本文關(guān)鍵詞： 體層攝影術(shù) X線計(jì)算機(jī) 低管電壓 下肢動(dòng)脈疾病　出處：《山東大學(xué)》2014年碩士論文　論文類型：學(xué)位論文

【摘要】：研究背景近年來(lái),隨著人口的老齡化和糖尿病人的增加,下肢動(dòng)脈硬化性疾病的發(fā)生率明顯提高。以前,數(shù)字減影血管造影(digital subtraction angiography, DSA)一直是評(píng)價(jià)下肢血管病變的金標(biāo)準(zhǔn),但因其有創(chuàng)、費(fèi)用高、易發(fā)生并發(fā)癥等缺點(diǎn),已較少用于下肢血管的首選檢查。超聲亦可顯示下肢血管,但受操作者經(jīng)驗(yàn)影響大,其空間分辨力低,不能為外科醫(yī)生提供血管全貌,從而不易進(jìn)行準(zhǔn)確的術(shù)前評(píng)價(jià)。磁共振血管造影(Magnetic Resonance Imaging,MRA)具有無(wú)創(chuàng)、無(wú)輻射的優(yōu)點(diǎn),但因其會(huì)高估血管的狹窄,小血管空間分辨率比CTA明顯降低,并且MRI有很多禁忌證,操作時(shí)間也長(zhǎng),對(duì)血管鈣化顯示欠佳。多層螺旋CT(multi slice spiral computed tomography,MSCT)推廣應(yīng)用以來(lái),由于它的強(qiáng)大優(yōu)點(diǎn),如無(wú)創(chuàng)、掃描速度快及圖像后處理功能強(qiáng)大等,CT血管成像(CTangiography,CTA)已變成下肢動(dòng)脈疾病的重要檢查手段。但是CTA的缺點(diǎn)是掃描范圍大,從而使受檢查者接受的輻射劑量增加,造成的潛在危害很大；另一方面,由于對(duì)比劑對(duì)人體具有腎毒性等不良反應(yīng),降低對(duì)比劑用量日益受到重視。本文采用128層螺旋CT低管電壓聯(lián)合低對(duì)比劑技術(shù)對(duì)下肢動(dòng)脈疾病患者進(jìn)行CTA檢查,探討該技術(shù)在降低輻射劑量和對(duì)比劑用量方面的臨床應(yīng)用價(jià)值。 目的主要探討128層螺旋CT低管電壓技術(shù)在下肢動(dòng)脈疾病應(yīng)用的可行性及臨床價(jià)值；同時(shí)關(guān)注低對(duì)比劑的應(yīng)用價(jià)值。方法選擇2012年12月至2013年10月利用128層螺旋CT行下肢動(dòng)脈CTA檢查的患者60例,采用低管電壓技術(shù)(80kV)進(jìn)行掃描,其中12例患者于CTA檢查后一周內(nèi)行數(shù)字減影血管造影(DSA)檢查。將圖像傳至工作站進(jìn)行容積再現(xiàn)(Volume Rendering,VR)、最大密度投影(maximum intensity projection,MIP)和多平面重組(multiplanar reconstruction,MPR)等圖像后處理,對(duì)圖像質(zhì)量進(jìn)行分析。測(cè)量每次掃描的股動(dòng)脈、胭動(dòng)脈、脛后動(dòng)脈、股直肌的CT值和股直肌的標(biāo)準(zhǔn)差(standard deviation, SD)三次,取平均值,以SD作為背景噪聲,計(jì)算出信噪比(Signal to Noise Ratio, SNR)及對(duì)比信噪比(contrast-to-noise ratios,CNR)。記錄CT容積劑量指數(shù)(CT dose index volume,CTDIvoI)、劑量長(zhǎng)度乘積(dose length product, DLP),得出有效輻射劑量(effective dose, ED)。為進(jìn)行對(duì)照,又連續(xù)統(tǒng)計(jì)出2012年1月至2012年11月接受常規(guī)劑量(120kV,150mAs)CTA檢查的60例患者的SNR, CNR、CTDIvoI、DLP、ED)。由2名具有多年心血管影像診斷經(jīng)驗(yàn)的放射醫(yī)師以5分制對(duì)圖像質(zhì)量進(jìn)行主觀評(píng)價(jià),包括下肢動(dòng)脈橫斷面及重組圖像的清晰度、血管顯示程度及整體圖像質(zhì)量等。采用SPSS19.0進(jìn)行統(tǒng)計(jì)學(xué)分析,包括獨(dú)立樣本的t檢驗(yàn)、單因素方差檢驗(yàn)(one-way ANOVA檢驗(yàn))。兩名醫(yī)師之間的主觀評(píng)分的一致性進(jìn)行Kappa檢驗(yàn)。以DSA為標(biāo)準(zhǔn),計(jì)算低劑量組12例行DSA檢查患者CTA的敏感度、特異度、準(zhǔn)確度、陽(yáng)性預(yù)測(cè)值、陰性預(yù)測(cè)值。結(jié)果此次低kV掃描共檢出雙下肢動(dòng)脈硬化并管腔狹窄、部分閉塞者(ASO)39例,動(dòng)靜脈瘺者4例,下肢動(dòng)脈血栓型閉塞性脈管炎者(TAO)15例,下肢動(dòng)脈畸形1例,雙側(cè)胭窩陷迫綜合征1例。12例患者CTA與DSA比較,低管電壓(80kV)CTA診斷下肢動(dòng)脈狹窄與閉塞的敏感度為99.3%,特異度為95.2%,準(zhǔn)確率為98.5%,陽(yáng)性預(yù)測(cè)值為97.9%,陰性預(yù)測(cè)值為98.2%。80kV組和120kV組下肢動(dòng)脈平均CT值分別為：533.42±63.00HU、376.28±46.95HU,前者較后者較增加明顯。