two for four cases of cardiovascular malformation, and the results were x~2=1.175, P > 0.05, the difference was not statistically significant. There was no significant difference in diagnostic accuracy between the two groups of images.
conclusion
The radiation dose used in the prospective large pitch scan mode is far lower than the radiation dose used in the retrospective ECG gated spiral scan mode, and there is no statistical difference in the image quality and diagnostic accuracy. For the patients with congenital heart disease, it is a safer scanning mode to reduce the potential risk of radiation in the subjects. It is of great significance.

【學(xué)位授予單位】：泰山醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2012
【分類號(hào)】：R816.92;R725.4

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