本文關(guān)鍵詞： 冠狀動(dòng)脈支架 能譜CT 診斷　出處：《寧夏醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的 利用寶石能譜CT設(shè)備對(duì)心臟能譜掃描進(jìn)行深入研究,在ASIR技術(shù)平臺(tái)上,建立規(guī)范優(yōu)化的冠狀動(dòng)脈評(píng)價(jià)檢查技術(shù)方案、圖像分析方法、診斷方法。比較分析單能量成像、混合能量成像及CAG對(duì)PCI術(shù)后冠狀動(dòng)脈評(píng)價(jià)的結(jié)果,驗(yàn)證單能量成像在PCI術(shù)后冠狀動(dòng)脈評(píng)價(jià)的準(zhǔn)確性,為PCI術(shù)后患者隨訪提供準(zhǔn)確性更高的影像檢查新方法。方法 收集2015年10月—2016年6月于我院接受寶石CT心臟能譜掃描的PCI術(shù)后患者38例(共97枚支架),利用后處理工具重組80-140 keV(80、90、100、110、120、130、140keV)、不同ASIR(20%,50%,80%)的21組單能量圖像和140kVp混合能量圖像。(1)由三位具有副高以上資歷的影像診斷醫(yī)師對(duì)圖像進(jìn)行評(píng)估,按照冠狀動(dòng)脈支架圖像質(zhì)量評(píng)分方法,選出最佳單能量圖像;(2)將97枚支架按真實(shí)內(nèi)徑2.0-3.0mm、3.0-3.5mm、3.5-4.0mm分為A、B、C三組,分別在最佳單能量圖像及140kVp混合能量圖像上對(duì)A、B、C三組支架管腔內(nèi)徑進(jìn)行測(cè)量,統(tǒng)計(jì)數(shù)據(jù),比較兩種圖像對(duì)支架內(nèi)腔顯示能力大小;(3)將有CAG結(jié)果的84枚支架分為無狹窄、輕度、中度、重度狹窄四組,重建其最佳單能量圖像及混合能量圖像,評(píng)價(jià)支架內(nèi)管腔狹窄情況,比較兩種圖像判斷支架內(nèi)腔狹窄程度的準(zhǔn)確性。結(jié)果 經(jīng)3名診斷醫(yī)師綜合考慮支架內(nèi)外冠狀動(dòng)脈顯示情況盲法評(píng)分,得出ASIR比例50%、keV值120keV評(píng)分最高,為最佳單能量圖像。在最佳單能量圖像下測(cè)得A、B、C三組支架內(nèi)平均直徑分別為1.57mm、2.04mm、2.59mm,混合能量圖像測(cè)得該三組支架內(nèi)平均直徑分別為1.30mm、1.64mm、2.05mm,最佳單能量圖像較140kVp混合能量圖像在三組支架顯示內(nèi)徑方面分別提高了20.76%、24.39%、26.34%。對(duì)應(yīng)三組支架,兩種成像模式測(cè)得的平均直徑之間差異均有統(tǒng)計(jì)學(xué)意義(P0.05)。通過與CAG結(jié)果相比較,最佳單能量圖像對(duì)支架腔內(nèi)情況評(píng)價(jià)的準(zhǔn)確率為89.28%,140kVp混合能量圖像對(duì)支架腔內(nèi)情況評(píng)價(jià)的準(zhǔn)確率為82.14%,采用χ2檢驗(yàn),分別將120keV、ASIR 50%圖像、CAG的診斷結(jié)果與140kVp圖像進(jìn)行比較分析,結(jié)果差異均有統(tǒng)計(jì)學(xué)意義(p0.05);將120keV、ASIR 50%圖像與CAG結(jié)果比較分析,兩者之間差異均無統(tǒng)計(jì)學(xué)意義(p0.05)。結(jié)論 120keV、ASIR 50%圖像為最佳單能量圖像,與140kVp混合能量相比,去偽影能力更強(qiáng),支架內(nèi)腔的顯示更接近真實(shí)支架內(nèi)徑,誤差更小,并能很好顯示支架結(jié)構(gòu);應(yīng)用最佳單能量圖像行冠狀動(dòng)脈三維重建,可以有效改善支架內(nèi)冠狀動(dòng)脈成像質(zhì)量,且在判斷再狹窄方面與冠脈造影結(jié)果有良好的一致性,較混合能量更為準(zhǔn)確,可以為PCI術(shù)后患者的冠狀動(dòng)脈評(píng)價(jià)提供安全無創(chuàng)、準(zhǔn)確性高的新方法。
[Abstract]:The purpose of energy spectrum of CT devices on the heart can be studied using scanning spectrum of gem, the technology of ASIR, establish the evaluation of coronary artery examination technique scheme optimization, image analysis method, diagnosis method. Comparative analysis of single energy imaging, mixed energy imaging and CAG of coronary artery after PCI evaluation results, verifying the accuracy of a single energy imaging after PCI in the evaluation of coronary artery, PCI patients were followed up with the accuracy of the new imaging methods higher. Methods from October 2015 to June 2016 in our hospital for heart gem CT spectrum scanning was performed in 38 cases of PCI patients (a total of 97 stents), using recombinant 80-140 (keV postprocessing tool 80,90100110120130140keV ASIR (20%), different, 50%, 80%) of the 21 groups of single energy image and 140kVp mixed energy images. (1) imaging diagnosis by three doctors who have