【摘要】：目的:利用寶石CT(Computed Tomography)能譜成像技術(shù)(Gemstone Spectral Imaging,GSI)綜合性分析頸動(dòng)脈粥樣硬化癥(carotid atherosclerosis,CA)患者的頸動(dòng)脈斑塊的組織成分,界定其斑塊性質(zhì),為預(yù)警缺血風(fēng)險(xiǎn)和干預(yù)治療提供重要的影像學(xué)依據(jù)。方法:42位患者,經(jīng)頸動(dòng)脈彩色多普勒超聲篩查,確診為頸動(dòng)脈硬化癥的患者。其中,20例患者行經(jīng)頸動(dòng)脈內(nèi)膜剝脫術(shù)(carotid endarterectomy,CEA)作為對(duì)照組(B組),其切除的斑塊行病理學(xué)分析并確認(rèn)斑塊性質(zhì)。未行CEA手術(shù)的22例患者作為研究組(A組)。兩組行CT血管造影(computed tomography angiography,CTA),采集質(zhì)量控制(quality control,QC)圖像(140Kvp混合能量)和70kev單能量成像,傳至GE能譜CT工作站AW4.4,獲得并計(jì)算QC圖像下和最佳kev值下的各斑塊的對(duì)比噪聲比(contrast to noise ratio,CNR),比較二者差異性。重建A、B組斑塊的能譜曲線圖、碘基物質(zhì)濃度值和有效原子序數(shù)(Effective-Z)圖譜,繪制其對(duì)三種斑塊的ROC(receiver operating characteristic)曲線圖,以敏感度和特異度之合最大者為最佳診斷閥值,并獲得相應(yīng)的敏感度和特異度,評(píng)估曲線斜率、標(biāo)準(zhǔn)化碘基物質(zhì)濃度以及有效原子序數(shù)對(duì)于檢測(cè)不同類(lèi)型斑塊的效果。結(jié)果:最佳kev下A、B兩組的平均CNR值明顯高于QC圖像下的平均CNR值,二者有顯著性差異(P0.01)。最佳kev下,以平均CT值判定斑塊性質(zhì)較QC圖像更可靠。能譜GSI技術(shù)中的能譜曲線斜率對(duì)界定脂類(lèi)斑塊的敏感度最低但特異度最高;碘基物質(zhì)濃度和有效原子序數(shù)對(duì)脂類(lèi)斑塊的敏感性最高,對(duì)纖維斑塊和混合斑塊的敏感度和特異度均較低。能譜曲線是界定脂類(lèi)斑塊相對(duì)最可靠的指標(biāo)。結(jié)論:GSI技術(shù)是研究頸動(dòng)脈粥樣硬化斑塊的新型可靠手段。利用高靈敏度和高特異性的GSI技術(shù)所得的不同指標(biāo)參數(shù),可對(duì)頸動(dòng)脈粥樣斑塊進(jìn)行定量、定性分析,獲得可靠的臨床診斷效果。
[Abstract]:Objective: to analyze the tissue components of carotid plaques in patients with carotid atherosclerosis (carotid) by using gem CT (Computed Tomography) imaging technique, and to determine the nature of carotid plaques. To provide an important imaging basis for early warning of ischemic risk and intervention therapy. Methods 42 patients with carotid arteriosclerosis were screened by color Doppler ultrasound. Carotid endarterectomy (carotid) was performed in 20 patients as control group (group B). Twenty-two patients without CEA operation served as study group (group A). Two groups were performed (computed tomography angiography (CTA), quality control QC images (140Kvp mixed energy) and 70kev single energy imaging. The contrast noise ratio of each plaque under QC image and optimal kev value was obtained and calculated, and the difference between the two groups was compared. The spectral curve, iodine based substance concentration and effective atomic number (Effective-Z) map of the plaques in group A and B were reconstructed and their ROC (receiver operating characteristic) curves for the three plaques were plotted. The best diagnostic threshold was the one with the greatest sensitivity and specificity. The sensitivity and specificity were obtained to evaluate the effect of curve slope, concentration of standardized iodized substance and effective atomic number on the detection of different types of plaque. Results: the average CNR value of Agna B group was significantly higher than that of QC image under optimal kev (P0.01). Under the optimal kev, the average CT value is more reliable than QC image in judging plaque property. The slope of energy spectrum curve in GSI technique has the lowest sensitivity but the highest specificity in the determination of lipid plaques, the concentration of iodized substances and the effective atomic number have the highest sensitivity to lipid plaques. The sensitivity and specificity to fibrous plaques and mixed plaques were low. The energy spectrum curve is the most reliable index to define the lipid plaque. ConclusionGSI is a new and reliable method for the study of carotid atherosclerotic plaques. The quantitative and qualitative analysis of carotid atherosclerotic plaques can be made by using different parameters obtained by high sensitivity and high specificity GSI technique, and reliable clinical diagnosis results can be obtained.
【學(xué)位授予單位】：青島大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2015
【分類(lèi)號(hào)】：R743;R816.1

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