發(fā)布時間：2018-04-22 13:35

  本文選題：雙源CT + Flash��； 參考：《山東大學(xué)》2017年碩士論文

【摘要】：第一部分:小兒先天性心臟病雙源CT Flash掃描和前瞻性心電門控序列掃描的多模態(tài)對比研究研究目的比較小兒先天性心臟病患兒行雙源CT(dual-source CT,DSCT)前瞻性心電門控大螺距掃描模式(即Flash掃描)和前瞻性心電門控序列掃描模式在圖像質(zhì)量、輻射劑量及診斷效能上的差異,探討雙源CT Flash掃描在小兒心臟大血管CTA(CTangiography)檢查中的應(yīng)用價值。資料與方法本研究獲得山東省醫(yī)學(xué)影像學(xué)研究所倫理委員會審核、批準,并由患兒父母簽署知情、同意。對于臨床懷疑先天性心臟病的患兒65例,行心臟大血管CTA檢查,最終納入60例患兒作為本研究對象。隨機選30名(男13例,女17例)患兒行雙源CTFlash掃描,另外30名(男10例,女20例)患兒行前瞻性心電門控序列掃描。以心血管造影檢查(conventional cardiac angiography,CCA)或傳統(tǒng)手術(shù)結(jié)果作為標準,計算兩組不同掃描方式對先天性心血管畸形的診斷的準確性。由兩名放射科醫(yī)生雙盲的情況下采用5分法對所獲得的圖像質(zhì)量進行總體評估(5分:圖像清晰,沒有確切的偽影和明顯噪聲;4分:圖像顯示有輕微偽影和噪聲,無診斷困難;3分:圖像顯示模糊,畸形結(jié)構(gòu)可明確診斷,中度的偽影和噪聲;2分:圖像有嚴重的偽影及噪聲,畸形診斷困難;1分:無法評價。圖像的主觀評分≥3分才被認定為是合格的圖像)。兩組患兒有效輻射劑量(effective dose,ED)的獲得,根據(jù)機器生成的CT容積劑量指數(shù)(volume CT dose index,CTDIvol)和劑量長度乘積(dose length produce,DLP)計算。結(jié)果兩組患兒的年齡(t=0.19,P0.05)、體重(t=0.35,P0.05)、心率(t=0.22,P0.05)無統(tǒng)計學(xué)差異。與CCA或手術(shù)結(jié)果相比較,Flash掃描組發(fā)現(xiàn)110種心血管異常,其敏感度、特異度、陽性似然比、陰性似然比及準確率分別為94.55%、99.78%、99.05%、98.71%、98.77%,前瞻性心電門控序列掃描組分別發(fā)現(xiàn)117種心血管異常,其以上各診斷參數(shù)分別為96.58%、99.56%、98.26%、99.12%、98.95%。圖像質(zhì)量的總體評分均達到了 3分以上,即所獲圖像均合格,達到診斷要求,且兩名醫(yī)師對圖像質(zhì)量總體評價一致性較高,分別為(4.53±0.73)分、(4.83±0.46)分,組間差異無統(tǒng)計學(xué)意義(t=1.90,P0.05)。Flash掃描組和序列掃描組的CTDIvol分別為0.24±0.05mGy和0.96±0.35mGy,差異有統(tǒng)計學(xué)意義(t=11.15,P0.01);DLP分別為4.27±1.48mGy·cm和10.50±4.09mG·cm,差異有統(tǒng)計學(xué)意義(t=7.85,P0.01);ED分別為0.27±0.06mSv和0.67±0.16mSv,差異有統(tǒng)計學(xué)意義(t=12.82,P0.01)。與序列掃描組相比較,Flash掃描組有效劑量降低了 60%。結(jié)論雙源CT Flash掃描和前瞻性心電門控序列掃描均可以獲得較好的準確率。與序列掃描組相比,Flash掃描明顯降低患兒輻射劑量,可用于小兒心臟大血管CTA檢查。第二部分:探討雙源CT Flash掃描在診斷先心病伴發(fā)氣道狹窄病變中的應(yīng)用價值研究目的討論雙源CT Flash掃描在診斷先天性心臟病(先心病)伴發(fā)氣道狹窄病變中的應(yīng)用價值。資料與方法納入2013.01-2015.12年間臨床懷疑先天性心臟病合并氣道狹窄,并于我科行雙源CT低劑量Flash掃描的患兒107例,最終經(jīng)心臟大血管CTA結(jié)果診斷為心臟大血管直接壓迫引起的氣道狹窄患兒共計99例并納入本研究。其中,男40例,女59例,平均年齡22月(1月-16歲),平均體重(10±7.7)kg(2.8 kg～45 kg)。由兩名放射科醫(yī)生雙盲的情況下采用5分法對所獲得的圖像質(zhì)量進行總體評估(5分:圖像清晰,沒有確切偽影和明顯噪聲;4分:圖像顯示有輕微偽影和噪聲,無診斷困難;3分:圖像顯示模糊,畸形結(jié)構(gòu)可明確診斷,中度的偽影和噪聲;2分:圖像有嚴重的偽影及噪聲,畸形診斷困難;1分:無法評價。圖像的主觀評分≥3分才被認定為是合格的圖像)。氣道被分為以下四部分:部位Ⅰ,氣管下三分之一;部位Ⅱ,右主支氣管;部位Ⅲ,左主支氣管;部位Ⅳ,葉支氣管。本研究中,氣管狹窄的診斷標準是指支氣管管腔口徑小于正常支氣管管腔口徑,在MPR/CPR、MinIP或VR圖像上測量管腔狹窄程度:(狹窄近端正常管腔直徑-最窄處管腔直徑)/狹窄近端正常管腔直徑× 100%,狹窄程度被分為3度:輕度,狹窄程度≤25%;中度,狹窄程度26%～75%;重度,狹窄程度≥76%。利用 MPR(Multiple planar reconstruction)及 VR(Volume rendering)圖像準確顯示狹窄段氣道周圍的解剖結(jié)構(gòu)關(guān)系,明確造成氣道狹窄的心外大血管畸形的責(zé)任病灶。按照引起小兒心血管源性氣道狹窄的不同血管畸形類型進行歸納總結(jié)。同時,在肺窗和MinIP(Minimum intensity projection)上觀察患兒肺內(nèi)繼發(fā)病變的特點。結(jié)果99例患兒Flash掃描的平均DLP為(7.32±6.19)mGy*cm,平均ED為(0.39±0.20)mSv。所獲得的圖像均滿足診斷要求;兩名醫(yī)師對圖像質(zhì)量的總體評價具有較高的一致性(K=0.754,P0.05)。99例患兒中,共計104處氣道狹窄被診斷是心血管源性的氣道狹窄,其中,因肺動脈高壓引起者38例(36.5%)、主動脈縮窄引起者32例(30.8%)、右位主動脈弓引起者14例(13.5%)、無名動脈壓迫12例(11.5%)、肺動脈吊帶6例(5.8%)、雙主動脈弓1例(1.0%)、左房大1例(1.0%)。同時還可以顯示并發(fā)的肺內(nèi)病變,包括36例磨玻璃樣變,19例肺實變,7例肺不張及66例肺氣腫。不同類型先心病引起的氣道狹窄部位不同,P值小于0.0001,差異有統(tǒng)計學(xué)意義,其中先心病引起的氣道狹窄以發(fā)生于Ⅲ段,即左主支氣管較多。結(jié)論雙源CT前瞻性心電門控大螺距掃描(Flash模式)一站式掃描可以同時顯示心內(nèi)外結(jié)構(gòu)畸形、伴發(fā)的氣道狹窄以及肺內(nèi)繼發(fā)病變,為臨床診治提供依據(jù)。
