本文關鍵詞：256層螺旋CT脾動脈成像低劑量高濃度對比劑的應用及對脾動脈解剖分析　出處：《河北聯(lián)合大學》2014年碩士論文　論文類型：學位論文

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【摘要】：目的將低劑量高濃度對比劑應用于256層螺旋CT脾動脈成像，分析其可行性；通過256層螺旋CT脾動脈成像觀察脾動脈解剖及變異，并探討256層螺旋CT脾動脈成像的臨床應用價值。 方法1將100例接受256層螺旋CT脾動脈成像的患者隨機分為兩組：研究組50例，注射高濃度對比劑碘普羅胺（370mgI/mL）50ml+生理鹽水20ml；對照組50例，注射70ml常規(guī)濃度對比劑碘海醇（300mgI/mL）。兩組注射速率均為4.0ml/s。兩組均為在膈頂水平腹主動脈內(nèi)設定感興趣區(qū)，設定閾值為150Hu，采用自動跟蹤技術，感興趣區(qū)內(nèi)CT值達閾值后自動激發(fā)掃描。分別測量兩組的腹主動脈腹腔干水平、脾動脈中段及脾葉動脈管腔內(nèi)對比劑CT值，比較兩組的對比劑增強水平，對兩組的脾動脈各級分支顯示率進行比較，對兩組的圖像質(zhì)量進行評分并比較。2選擇經(jīng)臨床及其他檢查未發(fā)現(xiàn)脾臟或脾血管疾病而行256層螺旋CT腹部動脈成像的患者100例作為研究對象，將原始圖像重建為0.625mm薄層后傳至工作站，應用多種后處理技術對圖像進行處理，如容積再現(xiàn)（VR）、多平面重組（MPR）、最大密度投影（MIP）、曲面重組（CPR）等，觀察脾動脈正常解剖及變異，探討脾動脈256層螺旋CT成像在腹腔鏡脾切除術前檢查及部分脾栓塞術前檢查的應用價值，并分析256層螺旋CT在脾動脈成像中的優(yōu)勢。3統(tǒng)計學方法：所有數(shù)據(jù)用SPSS17.0統(tǒng)計學軟件進行統(tǒng)計。用均數(shù)±標準差表示計量數(shù)據(jù)；用χ2檢驗對分類資料及率進行比較；用獨立樣本t檢驗比較不同組間的差異；利用雙變量相關分析來分析變量之間的相關性。若P 0.05，則差異具有統(tǒng)計學意義。 結果1研究組與對照組腹主動脈腹腔干水平、脾動脈中段及脾葉動脈內(nèi)對比劑濃度比較，分別為：研究組347.7±46.6Hu，321.1±49.9Hu，293.5±50.2Hu，平均320.81±47.43Hu；對照組276.4±47.2Hu，221.7±44.4Hu，175.9±44.0Hu，平均224.67±39.01Hu，各組數(shù)據(jù)研究組均高于對照組，兩組比較差異具有統(tǒng)計學意義（P 0.01）；兩組脾動脈各級分支顯示率比較存在統(tǒng)計學差異（P0.01），研究組Ⅲ級血管分支顯示率高于對照組；脾動脈圖像質(zhì)量評分比較，兩組間無統(tǒng)計學差異（P0.05）。2脾動脈起源為正常型者為85例（占85%），起源變異15例，變異率為15%，不同性別間變異率差異無統(tǒng)計學意義（χ2=1.050，P0.05）。脾動脈末端分支為集中型的35例，，分散型的62例。3例脾葉動脈為一支型，83例為二支型，14例為三支型。顯示脾上極動脈10例，脾下極動脈15例。脾動脈起始管徑為3.42～8.32mm，平均（5.86±1.08）mm；脾動脈末端管徑為1.92～6.41mm，平均（4.24±0.87） mm；脾葉動脈管徑為1.20～5.86mm，平均（3.35±0.87）mm；脾動脈主干長度為7.20～19.30mm，平均（12.22±2.09）mm；脾指數(shù)113.4～884.0cm3，平均（390.65±151.48）cm3。不同性別間脾動脈起始管徑、脾動脈末端管徑、脾葉動脈管徑及脾動脈主干長度比較具有統(tǒng)計學差異（P 0.05）；不同年齡組脾動脈起始管徑、脾動脈末端管徑、脾葉動脈管徑及脾動脈主干長度比較，無統(tǒng)計學差異（P0.05）。不同性別間脾指數(shù)比較具有統(tǒng)計學差異（P 0.05）；不同年齡組脾指數(shù)比較，不存在統(tǒng)計學差異（P0.05）。脾動脈起始管徑、脾動脈末端管徑及脾葉動脈管徑與脾指數(shù)具有相關性（P 0.05），且呈正相關。脾動脈主干長度與脾指數(shù)無相關性（P0.05）。脾動脈在胰尾上方走行65例，在胰尾后方走行24例，在胰尾前方走行11例。 結論1256層螺旋CT脾動脈成像中，應用低劑量高濃度對比劑可以降低發(fā)生對比劑不良反應的可能性，且得到的脾動脈圖像完全能夠滿足臨床診斷要求，值得臨床應用。2256層螺旋CT脾動脈成像能清晰顯示活體狀態(tài)下脾動脈的正常解剖及變異，可以為腹腔鏡脾切除術的術式選擇提供依據(jù)，并可為部分脾栓塞術提供解剖學參考及相關數(shù)據(jù)，從而可以準確控制栓塞程度并選擇合適的導管導絲。3256層螺旋CT技術上的先進性及強大的血管后處理分析軟件，用于脾動脈血管成像優(yōu)勢明顯。
[Abstract]:Objective to apply low-dose high-density contrast agent to 256 slice spiral CT splenic artery imaging, analyze its feasibility, observe the anatomy and variation of splenic artery by 256 slice spiral CT splenic artery imaging, and discuss the clinical application value of 256 slice spiral CT splenic artery imaging.
Methods: 100 patients were randomly divided into 1 underwent 256 slice spiral CT imaging of the splenic artery into two groups: study group 50 cases, injection of high concentration of contrast medium iopromide (370mgI/mL) 50ml+ 20ml normal saline; 50 cases in the control group, 70ml injection of conventional concentration of contrast agent iohexol (300mgI/mL) injection rate of two. The two group is 4.0ml/s. group were set in the top level of abdominal aorta in the region of interest in the diaphragm, set the threshold for 150Hu, automatic tracking technology using ROI automatic CT scanning of excitation threshold. The two groups were measured by abdominal aorta and celiac trunk, splenic artery and splenic artery lumen in middle lobe comparison the value of contrast agent CT, compared with two groups of enhanced level of splenic artery branches in two groups showed rate comparison, image quality scores were performed in two groups and compared.2 by clinical and other examination found no spleen or splenic vascular disease underwent 256 slice spiral CT Abdominal angiography in 100 patients as the research object, the original image reconstruction for 0.625mm layer and transferred to the workstation, application of various postprocessing technique of image processing, such as volume rendering (VR), multi planar reconstruction (MPR), maximum intensity projection (MIP), heavy surface (CPR), the observation group of splenic artery the normal anatomy and variants, investigate the application value of 256 slice spiral CT imaging in examination before laparoscopic splenectomy and partial splenic embolization of splenic artery before examination, and analyze the advantages of.3 statistical method of 256 slice spiral CT in splenic artery imaging: all data using SPSS17.0 statistical software for statistical data. The measurement standard deviation; 2 test was used to compare the classification and data rate; independent sample t test was used to compare the different differences between groups; correlation analysis with two variables to analyze the correlation between variables. If P is 0.05, the difference is the The significance of learning.
