本文選題：冠脈CTA　切入點(diǎn)：Force　出處：《浙江大學(xué)》2017年碩士論文

【摘要】：目的:研究65-75bpm心率下患者使用Force CT前瞻性觸發(fā)大螺距(Turbo Flash)螺旋掃描模式舒張期與收縮期不同采集時(shí)相的圖像質(zhì)量和輻射劑量。方法:分析60例接受Force CT冠狀動(dòng)脈CTA檢查的患者資料,包括25例女性患者和35例男性患者,年齡范圍41-82歲,平均年齡63.02±9.33歲,臨床確認(rèn)或懷疑有冠脈疾病。全部病例圖像數(shù)據(jù)均包含齊全的檢查時(shí)心電圖及劑量統(tǒng)計(jì)報(bào)告。依據(jù)冠狀動(dòng)脈CTA檢查時(shí)預(yù)設(shè)觸發(fā)采集期相的不同分病例為兩組:A組30例,使用Turbo Flash大螺距舒張期時(shí)相采集模式,預(yù)設(shè)觸發(fā)采集時(shí)相在R-R間期的65%處;B組30例,使用Turbo Flash大螺距收縮期時(shí)相采集模式,預(yù)設(shè)觸發(fā)采集時(shí)相在R-R間期的30%處。1、圖像掃描及后處理全部病例均選擇Force CT(德國(guó)西門(mén)子)進(jìn)行掃描。選擇ECG觸發(fā)Turbo Flash大螺距模式,啟用CT系統(tǒng)動(dòng)態(tài)輻射劑量控制CARE Dose 4D技術(shù),手動(dòng)設(shè)定管電壓參數(shù)值為100kV。掃描完成后各病例的原始數(shù)據(jù)由計(jì)算機(jī)系統(tǒng)自動(dòng)上傳到syngo.via工作站,由一名具有豐富心血管影像處理經(jīng)驗(yàn)的放射科醫(yī)生運(yùn)用容積再現(xiàn)成像、曲面重組成像等方法進(jìn)行影像處理。2、圖像質(zhì)量分析依據(jù)美國(guó)心臟協(xié)會(huì)最新提出的冠脈分支分段標(biāo)準(zhǔn)來(lái)進(jìn)行冠脈17節(jié)段主觀圖像質(zhì)量分析。為避免潛在的偏差,兩名富有心血管影像診斷經(jīng)驗(yàn)的放射科診斷醫(yī)師在未知分組情況、未知患者采集時(shí)心率及心率范圍等信息的情況下參照Likert評(píng)分法評(píng)估冠脈節(jié)段的圖像質(zhì)量。依據(jù)冠狀動(dòng)脈管腔的CT值、影像噪聲等參數(shù)計(jì)算得出其信噪比和對(duì)比噪聲比來(lái)進(jìn)行客觀圖像質(zhì)量評(píng)價(jià)。3、輻射劑量計(jì)算掃描完成后設(shè)備系統(tǒng)自動(dòng)生成參數(shù)報(bào)告,包含X線(xiàn)曝光次數(shù)、容積CT劑量指數(shù)、X線(xiàn)曝光時(shí)間、劑量長(zhǎng)度乘積等。有效輻射劑量定義為權(quán)重因子系數(shù)K與劑量長(zhǎng)度乘積兩個(gè)參數(shù)的乘積,權(quán)重因子系數(shù)選擇胸部K=0.014mSv/mGy·cm。4、統(tǒng)計(jì)學(xué)分析本研究選用SPSS 22.0統(tǒng)計(jì)軟件進(jìn)行數(shù)據(jù)統(tǒng)計(jì)和分析,選用Student's t-Test(T檢驗(yàn))進(jìn)行兩組病例臨床資料(包括性別、年齡、身高、體重、BMI指數(shù)等)、有效輻射劑量、信噪比、對(duì)比噪聲比等的對(duì)比。用Kappa一致性檢驗(yàn)評(píng)估兩位放射科評(píng)估醫(yī)師雙盲法冠狀動(dòng)脈圖像質(zhì)量評(píng)分結(jié)果的一致性。P值小于0.05代表差異具有統(tǒng)計(jì)學(xué)意義。結(jié)果:1、冠狀動(dòng)脈圖像質(zhì)量?jī)山M60例病例共評(píng)價(jià)分析779個(gè)冠狀動(dòng)脈節(jié)段,其中A組為392個(gè)冠狀動(dòng)脈節(jié)段,B組為387個(gè)冠狀動(dòng)脈節(jié)段。A組中冠狀動(dòng)脈圖像質(zhì)量最好的節(jié)段是第二鈍緣支(平均評(píng)分為1.00),其次是左冠狀動(dòng)脈主干(平均評(píng)分為1.15);圖像質(zhì)量最差的是右冠狀動(dòng)脈中段(平均評(píng)分為2.33)。B組中冠狀動(dòng)脈圖像質(zhì)量最好的節(jié)段是第二鈍緣支(平均評(píng)分為1.00),其次是左冠狀動(dòng)脈主干(平均評(píng)分為1.35);圖像質(zhì)量顯示最差的是左冠脈回旋支遠(yuǎn)段(平均評(píng)分為2.33)。A組中評(píng)分為4(不可診斷)的節(jié)段有9段(n=9,2.3%),分別為右冠狀動(dòng)脈中段(n=5)、右冠狀動(dòng)脈遠(yuǎn)段(n=3)、后降支(n=1)。B組中評(píng)分為4的節(jié)段有19段(n=19,4.9%),分別出現(xiàn)在右冠狀動(dòng)脈近段(n=3)、右冠狀動(dòng)脈中段(n=2)、右冠狀動(dòng)脈遠(yuǎn)段(n=2)、后降支(n=2)、左室后支(n=2)、左冠狀動(dòng)脈主干(n=1)、左冠狀動(dòng)脈前降支近段(n=1)、左冠狀動(dòng)脈前降支中段(n=1)、第一對(duì)角支(n=1)、左冠狀動(dòng)脈回旋支近段(n=1)、第一鈍緣支(n=2)、左冠狀動(dòng)脈回旋支中段(n=1)。兩組病例按照17節(jié)段分段法對(duì)冠狀動(dòng)脈分支評(píng)價(jià)結(jié)果表明,A組第一對(duì)角支、第一鈍緣支、左冠狀動(dòng)脈回旋支近段和中段的圖像質(zhì)量明顯優(yōu)于B組,其余各冠狀動(dòng)脈節(jié)段圖像質(zhì)量沒(méi)有差別。對(duì)兩名放射科評(píng)估醫(yī)師的主觀評(píng)分進(jìn)行一致性檢驗(yàn),檢驗(yàn)結(jié)果證明二者對(duì)圖像評(píng)價(jià)的一致性良好(Kappa=0.816)。兩組病例的升主動(dòng)脈根部、右冠狀動(dòng)脈和左冠狀動(dòng)脈的CT值、影像噪聲、信噪比等各項(xiàng)數(shù)據(jù)對(duì)比顯示結(jié)果沒(méi)有差別(P0.05)。2、輻射劑量A組患者平均容積CT劑量指數(shù)值為3.53,平均劑量長(zhǎng)度乘積值為59.82,平均有效輻射劑量值為0.84;B組平均容積CT劑量指數(shù)值為3.21,平均劑量長(zhǎng)度乘積值為54.78,平均有效輻射劑量值為0.77。兩組之間的輻射劑量參數(shù)值對(duì)比結(jié)果顯示沒(méi)有差別(P0.05)。結(jié)論:1、Force CT前瞻性大螺距Turbo Flash模式冠脈CTA使用低管電壓(100kV)、低造影劑量(40ml)技術(shù),結(jié)合ADMIRE迭代重建算法,所得冠脈圖像能夠達(dá)到臨床影像診斷的需要,有效輻射劑量小于1mSv。2、患者心率在65-75bpm時(shí)行Force CT冠脈CTA,使用大螺距Turbo Flash舒張期采集模式對(duì)LCX的顯示要優(yōu)于收縮期采集模式。
