本文選題：X線計算機體層攝影 + 尿路結(jié)石��； 參考：《華北理工大學(xué)》2017年碩士論文

【摘要】：目的評價CT低劑量聯(lián)合迭代算法對尿路結(jié)石成分分析的可行性,并探討其最優(yōu)掃描方案。方法第一部分:搜集泌尿外科手術(shù)后結(jié)石60枚,將其用蒸餾水清洗干凈,自然晾干、編號,分組放于豬腎集合系統(tǒng)內(nèi)并記錄位置,然后將其放于制作的組織模型中行不同劑量CT掃描。常規(guī)劑量:120k V,400m As,采用濾波反投影算法(Filtered back projection,FBP)1mm薄層重建;低劑量:(A組:120k V,200m As;B組:120k V,150m As;C組:120k V,100m As)分別行迭代算法i Dose1-6級1mm薄層重建。掃描結(jié)束后將60枚尿路結(jié)石用紅外光譜法測定其化學(xué)成分作為實驗的金標準。在常規(guī)劑量FBP 1mm重建下分別測量結(jié)石軟組織窗和骨窗CT值,初步判定結(jié)石化學(xué)成分;由兩位放射醫(yī)師采用雙盲法讀片并對圖像質(zhì)量做主觀評分,記錄CT容積劑量指數(shù)(CT dose Index Volume,CTDIvol)、劑量長度乘積(Dose length product,DLP)、計算有效劑量(Effective dose,ED);測量圖像的客觀噪聲值、計算信噪比、測量結(jié)石CT值及最大長徑、記錄結(jié)石檢出數(shù),評價低劑量聯(lián)合迭代算法對結(jié)石檢出情況及圖像質(zhì)量的影響。第二部分:搜集78例尿路結(jié)石患者,首次檢查均應(yīng)用常規(guī)劑量(120k V/400m As)掃描,采用FBP1mm薄層重建,保守治療后結(jié)石未排出,復(fù)查CT應(yīng)用低劑量(120k V/150m As)掃描,行迭代算法i Dose1-6級1mm薄層重建;首先通過圖像質(zhì)量評估及結(jié)石檢出情況評價出1mm最優(yōu)的i Dose等級,再對此等級行1.5mm及2mm重建,評價出最合理重建層厚。結(jié)果1 60枚尿路結(jié)石,其中純結(jié)石23枚(純尿酸結(jié)石8枚),混合結(jié)石37枚;60枚結(jié)石骨窗CT值高于軟組織窗CT值,但二者之間差異無統(tǒng)計學(xué)意義(P0.05);8枚純尿酸結(jié)石(軟組織窗和骨窗)CT值與52枚非尿酸結(jié)石的(軟組織窗和骨窗)CT值之間差異有統(tǒng)計學(xué)意義(P0.05);根據(jù)ROC曲線分析確定純尿酸結(jié)石的最佳臨界值(CT值)為483.5HU,以此為界值診斷純尿酸結(jié)石,其敏感度為96.20%,特異性為87.50%。低劑量各組的CTDIvol、DLP、ED與常規(guī)劑量組比較差異有統(tǒng)計學(xué)意義(P0.05);三組低劑量的i Dose1~6圖像測量結(jié)石大小、數(shù)量、CT值與常規(guī)劑量組比較差異無統(tǒng)計學(xué)意義(P0.05);A組的i Dose4圖像噪聲、信噪比及i Dose4-6圖像質(zhì)量主觀評分與常規(guī)劑量組比較差異無統(tǒng)計學(xué)意義(P0.05);B組的i Dose6圖像噪聲、信噪比及圖像質(zhì)量主觀評分與常規(guī)劑量組比較差異無統(tǒng)計學(xué)意義(P0.05);C組的i Dose1-6圖像噪聲、信噪比及圖像質(zhì)量主觀評分與常規(guī)劑量比較差異有統(tǒng)計學(xué)意義(P0.05)。2臨床研究中低劑量組的CTDIvol、DLP、ED與常規(guī)劑量組比較差異有統(tǒng)計學(xué)意義(P0.05);低劑量i Dose1~6 1mm重建圖像測量的結(jié)石大小、數(shù)量及CT值與常規(guī)劑量組比較差異無統(tǒng)計學(xué)意義(P0.05);i Dose1-5 1mm重建圖像噪聲、信噪比及圖像質(zhì)量主觀評分與常規(guī)劑量比較差異有統(tǒng)計學(xué)意義(P0.05);i Dose6 1mm重建圖像噪聲、信噪比及圖像質(zhì)量主觀評分與常規(guī)劑量組比較差異無統(tǒng)計學(xué)意義(P0.05);i Dose61.5mm和2mm的圖像噪聲與1mm的圖像噪聲比較差異有統(tǒng)計學(xué)意義(P0.05);i Dose6 1.5mm與1mm的圖像信噪比比較差異無統(tǒng)計學(xué)意義(P0.05);i Dose62mm與1mm的圖像信噪比比較差異有統(tǒng)計學(xué)意義(P0.05);i Dose6 1.5mm與1mm測量的結(jié)石CT值比較差異無統(tǒng)計學(xué)意義(P0.05);i Dose6 2mm與1mm測量的結(jié)石CT值比較差異有統(tǒng)計學(xué)意義(P0.05);i Dose6 2mm的結(jié)石檢出數(shù)低于1mm及1.5mm的結(jié)石檢出數(shù);三組層厚結(jié)石大小及圖像質(zhì)量主觀評分比較差異無統(tǒng)計學(xué)意義(P0.05)。結(jié)論1常規(guī)CT常規(guī)劑量條件下可以根據(jù)結(jié)石的CT值區(qū)分純尿酸結(jié)石與非尿酸結(jié)石,純尿酸結(jié)石的CT值多小于483.5HU。2在CT低劑量掃描中聯(lián)合迭代算法i Dose,可以明顯改善圖像質(zhì)量且不影響尿路結(jié)石的檢出及CT值測量的準確性,可以用來評價尿路結(jié)石成分。3為達到常規(guī)圖像質(zhì)量水平,管電壓120k V時,i Dose6水平管電流150m As為最低臨界水平,此水平1.5mm層厚重建為診斷尿路結(jié)石的最優(yōu)掃描方案。
[Abstract]:Objective to evaluate the feasibility of CT low dose combined iterative algorithm for the analysis of urinary calculi, and to explore the optimal scanning scheme. Method first part: collect 60 stones in the Department of Urology after surgery, clean it with distilled water, dry it naturally, numbered, and record the position in the pig kidney collection system, and then put it in the production. The conventional dose: 120K V, 400m As, the filter back projection algorithm (Filtered back projection, FBP) 1mm thin layer reconstruction, and the low dose: 60 urinary calculi after the end of the scan. Infrared spectroscopy was used to determine the chemical composition as the gold standard of the experiment. Under the routine dose FBP 1mm reconstruction, the CT values of the soft tissue window and bone window were measured respectively, and the chemical composition of the stones was preliminarily determined. The two radiologists used the double blind method and the subjective score of the image quality, and recorded the CT volume dose index (CT dose Index Volume, CTDIvol). ) the dose length product (Dose length product, DLP), the effective dose (Effective dose, ED), the objective noise value of the image, the calculation of the signal to noise ratio, the measurement of the CT value and the maximum length of the stone, the number of the stones, and the effect of the low dose combined iterative algorithm on the detection of stone and the quality of the images. The second part: 78 cases of urinary tract junction were collected. The stone patients were first examined with conventional dose (120K V/400m As) scanning, using FBP1mm thin layer reconstruction, and the stones were not discharged after conservative treatment. The low dose (120K V/150m As) scanning of CT was rechecked, and the iterative algorithm I Dose1-6 1mm thin layer reconstruction was performed. 