Results of the 1 study group and control group, abdominal aorta, celiac, comparison, contrast agent concentration of splenic artery and splenic artery in the middle respectively: the study group was 347.7 + 46.6Hu, 321.1 + 49.9Hu, 293.5 + 50.2Hu, average 320.81 + 47.43Hu; the control group was 276.4 + 47.2Hu, 221.7 + 44.4Hu, 175.9 + 44.0Hu, an average of 224.67 + 39.01Hu, each data in study group were higher than the control group, with significant differences between the two groups (P 0.01); the two group of splenic artery branches showed there is statistical difference rate (P0.01), the study group III vascular branches display rate is higher than that of the control group; comparison of splenic artery image quality score, no significant difference between the two between the groups (P0.05) origin of.2 into normal splenic artery in 85 cases (85%), 15 cases of the origin of variation, the variation rate was 15%, the variation rate between different gender difference was not statistically significant (2=1.050, P0.05). 35 cases of splenic artery terminal branch centralized, divided 62 cases of.3 patients with splenic artery is a discrete type, 83 cases of the two branch type, 14 cases of type three. Display superior splenic artery in 10 cases, splenic artery in 15 cases. The spleen artery diameter is 3.42 ~ 8.32mm, the average (5.86 + 1.08) mm; the end of the splenic artery the diameter is 1.92 ~ 6.41mm, the average (4.24 + 0.87) mm; splenic lobe artery diameter is 1.20 ~ 5.86mm, the average (3.35 + 0.87) mm; splenic artery length is 7.20 ~ 19.30mm, the average (12.22 + 2.09) mm; spleen index of 113.4 ~ 884.0cm3, the average (390.65 + 151.48) cm3. between different gender splenic artery diameter, the end of the splenic artery diameter, compare the splenic artery diameter and splenic artery length have significant difference (P 0.05); different age groups of spleen artery diameter, the end of the splenic artery diameter, compare the spleen artery diameter and splenic artery trunk and leaf length, no significant difference (P0.05). The spleen index of different gender the difference statistically significant ( P 0.05); comparison of different age groups of spleen index, there were no statistical differences (P0.05). The spleen artery diameter, associated with the end of the splenic artery diameter and splenic artery diameter and spleen index (P 0.05), and were positively correlated. No correlation between splenic artery length and spleen index (P0.05) of splenic artery. 65 cases of pancreatic tail in 24 cases above, walking in the tail of the pancreas in 11 cases in the rear, walking in front of the tail of the pancreas.
Conclusion 1256 slice spiral CT imaging of splenic artery, application of low dose and high concentration of contrast agent can reduce the possibility of the occurrence of adverse reaction of contrast medium, the splenic artery and the obtained image can fully meet the requirements of clinical diagnosis, worthy of clinical application of splenic artery imaging.2256 slice spiral CT can clearly display the living condition of the splenic artery anatomic variants can provide the basis for selection of surgical laparoscopic splenectomy, and provide anatomical reference and related data for partial splenic embolization, which can accurately control the degree of embolism analysis software and choose the appropriate catheter.3256 advanced slice spiral CT technology and powerful vessels for postprocessing, splenic artery angiography have obvious advantages.

【學位授予單位】：河北聯(lián)合大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R816.5

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