[Abstract]:Part one: a multi-modal contrast study of dual source CT Flash scan and prospective ECG gated sequence scan in children with congenital heart disease comparison of children with congenital heart disease with dual source CT (dual-source CT, DSCT) prospective ECG gated large pitch scanning mode (i.e. Flash scan) and prospective ECG gating sequence scanning mode The application value of dual source CT Flash scan in the CTA (CTangiography) examination of the great vessels of the heart of children was discussed in the difference of image quality, radiation dose and diagnostic efficacy. The data and methods were approved by the ethics committee of the medical imaging Institute of Shandong Province, and signed by the parents. 65 children with congenital heart disease were examined by CTA, and 60 children were included in this study. 30 patients (13 males and 17 women) were randomly selected for dual source CTFlash scan, and 30 (10 men and 20 women) were performed prospective ECG gated sequence scanning. Conventional cardiac angiography was performed. CCA) or traditional surgical results as a standard to calculate the accuracy of the diagnosis of congenital cardiovascular malformations in two groups of different scans. A total assessment of the quality of the images obtained by the 5 division of the two radiologists was made by the two radiologists, with a clear image, no false and obvious noise, and 4 points: the image was shown to be slight. Artifact and noise, no difficulty in diagnosis; 3 points: blurred image, abnormal structure diagnosis, moderate artifact and noise; 2 points: serious artifact and noise, malformed diagnosis difficulty; 1 points: inability to evaluate. The subjective score of the image is more than 3 points is identified as a coincidence image). The effective radiation dose (effective dose, ED) of the two groups of children The results were calculated according to the CT volume dose index (volume CT dose index, CTDIvol) and the product of the dose length (dose length produce, DLP). Results there were no statistical differences between the two groups of children (t=0.19, P0.05), body weight, and heart rate. Compared with the results of the surgery, the group found 110 kinds of blood. The sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and accuracy were 94.55%, 99.78%, 99.05%, 98.71%, 98.77%, respectively, and 117 kinds of cardiovascular abnormalities were found in the prospective ECG gated sequence scanning group, and the above diagnostic parameters were 96.58%, 99.56%, 98.26%, 99.12%, respectively, and the overall score of 98.95%. image quality reached 3. The images were all qualified and reached the diagnostic requirements, and the overall evaluation of the image quality was higher in two doctors, respectively (4.53 + 0.73) and (4.83 + 0.46). There was no statistically significant difference between the groups (t=1.90, P0.05).Flash scan group and sequence scanning group (0.24 + 0.05mGy and 0.96 + 0.35mGy respectively), and the