本文關(guān)鍵詞：左心室容積變化特征在高心率患者雙源CT冠狀動脈造影中的應(yīng)用研究　出處：《蘇州大學(xué)》2016年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 心室容積 冠狀動脈造影術(shù) 體層攝影術(shù) X線計(jì)算機(jī) 心率 心室容積 冠狀動脈造影術(shù) 體層攝影術(shù) X線計(jì)算機(jī) 心率

【摘要】：作為一種超低輻射劑量CT冠狀動脈造影(coronary computed tomography angiography,CCTA)技術(shù)(低至約1m Sv),第二代雙源CT所特有的大螺距前瞻性心電門控螺旋掃描模式(prospectively electrocardiogram-triggered high-pitch spiral acquisition mode,flash spiral mode),可在一個(gè)心動周期中的250毫秒完成CCTA的掃描。但flash spiral模式通常適用于規(guī)則低心率患者,對高心率(心率≥70次/分)患者,其失敗率較高。雖然有學(xué)者采用30%R-R時(shí)相啟動掃描的方法,改善了部分患者的CCTA質(zhì)量,但其總體失敗率仍較高,本研究旨在通過分析不同心率患者左心室容積在心動周期中的變化規(guī)律,以按心率分組設(shè)置flash spiral掃描的最佳啟動R-R時(shí)相,提高高心率患者的超低輻射劑量CCTA圖像質(zhì)量與檢查成功率,拓寬該技術(shù)的適檢人群。第一部分左心室容積變化特征與雙源CT冠脈成像flash spiral模式下啟動掃描最佳R-R時(shí)相的臨床研究目的采用第二代雙源CT行冠狀動脈造影,分析不同心率的患者左心室容積在心動周期中的變化規(guī)律,進(jìn)而尋找適合flash spiral模式掃描的的最佳啟動R-R時(shí)相。方法前瞻性選取68例臨床懷疑冠心病的患者,按平均心率分為5組,采用回顧性心電門控螺旋掃描模式行冠狀動脈造影檢查,以5%R-R間期為時(shí)間間隔重建0-100%共21個(gè)時(shí)像周期,利用心功能軟件測量左心室容積,繪制不同心率組左心室容積-時(shí)間曲線,計(jì)算250ms內(nèi)左心室容積變化速率的平均值,選取容積變化率最小的R-R區(qū)間作為flash spiral擬掃描區(qū)間,得到不同心率組使用flash spiral模式啟動掃描的最佳R-R時(shí)相。結(jié)果不同心率組患者的左心室容積-時(shí)間曲線和左心室容積的變化速率-時(shí)間曲線均有其規(guī)律,心率越高,250ms內(nèi)左心室容積變化速率最低的R-R區(qū)間越接近前一個(gè)R波,使用flash spiral模式啟動掃描的最佳R-R間期正性相對值時(shí)相越小,心率70次/分、(70~79)次/分、(80~89)次/分、(90~99)次/分、≥100次/分的患者最佳R-R時(shí)相分別為60.0%、30.5%、25.8%、23.0%、16.7%。結(jié)論通過分析患者左心室容積在心動周期中的變化規(guī)律,為臨床尋找適合第二代雙源CT特有的flash spiral模式掃描的最佳R-R時(shí)相提供了指導(dǎo)。第二部分改良的Flash spiral模式冠狀動脈造影在高心率患者中的應(yīng)用研究目的采用基于左心室容積變化規(guī)律的改良flash spiral方法,對規(guī)則高心率患者(心率≥70次/分)行CCTA檢查,并與二代雙源常規(guī)采用的前瞻性心電門控序列掃描模式(prospectively electrocardiography-gated step-and-shoot mode,SAS mode)比較,探討改良法在高心率患者CCTA中的臨床價(jià)值。方法心率≥70次/分且滿足入組標(biāo)準(zhǔn)的106例患者隨機(jī)分為AB兩組,A組參照本研究第一部分得到的不同心率組使用flash spiral模式掃描的最佳R-R時(shí)相,采用改良的flash spiral模式掃描。B組采用前瞻性心電門控序列掃描,并對A、B兩組各心率組的圖像質(zhì)量及患者有效射線劑量進(jìn)行比較分析。結(jié)果1.兩組間性別、年齡、BMI、心率比較均無統(tǒng)計(jì)學(xué)差異(P=0.556,0.164,0.124,0.859)。2.圖像質(zhì)量比較:兩組患者均根據(jù)心率分為4組,心率(70~79)次/分組和心率(80-89)次/分組的患者,A、B兩組間圖像質(zhì)量無統(tǒng)計(jì)學(xué)差異(P=0.883,0.617);心率(90-99)次/分組和心率≥100次/分組的患者,A、B兩組間圖像質(zhì)量有統(tǒng)計(jì)學(xué)差異(P=0.048,0.044),B組優(yōu)于A組。3.輻射射線劑量比較:A、B兩組射線劑量(DLP、ED)差異均有統(tǒng)計(jì)學(xué)差異(P均0.001),A組明顯低于B組。結(jié)論(1)較高心率(70~89次/分)患者采用改良flash spiral模式掃描可以得到與前瞻性心電門控序列掃描相似的、滿足診斷要求的圖像,且有效射線劑量可以明顯減少;(2)但對于心率高于90次/分、心率變異較大的患者,flash spiral模式掃描圖像質(zhì)量欠佳,建議選擇前瞻性心電門控序列掃描。
[Abstract]:As a kind of low radiation dose of coronary angiography with CT (coronary computed tomography angiography CCTA (1m) technology to about Sv), the unique second generation dual source CT high pitch prospective ECG gated helical scan mode (prospectively electrocardiogram-triggered high-pitch spiral acquisition mode, flash spiral, mode) in a cardiac cycle 250 milliseconds to complete CCTA scan. But flash spiral model is usually applied to regular low heart rate of the patients, the high heart rate (HR = 70 BPM) patients, the failure rate is high. Although some scholars start scanning method using 30%R-R, improve the patients quality of CCTA, but the overall failure rate is still this study aims to analyze the higher heart rate in patients with left ventricular volume changes during the cardiac cycle, with the best start R-R set flash spiral packet when scanning according to the heart rate By improving the ultra low radiation dose and image quality of CCTA examination in patients with high heart rate success rate, broaden the technology suitable examination population. The first part of left ventricular volume changes and coronary artery imaging with dual source CT flash spiral mode to start scanning at the optimal R-R: clinical study of the second generation dual source CT coronary angiography. Analysis of heart rate in patients with left ventricular volume changes during the cardiac cycle, and then look for flash spiral to start R-R the best scanning phase. Methods a total of 68 