1.5mm and 2mm reconstruction were used to evaluate the most reasonable reconstructive thickness. Results 160 urinary calculi, including 23 pure stones (8 pure uric acid stones), 37 mixed stones, 60 stone window CT values higher than the soft tissue window CT value, but no statistical difference between the two (P0.05), and 8 pure uric acid stones (soft tissue window and bone window) CT value and 52 The difference between the CT values of the non uric acid stones (soft tissue window and bone window) was statistically significant (P0.05). According to the ROC curve, the optimal critical value (CT value) was 483.5HU for the diagnosis of pure uric acid stone. The sensitivity was 96.20%, the specificity was CTDIvol in 87.50%. low dose groups, DLP, ED was worse than the conventional dose group. The difference was statistically significant (P0.05); there was no significant difference in the size, quantity and CT value of the three groups of low dose I Dose1~6 images compared with the conventional dose group (P0.05); the I Dose4 image noise in the A group, the subjective score of the image quality of the signal to noise ratio and the I Dose4-6 image were not statistically significant (P0.05) compared with the conventional dose group (P0.05). There was no significant difference in noise, signal-to-noise ratio and subjective score of image quality compared with conventional dose group (P0.05). The difference of I Dose1-6 image noise, signal noise ratio, image quality subjective score and conventional dose in group C was statistically significant (P0.05).2 clinical study in low dose group CTDIvol, DLP, ED and conventional dose groups were different Study significance (P0.05); the size, quantity and CT value of the low dose I Dose1~6 1mm reconstruction images were not statistically significant compared with the conventional dose group (P0.05); the noise of I Dose1-5 1mm reconstruction images, the signal-to-noise ratio and the subjective score of the image quality were statistically significant (P0.05) compared with the conventional dose (P0.05); I Dose6 to reconstruct the image noise, There was no significant difference in the signal-to-noise ratio and the subjective score of image quality compared with the conventional dose group (P0.05); the image noise of I Dose61.5mm and 2mm was significantly different from that of 1mm (P0.05); there was no statistical significance (P0.05) in the comparison of the image SNR of I Dose6 1.5mm and 1mm (P0.05). The difference was statistically significant (P0.05); there was no significant difference in the CT value between I Dose6 1.5mm and 1mm (P0.05); I Dose6 2mm and 1mm measured stone CT values were significant difference. The size of three groups of thick stones and the subjective evaluation of image quality were compared. The difference was not statistically significant (P0.05). Conclusion 1 conventional CT routine dose conditions can be used to distinguish pure uric acid stone and non uric acid calculi according to the CT value of stone. The CT value of pure uric acid stone is less than 483.5HU.2 combined with iterative algorithm I Dose in CT low dose scanning, which can obviously improve the image quality without affecting the detection of urinary calculi and C. The accuracy of the T measurement can be used to evaluate the urinary tract calculus component.3 to achieve the conventional image quality level. When the tube voltage is 120K V, the I Dose6 horizontal tube current 150m As is the lowest critical level, and the level 1.5mm thickness reconstruction is the best scan for the diagnosis of urinary calculi.

