本文選題：雙源CT + 支氣管擴(kuò)張癥�。� 參考：《泰山醫(yī)學(xué)院》2012年碩士論文

【摘要】：目的 探討DSCT支氣管動(dòng)脈成像技術(shù)在診斷咯血相關(guān)異常支氣管動(dòng)脈疾病的優(yōu)勢(shì)及臨床應(yīng)用價(jià)值。以DSCTA研究支氣管動(dòng)脈的解剖及變異，評(píng)估DSCTA支氣管動(dòng)脈成像檢查對(duì)臨床大咯血的診斷價(jià)值；以及雙源DSCTA支氣管動(dòng)脈成像檢查對(duì)臨床上懷疑或確診支氣管擴(kuò)張病變的診斷價(jià)值及臨床應(yīng)用。探討雙源DSCTA支氣管動(dòng)脈成像與DSA成像評(píng)估中的相關(guān)性及一致性。 材料和方法 采用DSCT對(duì)48例臨床以大量咯血、胸痛為主要癥狀的患者行胸部平掃及薄層增強(qiáng)掃描檢查。其中男27例，女21例，現(xiàn)將獲得的圖像資料進(jìn)行薄層重建圖像后，使用（maximum intensity projection，MIP）最大密度投影技術(shù)、（multi-planarreformation-MPR）多平面重建、容積再現(xiàn)技術(shù)、（volume rendering，VR）等圖像重建技術(shù)與Add/Remove Structure，任意角度旋轉(zhuǎn)等功能充分結(jié)合起來(lái)，充分顯示支氣管動(dòng)脈路徑及其與周?chē)M織的關(guān)系。 結(jié)合術(shù)中數(shù)字減影血管造影術(shù)（DSA），確定支氣管擴(kuò)張并大咯血患者供血諸支共干及交通動(dòng)脈，總結(jié)支氣管擴(kuò)張并咯血病人的供血?jiǎng)用}解剖學(xué)分型及DSA表現(xiàn)，指導(dǎo)臨床進(jìn)行介入栓塞治療，提高臨床治療有效率及治愈率。 結(jié)果 在本統(tǒng)計(jì)組病例48例中，左側(cè)支氣管動(dòng)脈亦能清晰顯示51支，平均1.11支/例。右側(cè)支氣管動(dòng)脈能夠清晰顯示65支，平均顯示1.35支/例。支氣管動(dòng)脈的分布類(lèi)型共存在6種分支類(lèi)型，最為常見(jiàn)的是R1L1（37.5%，18/48例）、R2L1（20.8%，10/48例）兩種類(lèi)型。 右側(cè)支氣管動(dòng)脈主要與右側(cè)肋間后動(dòng)脈共干，，尤其是第3、4肋間后動(dòng)脈共干，其次為直接來(lái)自降主動(dòng)脈分支。左側(cè)支氣管動(dòng)脈則主要來(lái)自降主動(dòng)脈，其次是主動(dòng)脈弓。最為常見(jiàn)的是右側(cè)支氣管動(dòng)脈開(kāi)口約對(duì)應(yīng)于T5--T6水平，所有左側(cè)支氣管動(dòng)脈開(kāi)口對(duì)應(yīng)于T5--T6水平最為常見(jiàn)。我們以DSA結(jié)果作為金標(biāo)準(zhǔn)，以能夠顯示支氣管數(shù)量為單位，將本組48例同時(shí)進(jìn)行DSA檢查的BA--DSCTA成像結(jié)果與BA-DSA對(duì)比，結(jié)果特異度為100%，真陽(yáng)性118支、真陰性0支、假陽(yáng)性9支、假陰性0支，敏感度為92.9%。 結(jié)論 DSCTA具有較高的空間分辨率及特異性，能夠利用各種重建技術(shù)，準(zhǔn)確、直觀地顯示出支氣管動(dòng)脈的解剖特征，掌握支氣管動(dòng)脈的開(kāi)口、起源、走行、管徑大小等信息，為臨床提供了準(zhǔn)確的信息；立體地再現(xiàn)了支氣管動(dòng)脈的形態(tài)特征，走形軌跡，為臨床介入栓塞治療，提高插管成功率、減少插管時(shí)間。此技術(shù)的應(yīng)用大大減小了患者和醫(yī)護(hù)人員的受照劑量，對(duì)治療方案的設(shè)計(jì)規(guī)劃、介入導(dǎo)管的選擇，還有路徑、栓塞材料的應(yīng)用提供必要的信息。更重要的是DSCTA為無(wú)創(chuàng)性檢查，使非血管患者免受創(chuàng)傷性DSA檢查。將CTA成像結(jié)果與DSA成像結(jié)果比對(duì)，敏感度為92.9%，特異度為100%。氣管支氣管動(dòng)脈三維圖像除了能夠清晰顯示出支氣管動(dòng)脈的起始開(kāi)口、部位、走形路徑(肺內(nèi)段和縱隔段)、血管管徑等情況外，而且還可以清晰顯示病灶的強(qiáng)化后病灶強(qiáng)化的形態(tài)，大小，密度以及邊緣與周?chē)M織的關(guān)系，以及強(qiáng)化程度和方式。不足之處是患者在檢查時(shí)不得不接受較大劑量的X線(xiàn)輻射；不能夠如DSA介入時(shí)對(duì)比劑在支氣管動(dòng)脈與肺動(dòng)靜脈瘺時(shí)的血液動(dòng)力流向不能實(shí)時(shí)進(jìn)行動(dòng)態(tài)觀察；圖像后處理過(guò)程費(fèi)時(shí)；存在一定的假陰性或假陽(yáng)性。在判斷縱隔、肺門(mén)大血管受侵時(shí)均為雙源CTA的局限性。將來(lái)不斷實(shí)踐操作，不斷總結(jié)改善，一定愈加完善。
[Abstract]:Purpose