[Abstract]:Objective: to trigger a large pitch in patients with Force CT prospective study using 65-75bpm heart rate (Turbo Flash) spiral scan mode diastolic and systolic phase of the acquisition of different image quality and radiation dose. Methods: Patients with 60 patients received Force CT coronary artery CTA examination, including 25 cases of female patients and 35 male patients, age 41-82 years old, the average age of 63.02 + 9.33 years, clinical confirmed or suspected coronary artery disease. All cases were complete image data includes examination of ECG and dose of statistical reports. According to different cases of coronary artery CTA examination preset trigger acquisition phase into two groups: group A 30 cases, Turbo Flash large pitch the diastolic phase acquisition mode, preset trigger acquisition phase at 65% R-R interval; 30 cases in group B, using Turbo Flash pitch systolic phase acquisition mode, preset trigger acquisition phase in R-R interval 30%.1, image scanning and postprocessing of all cases were Force CT (SIEMENS) ECG Turbo Flash scan. High pitch trigger, enable the CARE 4D technology Dose CT system dynamic radiation dose control, voltage parameters manually set the value of the original data for each tube in cases of 100kV. after the scan is complete by the computer system automatically upload to syngo.via workstation, by a rich experience in dealing with cardiovascular imaging radiologists using volume rendering, surface imaging methods such as.2 image processing, based on the analysis of coronary artery branch of the American Heart Association recently proposed new standards for piecewise analysis of 17 segments of coronary subjective image quality. In order to avoid the potential bias, two has the cardiovascular imaging experience in diagnostic radiology, doctors in the unknown group, with unknown acquisition of heart rate and heart rate range Image quality assessment of coronary artery segments according to Likert score information. On the basis of coronary artery CT values, calculated the SNR of objective image quality evaluation of.3 ratio and contrast to noise ratio of image noise and other parameters, automatically generated report parameters after scanning equipment system to calculate the radiation dose, including X-ray exposure times, volume CT dose index, X-ray exposure time and dose length product. The effective radiation dose for the product definition of product weight factor coefficient K and dose length two parameters, K=0.014mSv/mGy and cm.4 choose the weight factor of the chest coefficient analysis in this study using SPSS 22 statistical software for statistical data and statistical analysis, using Student's t-Test (T test) were the clinical data of two cases (including gender, age, height, weight, BMI index), effective radiation dose, SNR, contrast to noise ratio were compared with Ka. PPA consistency test to assess the consistency of Radiology physician assessment.P two double-blind method of coronary artery image quality score was less than 0.05 on behalf of the difference was statistically significant. Results: 1, two cases of coronary artery image quality evaluation and analysis 60 cases of 779 coronary artery segments, which A group of 392 coronary artery segment, segment B group of 387 coronary artery segments of coronary artery in group.A, the best image quality is second obtuse marginal branch (average score 1), followed by the left main coronary artery (average score 1.15); image quality is the worst middle segment of right coronary artery (mean score of 2.33) the image quality of coronary artery in the.B group the best segment is second obtuse marginal branch (average score 1), followed by the left main coronary artery (average score 1.35); image display quality is the worst left circumflex coronary artery distal (Ping Junping 2.33) scores in the.A group 涓，

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