本文選題：640層容積CT + 冠狀動(dòng)脈　； 參考：《河北北方學(xué)院》2017年碩士論文

【摘要】：冠狀動(dòng)脈粥樣硬化性心臟病(coronary heart disease,CHD)作為一種老年性常見疾病,不僅在全世界范圍內(nèi)較為常見,中國作為人口大國,且人口老齡化趨勢(shì)逐年升高,CHD事件在中國中老年人群中也愈來愈多,隨著生活質(zhì)量的提高和生活、工作壓力的增大,在青壯年人群中也常有發(fā)生。能夠及時(shí)發(fā)現(xiàn)早期CHD征象,一種較高端的影像檢查設(shè)備是必不可少的,日本東芝公司的320排640層容積CT的誕生,其擁有的160 mm的寬探測(cè)器,可以一次掃描覆蓋整個(gè)心臟,目前是篩查CHD價(jià)值較高且輻射劑量較低的無創(chuàng)性檢查方式。為了進(jìn)一步降低CHD患者接受冠狀動(dòng)脈(冠脈)CT血管成像(CT angiography,CTA)檢查時(shí)注射對(duì)比劑對(duì)患者身體產(chǎn)生的不良影響,降低對(duì)比劑碘濃度是至關(guān)重要的,其中等滲對(duì)比劑碘克沙醇(320mg I/ml)應(yīng)用于臨床以后,給廣大CHD患者帶來了福音,本文章旨在探討低劑量等滲對(duì)比劑碘克沙醇在640層容積CT冠脈CTA檢查中的應(yīng)用價(jià)值。首先,將146例行冠脈CTA檢查的患者按照對(duì)比劑使用劑量的不同進(jìn)行A項(xiàng)研究,分為三組:a組:對(duì)比劑用量0.6 ml/kg,64例;b組:0.7 ml/kg,45例;c組:0.8 ml/kg,37例,三組管電壓均為120k V。然后,又將86例行冠脈CTA檢查的患者按照管電壓及對(duì)比劑使用劑量的不同作為B項(xiàng)研究,分為兩組:分別為a組100k V,0.6 ml/kg,41例,b組:120k V,0.7 ml/kg,45例�？陀^評(píng)價(jià):對(duì)每個(gè)受試者的冠狀動(dòng)脈血管15個(gè)節(jié)段及主動(dòng)脈根部CT值及噪聲值進(jìn)行測(cè)量,并根據(jù)公式計(jì)算出各血管節(jié)段的信噪比(signal-to-noise,SNR)及對(duì)比噪聲比(contrast-to-noise,CNR);首先,將掃描后的數(shù)據(jù)傳輸至Vitrea后處理工作站,筆者通過數(shù)據(jù)重建測(cè)量各組圖像的CT值、噪聲,計(jì)算出每個(gè)測(cè)量部位的SNR及CNR,以此結(jié)果作為圖像質(zhì)量的客觀評(píng)價(jià)結(jié)果。主觀評(píng)價(jià):以5分評(píng)價(jià)法為判斷依據(jù),由兩名影像診斷醫(yī)師對(duì)圖像質(zhì)量進(jìn)行評(píng)分,當(dāng)兩位醫(yī)師評(píng)分結(jié)果意見不一致時(shí),再由另一名較高年資診斷醫(yī)師進(jìn)行評(píng)價(jià),以此結(jié)果作為圖像質(zhì)量的主觀評(píng)分結(jié)果;記錄每例患者的輻射劑量;最后,應(yīng)用SPSS17.0軟件進(jìn)行數(shù)據(jù)輸入及統(tǒng)計(jì)學(xué)分析。研究結(jié)果顯示,A項(xiàng)研究結(jié)果,CT值:a組低于b、c組(P0.05),但a組所有血管節(jié)段的CT值均大于250HU,能夠滿足臨床診斷需求。SNR及CNR:a組在RCA_p、RCA_m、RCA_d、PDA、LAD-D1、LAD-D2、LCX-OM1、LCX_m、LCX_d段SNR,CNR明顯高于b、c組(P0.05);在LM、LAD_p、LAD_p、LAD_m、LAD_d段CNR明顯高于b、c組(P0.05);在AA段SNR、CNR低于B、C組(P0.05);在LAD_p段SNR a組低于b組,而高于c組(P0.05);而在LM、LAD_m、LAD_d、LCX_p段SNR差異無統(tǒng)計(jì)學(xué)意義(P0.05)。圖像質(zhì)量主觀評(píng)分及輻射劑量比較,差異無統(tǒng)計(jì)學(xué)意義(P0.05)。B項(xiàng)研究結(jié)果:CT值:與b組比較,a組在AA、LM、LAD-D1、LAD-D2、LCX_p及LCX_d血管節(jié)段CT值差異有統(tǒng)計(jì)學(xué)意義(P0.05),a組明顯高于b組,余冠脈節(jié)段兩組間CT值差異無統(tǒng)計(jì)學(xué)意義(P0.05),且a組所有血管節(jié)段CT值均大于250 HU,能滿足診斷要求。SNR及CNR:a組在PDA、LAD-D1、LAD-D2血管節(jié)段SNR差異有統(tǒng)計(jì)學(xué)意義(P0.05),a組明顯高于b組,余冠脈節(jié)段兩組間SNR差異無統(tǒng)計(jì)學(xué)意義(P0.05);在LAD-D1血管節(jié)段CNR差異有統(tǒng)計(jì)學(xué)意義(P0.05),a組明顯高于b組,余冠脈血管節(jié)段CNR差異無統(tǒng)計(jì)學(xué)意義(P0.05)。兩組患者輻射劑量差異有統(tǒng)計(jì)學(xué)意義(P0.05),a組較b組輻射劑量降低了30%。因此,可以得出以下結(jié)論:640層容積CT冠脈CTA檢查中,管電壓采用120k V,根據(jù)體質(zhì)量(0.6 ml/kg)應(yīng)用碘克沙醇(320 mg I/ml),減少對(duì)比劑不良事件的發(fā)生率,可得到較好的冠脈圖像質(zhì)量,滿足臨床診斷需求;640層容積CT冠脈CTA檢查中,管電壓采用100k V,根據(jù)體質(zhì)量根據(jù)體質(zhì)量(0.6 ml/kg)應(yīng)用碘克沙醇(320 mg I/ml)能夠減少輻射劑量降低對(duì)比劑用量,從而減少對(duì)比劑腎病不良事件的發(fā)生率,減少患者在檢查過程中帶來的不必要的痛苦。
[Abstract]:Coronary heart disease (CHD), as a common disease of old age, is not only common in the world. China is a big country of population, and the trend of population aging is increasing year by year. The CHD event is becoming more and more among the middle-aged and elderly people in China. With the improvement of life quality and life and work pressure The increase of strength is often occurring among young and young people. It is possible to find early CHD signs. A more advanced image inspection device is essential. The birth of the 320 row 640 layer volume CT of the Japanese Toshiba Co, the 160 mm wide detector, can cover the whole heart at a time, now the value of screening CHD is high and the radiant is very high. In order to further reduce the adverse effects of injection contrast agents on the body of patients with coronary artery (CT angiography, CTA) angiography (CT angiography, CTA), it is essential to reduce the concentration of the contrast agent iodine, in which the isosmonic contrast agent iodide (320mg I/ml) is applied to the clinic. After that, the gospel was brought to the majority of CHD patients. The purpose of this article was to explore the value of low dose isosotic