To investigate the advantage and clinical application value of DSCT bronchial artery imaging technique in the diagnosis of hemoptysis related abnormal bronchial artery disease .
To investigate the diagnostic value and clinical application of dual - source DSCTA bronchial artery imaging ( DSCTA ) in the diagnosis of bronchiectasis .

Materials and Methods

With DSCT , the chest plain scan and thin layer enhanced scanning were performed on 48 patients with massive hemoptysis and chest pain . Among them , 27 male and 21 female patients were treated by thin layer reconstruction of image data , and the relationship between bronchial artery path and surrounding tissues was fully demonstrated by means of maximum intensity projection ( MIP ) maximum density projection technique , multi - plane reconstruction , volume rendering technique , volume rendering ( VR ) , etc .

Combined with the intraoperative digital subtraction angiography ( DSA ) , the blood supply arteries and the traffic arteries of the patients with bronchiectasis and hemoptysis were determined , the blood supply artery anatomy classification and DSA performance of the patients with bronchiectasis and hemoptysis were summarized , and the interventional embolization treatment was guided to improve the clinical treatment efficiency and cure rate .

Results

Among 48 cases in the present statistical group , 51 branches were clearly displayed on the left bronchial artery , with an average of 1.11 branches / case . The right bronchial artery could clearly show 65 branches , the average display 1.35 branches / cases . There were 6 types of branches in the distribution type of bronchial artery . The most common types were R1L1 ( 37.5 % , 18 / 48 ) , R2L1 ( 20.8 % , 10 / 48 cases ) .

The results of BA - DSCTA imaging of right - hand bronchial artery mainly come from descending aorta , followed by aortic arch . The most common is that right bronchial artery opening corresponds to T5 - -T6 level , all the left bronchial artery opening corresponds to T5 - -T6 level . The result of BA - DSCTA imaging with DSA is 100 % , true positive 118 branches , true negative 0 branch , false positive 9 branch , false negative 0 branch , sensitivity is 92.9 % .

Conclusion

DSCTA has high spatial resolution and specificity , and can be used in various reconstruction techniques to accurately and intuitively display the anatomical features of bronchial artery , grasp the information such as opening , origin , walk and size of bronchial artery , and provide accurate information for clinic .
The application of this technique greatly reduces the dosage of the bronchial artery , improves the success rate of the intubation , and reduces the intubation time . The application of this technique greatly reduces the patient and the medical personnel ' s exposure dose , and provides the necessary information for the design planning of the treatment plan , the selection of the interventional catheter , the relationship between the edge and the surrounding tissue and the enhancement degree and the way .
It is not possible to observe the dynamic flow of the contrast agent in the bronchial artery and the pulmonary arteriovenous fistula in real time when the bronchial artery and the pulmonary arteriovenous fistula can not be accessed by DSA ;
the post - image processing is time - consuming ;
There are some false negatives or false positives . The limitation of double - source CTA is the limitation of the two - source CTA .

【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(lèi)號(hào)】：R56

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