高壓電損傷肢體256層螺旋CT灌注成像的應(yīng)用研究
發(fā)布時間：2018-07-29 17:04
【摘要】：目的探索256層螺旋CT灌注成像技術(shù)對于高壓電后四肢損傷的應(yīng)用價值。 材料與方法選擇高壓電損傷患者53例,其中接受四肢灌注檢查者48例,常規(guī)四肢CTA檢查者5例。按照手術(shù)后截肢與否,將48例接受四肢灌注檢查者分為截肢組14例及未截肢組34例。將MSCTP檢查結(jié)果(肌肉微循環(huán)灌注信息及相應(yīng)部位血管CTA圖像)與手術(shù)、病理對照,以及進(jìn)行自身、雙側(cè)對照。將灌注所得圖像傳入Phillips公司專屬EBW工作站,用Functional CT-general模式行灌注圖像處理。(1)從灌注掃描結(jié)果中,選擇最佳時相提取CTA圖像,采用MPR、 CPR、VR、MIP及高級血管分析(advantage vessel analysis, AVA)軟件進(jìn)行分析,獲得相應(yīng)部位的血管圖像；(2)截肢組及未截肢組中選定興趣區(qū)即得到包含血流灌注(BF),峰值增強(qiáng)(PEI),達(dá)峰時間(TTP),血容量(BV)的偽彩圖、具體量化數(shù)值及時間密度曲線(TDC)。53例均進(jìn)行血管等形態(tài)學(xué)分析,截肢組、未截肢組48例進(jìn)行t檢驗(yàn),其中對截肢組另外進(jìn)行判別分析,以比較各組肢體各部位灌注參數(shù)的差異。 結(jié)果1、高壓電損傷后肌肉、皮膚及骨骼CT表現(xiàn)患者肌肉損傷在CT平掃、增強(qiáng)圖像上一般表現(xiàn)為低密度影；皮膚損傷表現(xiàn)為皮膚局部缺損、皺褶；骨骼破壞后表現(xiàn)為骨皮質(zhì)不連續(xù)、錯位。2、高壓電損傷后CTA表現(xiàn)CTA對血管顯示較為清晰,損傷血管表現(xiàn)為節(jié)段性狹窄或血管遠(yuǎn)端的鼠尾狀閉塞、中斷。3、高壓電損傷后CT灌注表現(xiàn)高灌注、低灌注及無血流灌注表現(xiàn)。各組參數(shù)分析如下：(1)截肢組：a、患側(cè)與健側(cè)各部位灌注參數(shù)的比較�；紓�(cè)截肢平面下份與健側(cè)相對應(yīng)下份層面比較,BF值：前者后者,差異有統(tǒng)計學(xué)意義；PEI值：前者后者,差異有統(tǒng)計學(xué)意義；TTP、BV值：前者均后者,差異無統(tǒng)計學(xué)意義�；紓�(cè)截肢平面上份與健側(cè)相對應(yīng)上份層面比較,BF、PEI、BV值：前者均后者,TTP值：前者后者,差異均無統(tǒng)計學(xué)意義�；紓�(cè)截肢平面與患側(cè)相對應(yīng)平面比較,BF、PEI、TTP、BV值：前者均后者,差異均無統(tǒng)計學(xué)意義。截肢組的患側(cè)各部位灌注參數(shù)的比較。b、患側(cè)截肢平面上份與截肢平面比較,BF值：前者后者,差異有統(tǒng)計學(xué)意義。PEI、TTP、BV值：前者均后者,差異均無統(tǒng)計學(xué)意義。c、患側(cè)截肢平面下份與截肢平面參數(shù)比較,BF值：前者后者,差異有統(tǒng)計學(xué)意義；PEI值：前者后者,差異有統(tǒng)計學(xué)意義；BV值：前者后者,差異有統(tǒng)計學(xué)意義。TTP值：前者后者,差異無統(tǒng)計學(xué)意義。通過判別分析得出,以上三組的kappa值均0.6,一致性比較好。BF、PEI、 TTP、BV值對測量肢體是否需截肢的判定具有實(shí)際意義。(2)未截肢組：患者上肢BF、PEI、BV值患側(cè)健側(cè),TTP值：患側(cè)健側(cè),差異均無統(tǒng)計學(xué)意義。未截肢患者下肢BF、PEI、BV:患側(cè)健側(cè),未截肢患者下肢TTP值：患側(cè)健側(cè),差異均無統(tǒng)計學(xué)意義。 結(jié)論應(yīng)用256層螺旋CT灌注診斷四肢高電壓損傷,能夠獲得清晰的血管CTA圖像及不同損傷部位灌注參數(shù)值,并且這些灌注參數(shù)對肢體是否需要截肢的判定具有實(shí)際意義；MSCTP對區(qū)別高壓電損傷和電弧損傷有一定的幫助作用。MSCTP是臨床診斷、治療高壓電損傷的方便、安全、定性、定量的理想檢查方法。
[Abstract]:Objective to explore the application value of 256 slice spiral CT perfusion imaging in limbs injury after high-voltage electricity.
