本文選題：雙能量 + 雙源CT�。� 參考：《蘭州大學(xué)》2017年碩士論文

【摘要】：目的:評價雙源CT雙能量掃描肉眼定性、nIC定量及肉眼定性結(jié)合nIC定量三種方法分別對支架腔內(nèi)再狹窄的診斷準(zhǔn)確性。方法:使用西門子第二代雙源CT掃描機對2015年11月~2016年12月于蘭州大學(xué)第一醫(yī)院行冠狀動脈支架植入術(shù)后復(fù)診的88例冠心病患者進(jìn)行雙能量掃描,最終納入86名受試者,共152枚支架,其中男70名,女16名,年齡40-76歲,平均60.84±9.43歲。首先,采用5分半定量法對圖像質(zhì)量進(jìn)行評估,并通過Spearman等級相關(guān)分析其影響因素;其次,以選擇性冠狀動脈造影結(jié)果為金標(biāo)準(zhǔn),分別計算出肉眼定性分析、nIC定量分析及兩者結(jié)合診斷冠狀動脈支架內(nèi)再狹窄的敏感度、特異度、陽性似然比、陰性似然比、陽性預(yù)測值、陰性預(yù)測值及診斷準(zhǔn)確度,同時運用x2檢驗分別比較上述三種方法與金標(biāo)準(zhǔn)間差異;最后,采用x2檢驗比較肉眼定性分析、nIC定量分析及兩者結(jié)合診斷冠狀動脈支架再狹窄的各項準(zhǔn)確性指標(biāo)之間有無區(qū)別;所有統(tǒng)計學(xué)分析均通過SPSS Statistics version 21.0及MedCalc軟件進(jìn)行處理,P0.05為差異有統(tǒng)計學(xué)意義。結(jié)果:1.掃描所得86幅冠狀動脈CT血管造影的圖像質(zhì)量評分范圍為1~4分,平均1.86±0.78分。2.在金標(biāo)準(zhǔn)評定的152枚支架中,未見狹窄支架75枚,占49.34%;輕微狹窄支架29枚,占19.08%;輕度狹窄支架17枚,占11.18%;中度狹窄支架7枚,占4.60%;重度狹窄支架13枚,占8.55%;完全閉塞支架11枚,占7.24%。其中,屬顯著性狹窄(狹窄程度≥50%)支架共31枚,占20.39%。3.肉眼定性分析共檢出未見狹窄支架103枚(67.76%)、輕微狹窄支架13枚(8.55%)、輕度狹窄支架11枚(7.24%)、中度狹窄支架3枚(1.97%)、重度狹窄支架13枚(8.55%)、閉塞支架9枚(5.92%);其中,屬顯著狹窄支架25枚,占16.45%。診斷冠狀動脈支架腔內(nèi)顯著性狹窄的敏感度、特異度、陽性似然比、陰性似然比、陽性預(yù)測值、陰性預(yù)測值及診斷準(zhǔn)確度分別為67.74%、96.69%、20.49、0.33、84%、92.13%、90.79%,與選擇性冠狀動脈造影所得結(jié)果的差異無統(tǒng)計學(xué)意義;4.nIC定量分析檢出顯著性狹窄支架27枚(17.76%),無顯著性狹窄支架125枚(82.24%)。診斷冠狀動脈支架腔內(nèi)顯著性狹窄的敏感度、特異度、陽性似然比、陰性似然比、陽性預(yù)測值、陰性預(yù)測值及診斷準(zhǔn)確度分別為58.06%、92.56%、7.81、0.45、66.67%、89.60%、85.53%,與選擇性冠狀動脈造影所得結(jié)果的差異無統(tǒng)計學(xué)意義;5.肉眼定性結(jié)合nIC定量分析共檢出顯著性狹窄支架35枚(23.03%),無顯著性狹窄支架117枚(76.97%)。診斷冠狀動脈支架腔內(nèi)顯著性狹窄的敏感度、特異度、陽性似然比、陰性似然比、陽性預(yù)測值、陰性預(yù)測值及診斷準(zhǔn)確度分別為83.87%、92.56%、11.28、0.17、74.29%、95.73%、90.79,與選擇性冠狀動脈造影所得結(jié)果的差異不具有統(tǒng)計學(xué)意義;6.肉眼定性分析、nIC定量分析及兩者結(jié)合評價冠脈支架術(shù)后支架腔內(nèi)顯著性狹窄的各項準(zhǔn)確性指標(biāo)之間的差異均不具有統(tǒng)計學(xué)意義。結(jié)論:1.雙源CT雙能量掃描所得圖像能將支架的植入位置以及管腔內(nèi)的充盈程度明顯清楚的展示出來,并能夠較準(zhǔn)確的對支架再狹窄進(jìn)行分度、分級,明確再狹窄的原因及累及范圍;2.雙源CT雙能量掃描可得到清晰的碘分布圖,通過測量支架內(nèi)碘含量,較大程度的提高了其診斷支架再狹窄的敏感度,但因其高假陽性導(dǎo)致特異度有所下降;3.雙源CT雙能量掃描初步實現(xiàn)了CT對支架再狹窄的定量分析,并為支架腔內(nèi)斑塊性質(zhì)分析以及心肌缺血判斷的定量分析奠定了堅實的基礎(chǔ)。
[Abstract]:Objective: To evaluate the accuracy of the diagnosis of stent restenosis by three methods: double source CT double energy scanning naked eye, nIC quantitative and naked eye qualitative combination with nIC quantitative method. Method: 88 cases in December November 2015, First Hospital Affiliated to Lanzhou University after coronary stent implantation were reviewed with SIEMENS second generation double source CT scanner. The patients with coronary heart disease were scanned with double energy and were finally included in 86 subjects, with a total of 152 stents, including 70 men, 16 women, 40-76 years old and an average of 60.84 9.43 years. First, the quality of the images was evaluated by the method of 5 and half quantitation, and the influence factors were analyzed by Spearman level correlation; secondly, selective coronary arteriography was gold. Criteria, the sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, positive predictive value, negative predictive value and diagnostic accuracy were calculated by quantitative analysis of the naked eye, nIC quantitative analysis and combined diagnosis of restenosis in coronary artery stents, and the differences between the three methods were compared with the gold standard respectively by x2 test. Finally, X2 was used. There was no difference between the qualitative analysis of the naked eye, nIC quantitative analysis and the accuracy of the diagnosis of coronary artery stenting restenosis. All statistical analysis were processed by SPSS Statistics version 21 and MedCalc software. The difference of P0.05 was statistically significant. Results: 86 coronary arteries CT were obtained by 1. scan. The image quality score of the angiography was 1~4, with an average of 1.86 + 0.78.2. in the 152 stents of the gold standard, no narrow stent 75, 49.34%, 29 for mild stenosis, 19.08%, 17 for mild stenosis, 11.18%, 7 for moderate stenosis, 4.60%, 13, 8.55%, and totally blocked stent. A total of 31 stents (7.24%. stenosis or more than 50%) accounted for a total of 31 stents. 