80kV組的CTDIvoI、DLP、ED分別為4.88±0.00mGy.602.85±42.00mGy.cm,9.05±0.63mSv,120kV組的CTDIvoI、DLP.ED分別為：10.07±0.00mGy、1282.80±61.81mGy.cm、19.20±0.88mSv,前者較后者輻射劑量下降了近50%。A醫(yī)師80kV組及120kV組的平均分為4.32±0.54、4.37±0.58,組間差別無(wú)統(tǒng)計(jì)學(xué)意義；B醫(yī)師80kV組及120kV組的平均評(píng)分分別為4.33±0.54、4.42±0.53,組間差別無(wú)統(tǒng)計(jì)學(xué)意義。兩名醫(yī)師對(duì)圖像的主觀評(píng)分一致性好(Kappa=0.921,P0.01).結(jié)論采用低管電壓技術(shù)行下肢動(dòng)脈CTA檢查,受檢者的輻射劑量和對(duì)比劑用量明顯降低,且圖像質(zhì)量滿足診斷要求,對(duì)下肢動(dòng)脈疾病的診斷和復(fù)查具有較大的臨床應(yīng)用價(jià)值。
[Abstract]:Background: in recent years, with the increase of population aging and diabetes, the incidence of lower extremity arterial disease was significantly improved. Previously, digital subtraction angiography (digital subtraction angiography, DSA) has been the gold standard for assessment of lower extremity vascular disease, but because there is a high cost disadvantage, prone to complications etc. that is less used. The preferred examination of lower extremity vascular ultrasound can show lower extremity vessels, but by the effect of operator experience, the spatial resolution is low, cannot provide the picture for vascular surgeons, which is not easy to evaluate the accuracy of preoperative magnetic resonance angiography. (Magnetic Resonance, Imaging, MRA) has the advantages of non-invasive, no radiation but, because of the overestimation of vascular stenosis, vascular spatial resolution is much lower than CTA and MRI, there are a lot of contraindications, the operation time is long, on vascular calcification of multi-slice spiral C showed poorly. T (multi slice spiral computed tomography, MSCT) application has strong because of its advantages, such as non-invasive, fast scanning speed and powerful image postprocessing, CT angiography (CTangiography, CTA) has become an important examination method for lower extremity arterial diseases. But the disadvantage is that the CTA scan range, radiation to check the received dose by increasing the potential harm caused by the great; on the other hand, due to the contrast agent has adverse effects on human renal toxicity, reduce the amount of contrast agent is paid more and more attention. In this paper, using 128 slice spiral CT low tube voltage and low contrast agent in patients with lower extremity arterial disease were examined by CTA, to investigate the technology in reducing radiation dose and contrast agent dosage in clinical application value.