fugaoyishang qualifications assessment of image According to estimates, scores of image quality of coronary artery stent method, select the best single energy image; (2) the 97 stents according to the true inner diameter of 2.0-3.0mm, 3.0-3.5mm, 3.5-4.0mm into A, B, C three groups, respectively in the best single energy image and 140kVp mixed energy images on A, B, C three groups of stent lumen diameter measurement, statistics, comparison of two kinds of image display capability of the stent lumen size; (3) there will be CAG results 84 stents were divided into mild, moderate stenosis, severe stenosis group, four, reconstruction of the optimal monochromaticenergy image and mixed energy images, evaluation of stent lumen stenosis, two image accuracy degree of the stent lumen stenosis. Results after 3 considering the diagnosis of coronary artery stent and physician blinded scoring display that ASIR, the proportion of 50%, the value of keV 120keV highest score is the best single energy image. The measured A in the best single energy image B, C, the average diameter of three stent group were 1.57mm, 2.04mm, 2.59mm, mixed energy images measured in the three groups of average stent diameter were 1.30mm, 1.64mm, 2.05mm, 140kVp is the best single energy image mixed energy images show aspects of diameter were increased by 20.76%, 24.39% in three groups corresponding to the three 26.34%. bracket. The average diameter of stent group between the two imaging mode measured differences were statistically significant (P0.05). By comparing with the CAG results, the accuracy of optimal monochromaticenergy image evaluation of the stent was 89.28%, the accuracy rate of 140kVp mixed energy images of stent evaluation was 82.14%, with 2 test, respectively. 120keV, 50% ASIR images, CAG 140kVp images and the diagnostic results were compared, the differences were statistically significant (P0.05); 120keV, ASIR and CAG 50% image analysis results, the difference between the two there is no unity Statistically significant (P0.05). Conclusion: 120keV and ASIR 50% image is the best single energy image, compared with the 140kVp hybrid energy deghost ability is stronger, the more close to the real display stent lumen diameter of stent, the error is smaller, and can show the support structure; the application of the best single energy images for 3D reconstruction of coronary artery, can improve the quality of in stent coronary angiography, and in the judgment of restenosis and coronary angiography results are in good agreement, with mixed energy is more accurate and can provide safe and noninvasive evaluation of coronary artery in patients after PCI, the new method with high accuracy.

【學(xué)位授予單位】：寧夏醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R541.4;R816.2

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