patients suspected of coronary heart disease patients, according to the average heart rate divided into 5 groups, using retrospective ECG gated spiral scanning mode for coronary angiography check with 5%R-R interval time interval for reconstruction of 0-100% a total of 21 as a cycle, using left ventricular function measurement software volume rendering, heart rate and left ventricular volume time curve, meter The average rate of change of left ventricular volume in the 250ms value, select the volume change of the minimum rate of R-R interval as flash spiral quasi optimal R-R scanning interval, different heart rate groups using flash spiral mode scanning phase. The heart rate in patients with left ventricular volume time curve and left ventricular volume change rate time curve has its regularity, the heart rate is higher, 250ms R-R interval minimum left ventricular volume change rate is close to the front of a R wave, using the flash spiral mode optimal scan R-R interval is the relative value of phase is small, the heart rate of 70 beats / min / min (70~79), (80~89) / min. (90~99) = 100 / min / min, the patients with the best R-R phase were 60%, 30.5%, 25.8%, 23%, 16.7%. through analysis of left ventricular volume in patients with cardiac changes in the cycle, searching for the second generation dual source CT specific f for clinical The best R-R lash spiral scanning mode phase provides guidance. In the second part, the improved Flash spiral model of coronary angiography in patients with high heart rate to applied research in the modified flash spiral method changes of left ventricular volume based on the rules of patients with high heart rate (heart rate greater than 70 beats / min) and examined by CCTA. With the two generation dual source routine using prospective ECG gated sequence scan mode (prospectively electrocardiography-gated step-and-shoot mode, SAS mode), to explore the improvement method in the high heart rate in patients with CCTA. Methods the heart rate more than 70 BPM and meet the inclusion criteria of 106 patients were randomly divided into two groups of AB, the first part of this study the different heart rate groups using flash spiral scanning mode of the best R-R phase according to the A group, by flash spiral scanning mode of.B modified group using prospective ECG gated sequence Scanning, and the A B, comparative analysis of two groups of heart rate group of patients with image quality and effective radiation dose. The results of 1. between the two groups in gender, age, BMI, heart rate were no statistically significant difference (P=0.556,0.164,0.124,0.859).2. image quality: two groups of patients were divided into 4 groups according to heart rate, heart rate (70~79) time / packet and heart rate (80-89) / group of patients, A, there was no significant difference in B between the two groups of image quality (P=0.883,0.617); heart rate (90-99) and heart rate is more than 100 times / group / subgroup of patients, A, B between the two groups have significant difference in image quality (P=0.048,0.044), B group the radiation dose is better than that of A group.3.: A, B two groups of radiation dose (DLP, ED) were statistically significant difference (P 0.001), A group was significantly lower than that of B group. Conclusion (1) high heart rate (70~89 / min) were treated with modified flash spiral mode scan can be obtained with prospective ECG gated sequence a similar scan, To meet the requirements of image diagnosis, and effective radiation dose can be significantly reduced; (2) but for heart rate more than 90 BPM, heart rate variability in patients with larger flash, spiral scanning mode of poor image quality, recommendations for the selection of prospective ECG gated scanning sequence.

【學(xué)位授予單位】：蘇州大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R816.2;R541.4

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