Materials and methods 53 cases of high voltage electrical injury were selected, including 48 cases of extremities and 5 cases of conventional extremities CTA. 48 cases were divided into 14 cases of amputation group and 34 cases of non amputation group according to the amputation after operation. The results of MSCTP examination (the information of microcirculation perfusion of muscles and the CTA image of blood vessels in the corresponding parts) were examined. The images were introduced into the EBW workstation of Phillips company, and the perfusion images were processed by Functional CT-general mode. (1) from the results of the perfusion scan, the optimum phase was selected to extract the CTA image, using MPR, CPR, VR, MIP and advanced vascular analysis (advantage vessel analysis,). AVA) the software was analyzed and the vascular images of the corresponding parts were obtained; (2) the selected interest areas in the amputation group and the amputated group were selected to include blood flow perfusion (BF), peak enhancement (PEI), peak time (TTP), blood volume (BV) pseudo color map, specific quantitative numerical time density curve (TDC).53 cases performed vascular morphology analysis, amputation group, not cut. T test was performed in 48 cases of limb group, and discriminant analysis was performed in amputation group to compare the difference of perfusion parameters in different parts of limbs.
Results 1, the muscle, skin and bone CT manifestations of the muscle, skin and bone in the patients with high voltage electrical injury were performed on CT plain scan, and the enhanced image was generally low density. The skin injury showed local defect and wrinkle, after the destruction of the bone, the bone cortical discontinuity was discontinuous, the.2 was misplaced, and the CTA displayed CTA to the blood vessels clearly and damaged blood after the high voltage electrical injury. The tube showed a segmental stenosis or a rat caudate occlusion of the distal part of the vessel, interrupting.3. High perfusion, low perfusion and no blood flow perfusion after high voltage electrical injury. The parameters of each group were as follows: (1) the amputation group: A, the comparison of the perfusion parameters between the affected side and the healthy side. The lower part of the affected side amputation plane was compared with the healthy side, BF Value: the former, the difference has statistical significance; PEI value: the former and the latter, the difference has statistical significance; TTP, BV value: the former is the latter, the difference is not statistically significant. The upper limb of the amputated plane should be compared with the healthy side at the upper level, BF, PEI, BV value: the former is both the latter, the former is the latter, the difference is not statistically significant. The affected side section is not statistically significant. BF, PEI, TTP, BV value: the former was the latter, the difference was not statistically significant. The comparison of the perfusion parameters of the affected side of the amputation group was.B, the upper part of the amputated limb was compared with the amputation plane, BF value: the former, the difference was statistically significant.PEI, TTP, BV value: the former were all the latter, and the difference was not statistically significant. Significance.C, the lower part of the affected side of the amputation plane compared with the amputation plane parameters, BF value: the former, the difference has statistical significance; PEI value: the former and the latter, the difference has statistical significance; the former is the former and the former, the difference has a statistically significant.TTP value: the former is the latter, the difference is not statistically significant. By discriminant analysis, the above three groups of kappa values All 0.6, the consistency of.BF, PEI, TTP, BV value for the determination of limb amputation is of practical significance. (2) unamputated group: the upper limb BF, PEI, BV value of the side healthy side, TTP value: the side of the affected side, the difference is not statistically significant. The lower limb BF, PEI, BV: affected side, the lower limb TTP values of the lower extremity patients: the side health side, difference of the affected side, the side health, difference of the affected side There was no statistical significance.
Conclusion 256 layers of spiral CT is used to diagnose the high voltage injury of extremities, which can obtain clear blood vessel CTA image and the perfusion parameters of different injury sites. And these perfusion parameters are of practical significance to the determination of limb amputation, and MSCTP can help to distinguish high voltage electrical injury and arc injury..MSCTP is clinical It is a convenient, safe, qualitative and quantitative method for diagnosis and treatment of high voltage electrical injury.
