發(fā)布時間：2018-05-09 10:25

  本文選題：兒童 + 低劑量　； 參考：《上海交通大學(xué)》2015年博士論文

【摘要】：目的通過巴馬小型豬計算機(jī)體層成像(CT),研究心臟CT低劑量掃描模式和掃描參數(shù),優(yōu)化低劑量掃描方案,進(jìn)而探討低劑量心臟CT在兒童先天性心臟病合并氣道異常的應(yīng)用價值。通過巴馬小型豬磁共振(MRI)不同序列的氣道成像,選擇最佳顯示氣道MRI序列,進(jìn)而探討MRI氣道成像及替代CT的可能性。材料與方法1,選取巴馬小型豬4頭,體重7.5至14.4kg,麻醉后進(jìn)行心臟CT掃描。采用前門控及后門控掃描模式。在前門控掃描模式下,固定管電壓于80KVp,調(diào)節(jié)管電流在60-180 mA,80%ASIR后重建算法。在后門控掃描模式下,固定管電壓80KVp,根據(jù)心電圖調(diào)控管電流模式,設(shè)置最大管電流范圍80-220 mA,最小管電流范圍20-45 mA,80%ASIR后重建算法。選取巴馬小型豬2頭,體重7.5至10.5kg,麻醉后進(jìn)行磁共振氣道掃描。掃描序列選取CE-MRA、3D-TFE和3D-B-TFE。2,選取323例先天性心臟病患兒行前門控低劑量心臟CT掃描。按體重分三組(0-5kg、6-10kg、11-15kg),連續(xù)入組,三個體重組固定管電壓、采用二組不同管電流掃描條件,0-5kg組120 mA和300 mA,6-11kg組180 mA和300 mA、11-15kg組200-250 mA和300 mA。相同掃描條件下獲取虛擬后門控劑量參數(shù)。3,選取357例先天性心臟病患兒行心臟MRI檢查。全部病例行三維擾相梯度回波序(3D-TFE)掃描;其中46例患兒同時有CT檢查結(jié)果做對比;26例病例同時行三維穩(wěn)態(tài)梯度回波(3D-B-TFE)序列掃描,并有CT結(jié)果做對比。結(jié)果1,CT前門控模式與后門控掃描模式輻射劑量比較顯示在相同的掃描參數(shù)及圖像主觀評分無差異的條件下前門控掃描輻射劑量明顯低于后門控模式,兩頭實(shí)驗(yàn)豬輻射有效劑量分別下降了81%和77%;前門控心臟ct掃描模式其有效劑量均在亞毫西弗以內(nèi)。在80kkvp、100ma低劑量掃描條件下大血管圖像的主觀評分較好(3.8-4.5分)。在顯示氣道圖像質(zhì)量方面,各掃描參數(shù)下主觀評分均在4分以上。磁共振三個掃描序列在顯示氣道方面主觀評分顯示3d-tfe顯示氣道評分最高。2,三個體重組在同組掃描參數(shù)下(相同管電壓和管電流),兩位觀察者對于大血管及氣道圖像主觀評分均無顯著性差異,一致性好(kappa值0.72-0.89;0.59-0.91)。同組不同掃描參數(shù)條件下(固定管電壓、高低管電流調(diào)節(jié)),大血管圖像觀察者主觀評分在0-5kg、6-10kg組中有統(tǒng)計學(xué)差異,但是低管電流組評分均在3.9-4.5分之間。11-15kg組間沒有統(tǒng)計學(xué)差異;氣道圖像主觀評分各組均無顯示性統(tǒng)計差異。在同組不同掃描劑量條件下,對比噪聲比無統(tǒng)計學(xué)差異。三個體重組同組高低掃描參數(shù)下有效劑量分別下降了64.3%、38.8%和32.9%。與虛擬后門控的輻射劑量比較,三組有效劑量間有顯著的統(tǒng)計學(xué)差異,有效劑量分別下降了75%、79%和85%。323例先天性心臟病患兒中,非青紫型先天性心臟病與青紫型先天性心臟病的比例為2.3:1;術(shù)前病例占88.2%。非青紫型先天性心臟病中主要為簡單的左向右分流先天性心臟病;青紫型先天性心臟病為圓錐動脈干畸形系列疾病為主。323例先天性心臟病合并氣道異常83例,其中氣道狹窄65例,氣管性支氣管13例,心房異構(gòu)型支氣管4例,氣管反位1例。引起氣管支氣管狹窄的主要為主動脈畸形包括雙主動脈弓、右位主動脈弓伴迷走左鎖骨下動脈、左弓右降等。323例中214例手術(shù)治療,心外大血管診斷準(zhǔn)確率100%,心內(nèi)缺損診斷準(zhǔn)確率94%。3,357例行3d-tfe檢查的先天性心臟病患兒中,92%(328/357)例為術(shù)前檢查,8%(29/347)為術(shù)后隨訪。非青紫型先天性心臟病占71%(253/357),青紫型先天性心臟病占29%(104/357)。在357例檢查中,27%(97/357)有氣管支氣管異常,包括氣道狹窄66例,氣管性支氣管18例,10例心房異構(gòu)型支氣管,3例心房反位。與ct檢查結(jié)果比較,3d-tfe和3d-b-tfe序列在顯示氣道上其敏感性、特異性、陽性預(yù)測值、陰性預(yù)測值、陽性似然比、陰性似然比分比分別為90%、84%、91%、5.6、0.1和80%、62%、71%、2.1、0.3。3D-TFE與CT檢查結(jié)果一致性極好(Kappa 0.868)結(jié)論前門控掃描模式為心臟CT低劑量掃描方案的首選掃描模式,能實(shí)現(xiàn)亞毫西弗低劑量掃描,使得CT在兒童先天性心臟病合并氣道異常中應(yīng)用更加廣泛。3D-TFE序列為目前MRI顯示氣道首選序列,MRI可以用來診斷先天性心臟病伴氣道異常病變。
[Abstract]:Objective to study the low dose scanning mode and scanning parameters of the low dose of heart CT through the computer tomography (CT) of the Bama miniature pig, and to optimize the low dose scanning scheme, and to explore the application value of low dose cardiac CT in children with congenital heart disease with airway abnormality. Display the MRI sequence of airway, and then discuss the possibility of MRI airway imaging and replacement of CT. Material and method 1, select 4 Bama miniature pigs, weight 7.5 to 14.4kg, and carry out CT scan after anaesthesia. Using front door control and backdoor control scan mode. Under the front gate control mode, the fixed tube electric pressure is 80KVp, the regulating tube current is at 60-180 mA, 80%ASIR back weight. Under the backdoor control scanning mode, the fixed tube voltage was 80KVp, the maximum tube current range was 80-220 mA, the minimum tube current range was 20-45 mA, the 80%ASIR post reconstruction algorithm was set according to the electrocardiogram control tube current mode. The 2 Bama miniature pig was selected, the weight was 7.5 to 10.5kg, and the magnetic resonance airway scan was performed after the anesthesia. The scanning sequence selected CE-MRA, 3D-TFE And 3D-B-TFE.2, 323 children with congenital heart disease were selected in the front door controlled low dose cardiac CT scan. According to the weight of three groups (0-5kg, 6-10kg, 11-15kg), the group of three individuals recombined the fixed tube voltage, two groups of different tube current scanning conditions, 0-5kg group 120 mA and 300 mA, 6-11kg group 180 mA and 300 mA, 11-15kg 200-250, 200-250 and 300 sweeps were the same sweep. The virtual posterior gate controlled dose parameter.3 was obtained under the condition of drawing, and 357 children with congenital heart disease were selected for the cardiac MRI examination. All cases were scanned with three dimensional perturbation gradient echo sequence (3D-TFE); of which 46 cases were compared with the results of CT examination; 26 cases were simultaneously