本文選題：MSCT　切入點(diǎn)：顱內(nèi)結(jié)核　出處：《山東大學(xué)》2014年博士論文

【摘要】：目的探討多層面CT (multi-slice computed tomography, MSCT)雙期掃描技術(shù),比較5分鐘延遲期掃描與注射對(duì)比劑后立即掃描在顱內(nèi)結(jié)核病灶的顯示上的優(yōu)勢(shì)。 材料一般資料收集本院經(jīng)臨床資料證實(shí)的顱內(nèi)結(jié)核患者30例,其中男19例,女11例,年齡10-58歲,平均年齡29.3歲。臨床以發(fā)熱、頭痛、惡心伴嘔吐為主要癥狀就診,所有病例均符合顱內(nèi)結(jié)核的臨床診斷標(biāo)準(zhǔn)。本研究所有患者都簽署了知情同意書,并通過(guò)醫(yī)院醫(yī)學(xué)倫理委員會(huì)醫(yī)學(xué)倫理學(xué)審查批準(zhǔn)。 方法采用多層螺旋CT先常規(guī)平掃后行雙期掃描,即動(dòng)脈期注入對(duì)比劑后25秒行掃描,延遲期注入對(duì)比劑5分鐘后掃描。對(duì)兩期圖像在顯示顱內(nèi)結(jié)核病灶的能力進(jìn)行評(píng)價(jià)。 結(jié)果30例患者526個(gè)病灶中,各類型病灶延遲期圖像顯示顱內(nèi)結(jié)核灶的能力均優(yōu)于動(dòng)脈期圖像,在病灶與鄰近血管斷面的區(qū)分上延遲期也明顯優(yōu)于動(dòng)脈期。 結(jié)論MSCT雙期掃描對(duì)顱內(nèi)結(jié)核病灶的顯示具有優(yōu)勢(shì),尤其是延遲期掃描。CT雙期增強(qiáng)掃描既可以在動(dòng)脈期通過(guò)CTA圖像評(píng)價(jià)血管的病理改變,又能更好通過(guò)延期期圖像早期發(fā)現(xiàn)并評(píng)價(jià)結(jié)核性腦膜炎和顱內(nèi)結(jié)核瘤的情況,為臨床治療提供幫助,可以顯著改善顱內(nèi)結(jié)核患者的預(yù)后。 目的探討迭代重建(Iterative Reconstruction, IR)算法在頭頸部CT血管成像(CT angiography,CTA)中的臨床應(yīng)用價(jià)值。 材料與方法行頭頸部CTA檢查的患者100例,隨機(jī)分為A、B兩組,每組50例。A組為常規(guī)劑量掃描(管電壓120kV、管電流300mAs),用濾過(guò)反投影法(filtered back projection, FBP)進(jìn)行重建；B組為低劑量掃描(管電壓100kV、自適應(yīng)動(dòng)態(tài)管電流(199～399mAs),用IR進(jìn)行重建。由2名經(jīng)驗(yàn)豐富的放射醫(yī)生采用雙盲法對(duì)兩組圖像質(zhì)量進(jìn)行評(píng)分,并比較單次掃描的CT劑量指數(shù)容積(CT dose index volume, CTDIvol)和劑量長(zhǎng)度乘積(dose-length product, DLP)。 結(jié)果A、B兩組的輻射劑量及圖像質(zhì)量的差異均有統(tǒng)計(jì)學(xué)意義(P0.001),B組的輻射劑量明顯低于A組,而B組的圖像質(zhì)量明顯優(yōu)于A組。 結(jié)論在頭頸部CTA應(yīng)用中,與常規(guī)FBP比較,采用IR算法可以降低輻射劑量,同時(shí)提高圖像質(zhì)量。
[Abstract]:Objective to investigate the advantages of multi-slice computed tomographic (MSCT) dual-phase scanning technique in the diagnosis of intracranial tuberculosis (TB) in patients with intracranial tuberculosis after 5 minutes delayed phase scan and immediately after injection of contrast agent.Materials General data were collected from 30 patients with intracranial tuberculosis confirmed by clinical data including 19 males and 11 females aged 10-58 years with an average age of 29.3 years.Fever, headache, nausea and vomiting were the main symptoms.Informed consent was signed and approved by the Medical Ethics Committee of the Hospital.Methods Multi-slice spiral CT was performed with conventional plain scan and then double-phase scanning, that is, 25 seconds after arterial phase injection of contrast agent, and 5 minutes after delayed phase injection of contrast agent.The ability of two-phase images to display intracranial tuberculosis foci was evaluated.Results among the 526 lesions in 30 patients, the ability of each type of lesions to display intracranial tuberculous foci was superior to that of arterial phase images, and the delayed phase was also superior to the arterial phase in differentiating the lesions from the adjacent vascular sections.Conclusion Dual-phase MSCT scan has advantages in displaying intracranial tuberculosis foci, especially in delayed phase scanning. Dual phase enhanced CT scan can be used to evaluate the pathological changes of blood vessels in arterial phase by CTA images.It can also be better to detect and evaluate the situation of tuberculous meningitis and intracranial tuberculoma in the early stage by delayed image, and to provide help for clinical treatment, which can significantly improve the prognosis of patients with intracranial tuberculosis.Objective to evaluate the clinical value of iterative reconstruction (IRI) algorithm in head and neck CT angiography (CTAA).Materials and methods 100 patients with head and neck CTA were randomly divided into two groups.Each group consisted of 50 cases. Group A was scanned with conventional dose (voltage 120kV, current 300mAs1). Group B was scanned with low dose (voltage 100kV, self-adaptive dynamic current 199399mAs1) by filter back projection (FBP), and was reconstructed by IR.Two experienced radiologists scored the image quality of the two groups by double blind method, and compared CT dose index volume (CTDIvoll) and dose length product (DLPX) with single scan.Results the difference of radiation dose and image quality between group A and group B was statistically significant. The radiation dose of group B was significantly lower than that of group A, but the image quality of group B was significantly better than that of group A.Conclusion in the application of head and neck CTA, compared with conventional FBP, IR algorithm can reduce radiation dose and improve image quality.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2014
【分類號(hào)】：R529.0;R816.1

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