contrast agent iodide in the 640 layer volume CT coronary CTA examination. First, 146 patients with coronary CTA examination were studied according to the different dosage of contrast agent, divided into three groups: a group: contrast agent dosage 0.6 ml/kg, 64 cases; B group: 0.7 Ml/kg, 45 cases, C group: 0.8 ml/kg, 37 cases, three group of tube voltages were 120K V., and 86 cases of coronary CTA examination were divided into two groups according to the difference of the tube voltage and the dosage of contrast agent, divided into two groups: a group 100k V, 0.6 ml/kg, 41 cases, 0.7, 45 cases. Objective evaluation: coronary blood blood for each subject. The 15 segments and the CT values and noise values of the root of the aorta are measured, and the signal-to-noise ratio (signal-to-noise, SNR) and the contrast noise ratio (contrast-to-noise, CNR) are calculated according to the formula. First, the data after the scanning are transferred to the Vitrea post processing station. The author reconstructs the CT value of each group of images, noise, and meter through the data reconstruction. The results of SNR and CNR of each measurement area were calculated as the objective evaluation results of image quality. Subjective evaluation: Based on the 5 score evaluation method, the image quality was evaluated by two image diagnostics. When the scores of two doctors were different, the results were evaluated by a higher seniority physician. As a result of the subjective score of the image quality, the radiation dose of each patient was recorded. Finally, the SPSS17.0 software was used for data input and statistical analysis. The results showed that the results of A study, CT value: a group was lower than B and C group (P0.05), but all the CT values of all vascular segments in a group were greater than 250HU, and could satisfy the clinical diagnostic requirement.SNR and CNR:a group. In RCA_p, RCA_m, RCA_d, PDA, LAD-D1, LAD-D2, LCX-OM1, LCX_m, and LCX_d SNR, CNR obviously higher than B. 0.05) the subjective score of image quality and the comparison of radiation dose, there was no significant difference (P0.05).B research results: CT value: compared with group B, the difference of CT values of a group in AA, LM, LAD-D1, LAD-D2, LCX_p and LCX_d vascular segments was significantly higher than that in the group, and there was no significant difference between the groups of the remaining coronary segments. The CT value of all vascular segments was greater than 250 HU, which could meet the diagnostic requirements of.SNR and CNR:a group in PDA, LAD-D1, LAD-D2 segment SNR differences (P0.05), a group was significantly higher than the B group, and there was no statistical significance between the two groups of the residual coronary segments. There was no significant difference in the CNR difference between the remaining coronary artery segments (P0.05). The radiation dose difference between the two groups was statistically significant (P0.05), and the radiation dose in the group A was lower than that of the B group, so the following conclusion could be concluded: in the 640 layer volume CT coronary CTA examination, the tube voltage was used as 120K V, and the volume mass (0.6 ml/kg) used iodipol (320 mg), and decreased. Compared with the incidence of adverse events, a better quality of coronary images can be obtained to meet the needs of clinical diagnosis. In the 640 layer volume CT coronary CTA examination, the tube voltage is 100k V, and the use of iodik (320 mg I/ml) according to body mass (0.6 ml/kg) can reduce the dose of the contrast agent and reduce the contrast agent kidney disease. The incidence of good events reduces the unnecessary suffering of patients during the examination.

【學(xué)位授予單位】：河北北方學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R816.2;R541.4

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