【學(xué)位授予單位】：昆明醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2012
【分類號】：R318.51
本文編號：2153381
[Abstract]:Objective to explore the application value of 256 slice spiral CT perfusion imaging in limbs injury after high-voltage electricity.
Materials and methods 53 cases of high voltage electrical injury were selected, including 48 cases of extremities and 5 cases of conventional extremities CTA. 48 cases were divided into 14 cases of amputation group and 34 cases of non amputation group according to the amputation after operation. The results of MSCTP examination (the information of microcirculation perfusion of muscles and the CTA image of blood vessels in the corresponding parts) were examined. The images were introduced into the EBW workstation of Phillips company, and the perfusion images were processed by Functional CT-general mode. (1) from the results of the perfusion scan, the optimum phase was selected to extract the CTA image, using MPR, CPR, VR, MIP and advanced vascular analysis (advantage vessel analysis,). AVA) the software was analyzed and the vascular images of the corresponding parts were obtained; (2) the selected interest areas in the amputation group and the amputated group were selected to include blood flow perfusion (BF), peak enhancement (PEI), peak time (TTP), blood volume (BV) pseudo color map, specific quantitative numerical time density curve (TDC).53 cases performed vascular morphology analysis, amputation group, not cut. T test was performed in 48 cases of limb group, and discriminant analysis was performed in amputation group to compare the difference of perfusion parameters in different parts of limbs.
Results 1, the muscle, skin and bone CT manifestations of the muscle, skin and bone in the patients with high voltage electrical injury were performed on CT plain scan, and the enhanced image was generally low density. The skin injury showed local defect and wrinkle, after the destruction of the bone, the bone cortical discontinuity was discontinuous, the.2 was misplaced, and the CTA displayed CTA to the blood vessels clearly and damaged blood after the high voltage electrical injury. The tube showed a segmental stenosis or a rat caudate occlusion of the distal part of the vessel, interrupting.3. High perfusion, low perfusion and no blood flow perfusion after high voltage electrical injury. The parameters of each group were as follows: (1) the amputation group: A, the comparison of the perfusion parameters between the affected side and the healthy side. The lower part of the affected side amputation plane was compared with the healthy side, BF Value: the former, the difference has statistical significance; PEI value: the former and the latter, the difference has statistical significance; TTP, BV value: the former is the latter, the difference is not statistically significant. The upper limb of the amputated plane should be compared with the healthy side at the upper level, BF, PEI, BV value: the former is both the latter, the former is the latter, the difference is not statistically significant. The affected side section is not statistically significant. BF, PEI, TTP, BV value: the former was the latter, the difference was not statistically significant. The comparison of the perfusion parameters of the affected side of the amputation group was.B, the upper part of the amputated limb was compared with the amputation plane, BF value: the former, the difference was statistically significant.PEI, TTP, BV value: the former were all the latter, and the difference was not statistically significant. Significance.C, the lower part of the affected side of the amputation plane compared with the amputation plane parameters, BF value: the former, the difference has statistical significance; PEI value: the former and the latter, the difference has statistical significance; the former is the former and the former, the difference has a statistically significant.TTP value: the former is the latter, the difference is not statistically significant. By discriminant analysis, the above three groups of kappa values All 0.6, the consistency of.BF, PEI, TTP, BV value for the determination of limb amputation is of practical significance. (2) unamputated group: the upper limb BF, PEI, BV value of the side healthy side, TTP value: the side of the affected side, the difference is not statistically significant. The lower limb BF, PEI, BV: affected side, the lower limb TTP values of the lower extremity patients: the side health side, difference of the affected side, the side health, difference of the affected side There was no statistical significance.
Conclusion 256 layers of spiral CT is used to diagnose the high voltage injury of extremities, which can obtain clear blood vessel CTA image and the perfusion parameters of different injury sites. And these perfusion parameters are of practical significance to the determination of limb amputation, and MSCTP can help to distinguish high voltage electrical injury and arc injury..MSCTP is clinical It is a convenient, safe, qualitative and quantitative method for diagnosis and treatment of high voltage electrical injury.
【學(xué)位授予單位】：昆明醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2012
【分類號】：R318.51
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