scanned with three dimensional steady ladder echo (3D-B-TFE) sequence and CT results were done. Compared with results 1, the CT front gate control mode and the backdoor control scan mode radiate dose show that under the same scanning parameters and the subjective score of the image, the front gated radiation dose is obviously lower than the back door control mode, and the effective dose of the two experimental pigs decreased by 81% and 77% respectively, and the front door controlled heart CT scan mode is the effective agent. The subjective score of the images of the large vessels was better (3.8-4.5) under the condition of 80kkvp, 100mA low dose scanning. The subjective scores of the scanning parameters were more than 4 in the image quality of the airway. The subjective score of the three scan sequences in the display of the airway showed that the score of the airway was the highest.2, three of the airway score, three Under the same group of scanning parameters (the same tube voltage and tube current), there was no significant difference between the two observer on the subjective score of the large vessels and the airway images (kappa value 0.72-0.89; 0.59-0.91). The subjective score of the large blood vessel image observer under the same group of scanning parameters (fixed tube voltage, high and low tube current regulation) was subjective score There were statistical differences in group 0-5kg and 6-10kg, but there was no statistical difference between the low tube current group and the.11-15kg group in the 3.9-4.5 score. There was no statistical difference in the subjective score of the airway image. The comparison of the contrast noise ratio under the same group of different scanning doses was not statistically different. The three individuals were effective under the high and low scanning parameters of the same group. The dose decreased by 64.3%, 38.8% and 32.9%., compared with the radiation dose of virtual backdoor control. There were significant differences in the effective dose between the three groups. The effective dose decreased by 75%. 79% and 85%.323 cases with congenital heart disease, the proportion of non blue purple congenital heart disease and purple congenital heart disease was 2.3:1; the preoperative cases accounted for 8. 8.2%. non blue purple congenital heart disease is mainly a simple left to right shunt congenital heart disease; purple congenital heart disease is mainly conical artery stem malformation disease series disease mainly.323 congenital heart disease combined with airway abnormality in 83 cases, including 65 cases of airway stenosis, 13 cases of tracheal tracheal tracheal tube, 4 cases of atrium isomer bronchus, and 1 tracheal reverse. Cases of tracheobronchial stenosis were mainly aortic malformation, including double aortic arch, right aortic arch with left subclavian artery, left arch and right subclavicular artery, 214 cases of.323 cases, 100% of the diagnosis of great vessels in the heart, and 92% of children with congenital heart disease with the accuracy of 94%.3357 routine 3d-tfe examination (328/3 57) preoperative examination, 8% (29/347) for postoperative follow-up. Non blue purplish congenital heart disease accounted for 71% (253/357), and purple congenital heart disease accounted for 29% (104/357). 27% (97/357) had tracheobronchial abnormality in 357 cases, including 66 cases of airway stenosis, 18 cases of tracheobronchial tube, 10 atrium isomer, 3 atrium reverse. And CT examination. The results were compared. The sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, negative likelihood ratio of 3d-tfe and 3d-b-tfe sequences were 90%, 84%, 91%, 5.6,0.1 and 80%, 62%, 71%, and 2.1,0.3.3D-TFE and CT were excellent conconformance (Kappa 0.868). Conclusion the front door controlled scan mode was low dose of cardiac CT scan. The preferred scanning mode of the drawing scheme can achieve low dose scans of submilsever, making CT more extensive.3D-TFE sequence used in children with congenital heart disease associated with airway abnormalities as the current MRI display of the first choice of the airway, and MRI can be used to diagnose congenital heart disease associated with abnormal airway disease.

【學(xué)位授予單位】：上海交通大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2015
【分類號】：R725.4

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