【學(xué)位授予單位】：華北理工大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R691.4;R816.7

【參考文獻】

相關(guān)期刊論文 前10條

1 曾家元;楊蓉;張龍;黎華盛;羅超;夏朝暉;姚志林;楊利明;劉京;錢源江;孫爽;張名均;;185例尿路結(jié)石患者結(jié)石成分及分布特征分析[J];重慶醫(yī)學(xué);2016年36期

2 邢春滿;;超聲檢查在泌尿系結(jié)石中的應(yīng)用體會[J];首都食品與醫(yī)藥;2016年24期

3 劉志鵬;沈劍輝;湯連志;姜洪;;雙源CT雙能量技術(shù)在尿路結(jié)石成分分析中的應(yīng)用價值研究[J];系統(tǒng)醫(yī)學(xué);2016年10期

4 王輝;張力;郝宗耀;梁朝朝;;尿石病相關(guān)風險因素的研究現(xiàn)況[J];現(xiàn)代泌尿外科雜志;2016年10期

5 孫昊洋;李文武;;iDose 6迭代重建在降低盆腔CT掃描輻射劑量中的應(yīng)用[J];中國中西醫(yī)結(jié)合影像學(xué)雜志;2016年05期

6 王煒;李先承;;泌尿系結(jié)石CT值的臨床應(yīng)用價值[J];醫(yī)學(xué)與哲學(xué)(B);2016年08期

7 范兵;王霄英;邱建星;郭小超;董健;龔侃;;能譜CT與常規(guī)CT對泌尿系結(jié)石CT值的相關(guān)性分析[J];CT理論與應(yīng)用研究;2016年04期

8 李文威;周微;丁智兵;伍文兵;朱寒亮;;復(fù)雜性輸尿管上段結(jié)石患者的手術(shù)方案選取及取石碎石效果研究[J];微創(chuàng)泌尿外科雜志;2016年04期

9 趙春榮;徐磊;范占明;楊琳;陸東旭;;低管電壓結(jié)合迭代重建成像對冠狀動脈支架評價的心臟體模研究[J];心肺血管病雜志;2016年04期

10 陳劍;劉彩光;陳春華;;CT值在泌尿結(jié)石化學(xué)成分預(yù)測中的價值[J];實用臨床醫(yī)學(xué);2015年11期

相關(guān)碩士學(xué)位論文 前6條

1 麥合莫提·依明（Mahmut·Yiming）;CT值判斷上尿路結(jié)石化學(xué)成分的前瞻性研究[D];新疆醫(yī)科大學(xué);2014年

2 史振峰;CT值診斷泌尿系統(tǒng)結(jié)石成分的準確性研究[D];新疆醫(yī)科大學(xué);2012年

3 江杰;DSCT對上尿路結(jié)石成分分析臨床價值的探討[D];昆明醫(yī)科大學(xué);2012年

4 張帆;iDose迭代重建技術(shù)在盆腔惡性腫瘤低劑量CT檢查中的應(yīng)用研究[D];濟南大學(xué);2012年

5 史懷林;CT迭代圖像重建技術(shù)若干問題的應(yīng)用研究[D];山東大學(xué);2012年

6 李小虎;能譜CT對泌尿系結(jié)石化學(xué)成分分析的實驗研究[D];安徽醫(yī)科大學(xué);2011年

，

本文編號：1836503