Objective to explore the 128 layer spiral CT low voltage technology in application feasibility and clinical value of lower limb arterial disease; at the same time, pay close attention to the application value of low contrast. Methods from December 2012 to October 2013 by CTA in 60 patients with 128 slice spiral CT for lower extremity arteries in patients with low tube voltage (80kV) scan, 12 of them patients in the CTA examination within one week after the digital subtraction angiography (DSA) examination. The images were transmitted to the workstation for volume rendering (Volume Rendering, VR), maximum intensity projection (maximum intensity, projection, MIP) and multiplanar reconstruction (multiplanar reconstruction MPR) image postprocessing, analysis of image quality. Shares measurement of artery, each scan popliteal artery, posterior tibial artery, the rectus femoris CT value and the standard deviation of the rectus femoris (standard deviation, SD) three times, were mean to SD as background noise meter To calculate the signal-to-noise ratio (Signal to Noise Ratio, SNR) and contrast to noise ratio (contrast-to-noise ratios, CNR). Record the volume CT dose index (CT dose index volume, CTDIvoI), dose length product (dose length, product, DLP), the effective radiation dose (effective, dose, ED). For the control. Statistics from January 2012 to November 2012 and received routine dose (120kV, 150mAs) CTA examination of 60 cases of patients with SNR, CNR, CTDIvoI, DLP, ED). By 2 radiologists with years of cardiovascular imaging experience to 5 points on the image quality of subjective evaluation, including cross section and reorganization of lower extremity artery image definition, vascular display level and overall image quality. The SPSS19.0 for statistical analysis, including independent samples t test, one-way ANOVA test (one-way ANOVA test). Kappa consistency between subjective scores of two physicians. Test. Based on the standard of DSA, calculation of low dose group DSA was performed in 12 cases of patients with CTA sensitivity, specificity, accuracy, positive predictive value, negative predictive value. Results the low kV scan were detected in the lower limb arteriosclerosis and stenosis, partial occlusion (ASO) in 39 cases, 4 cases of arteriovenous fistula that type of arterial thrombosis obliterans patients (TAO) in 15 cases, lower extremity artery malformation in 1 cases, bilateral popliteal entrapment syndrome of 1 cases of.12 patients with CTA and DSA, low tube voltage (80kV) CTA in the diagnosis of lower extremity arterial stenosis and occlusion of the sensitivity was 99.3%, specificity was 95.2%. The accuracy rate was 98.5%, the positive predictive value was 97.9%, negative predictive value of 98.2%.80kV group and 120kV group of lower extremity artery average CT = 533.42 + 63.00HU, 376.28 + 46.95HU, the former than the latter is increased significantly in group.80kV, CTDIvoI, DLP, ED were 4.88 + 0.00mGy.602.85 + 42.00mGy.cm, 9.05 + 0.63mSv, group 120kV the CTDIvoI, DLP.ED were 10.07 + 0.00mGy, 1282.80 + 61.81mGy.cm, 19.20 + 0.88mSv, the radiation dose decreased an average of nearly 50%.A physicians in 80kV group and 120kV group was 4.32 + 0.54,4.37 + 0.58, the differences were not statistically significant; Dr. B 80kV group and 120kV group. The average score was 4.33. 0.54,4.42 + 0.53, difference between the groups was not statistically significant. Two physicians subjective score of image consistency (Kappa=0.921, P0.01). Conclusion the low voltage technology for lower extremity arterial CTA examination, radiation dose and dosage of contrast subjects decreased significantly, and the image quality meets the requirement of diagnosis, diagnosis and review lower extremity arterial disease has great clinical application value.

【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R543;R816.2

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