103 (67.76%), 13 stents (8.55%) for mild stenosis, 11 (7.24%) for mild stenosis, 3 (1.97%) for moderate stenosis, 13 (8.55%) in severe stenotic stents and 9 (5.92%) in severe stenosis, were found in the qualitative analysis of 20.39%.3. naked eyes. 25 stents were significantly narrowed, accounting for the sensitivity of 16.45%. in the diagnosis of coronary artery stent stenosis, specificity, positive likelihood ratio, negative likelihood ratio, positive predictive value, negative predictive value, and diagnostic accuracy of 67.74%, 96.69%, 20.49,0.33,84%, 92.13%, 90.79%, respectively, and there was no statistical difference from the results of selective coronary angiography. 4.nIC quantitative analysis was used to detect 27 significant stenotic stents (17.76%) and 125 (82.24%) without significant stenosis. The sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, positive predictive value, negative predictive value, and diagnostic accuracy were 58.06%, 92.56%, 7.81,0.45,66.67%, 89.60%, respectively, in the diagnosis of coronary artery stent stenosis. 85.53%, the difference between the results obtained from the selective coronary angiography was not statistically significant. 5. the quantitative analysis of the coronary artery stents, 35 (23.03%) and no significant narrowing stents (76.97%) were detected by quantitative analysis of nIC, and the sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, positive likelihood ratio, positive likelihood ratio, positive likelihood ratio, positive likelihood ratio, positive likelihood ratio, positive likelihood ratio, positive likelihood ratio, positive likelihood ratio, and positive likelihood ratio of the coronary artery stents were diagnosed. The predictive value, negative predictive value and diagnostic accuracy were 83.87%, 92.56%, 11.28,0.17,74.29%, 95.73%, 90.79, and the difference between the results obtained from the selective coronary angiography was not statistically significant. 6. qualitative analysis of the naked eyes, nIC quantitative analysis and the combination of the two methods to evaluate the accuracy of the significant stenoses in the stent after coronary stenting. The differences between the markers are not statistically significant. Conclusion: 1. dual source CT dual energy scanning images can clearly show the position of the stent implantation and the filling degree in the lumen, and can accurately distinguish the stent restenosis, classify, clear the cause and range of the narrow narrow, and 2. dual source dual energy scanning. A clear iodine distribution map was obtained. By measuring the iodine content in the stent, the sensitivity of the stent restenosis was greatly improved, but the specificity decreased because of its high false positive. 3. dual source CT dual energy scanning has preliminarily realized the quantitative analysis of the stent restenosis by CT, and the analysis of the plaque properties of the stent and the deficiency of the myocardium. The quantitative analysis of blood judgment laid a solid foundation.

【學(xué)位授予單位】：蘭州大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R541.4;R816.2

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