difference was statistically significant Significance (t=11.15, P0.01); DLP were 4.27 + 1.48mGy cm and 10.50 + 4.09mG cm respectively. The difference was statistically significant (t=7.85, P0.01), ED was 0.27 + 0.06mSv and 0.67 + 0.16mSv respectively, and the difference was statistically significant. ECG gated sequence scanning can obtain better accuracy. Compared with the sequence scanning group, Flash scan obviously reduces the radiation dose of the children and can be used in the CTA examination of the large blood vessels of the heart. The second part: to discuss the application value of the dual source CT Flash scan in the diagnosis of congenital heart disease accompanied by the stenosis of the airway, and to discuss the dual source CT Flash scan The application value of the diagnosis of congenital heart disease (congenital heart disease) accompanied by airway stenosis. Data and methods were included in clinical suspicion of congenital heart disease combined with airway stenosis in 2013.01-2015.12 during 2013.01-2015.12, and 107 children with low dose of double source CT scan in our department, and the final diagnosis of the large blood vessels of the heart and the large blood vessels of the heart was direct to the large blood vessels of the heart. A total of 99 children with airway stenosis caused by compression were included in this study, including 40 males and 59 females, with an average age of 22 months (January -16 years) and an average weight of (10 + 7.7) kg (2.8 kg to 45 kg). The image quality obtained by 5 scores was evaluated by two radiologists in the case of 5 (5 points: clear image, no exact artifact and no exact artifact. Obvious noise; 4 points: the image showed slight artifact and noise, no difficulty in diagnosis; 3 points: blurred image, malformed structure clearly diagnosed, moderate artifact and noise; 2 points: serious artifact and noise, malformation difficulty; 1 points: no evaluation. The subjective score of the image was more than 3 points was identified as a qualified image). Airway was divided. The following four parts: site I, sub trachea 1/3; Part II, right main bronchus; Part III, left main bronchus; Part IV, lobar bronchus. In this study, the diagnostic criteria for tracheal stenosis are that the bronchial tube diameter is less than the normal bronchial tube diameter, and the degree of stenosis is measured on MPR/ CPR, MinIP, or VR images: (narrow near correct) Ordinary lumen diameter - the narrowest canal diameter) / narrow proximal normal lumen diameter * 100%, the degree of stenosis was divided into 3 degrees: mild, narrow degree less than 25%; moderate, stenosis degree 26% ~ 75%; severe, stenosis degree more than 76%. using MPR (Multiple planar reconstruction) and VR (Volume rendering) images to accurately display the anatomy around the narrow segment of the airway Structural relationship, clearly responsible for the tracheal stenosis of the large vascular malformation. According to the different types of vascular malformation causing cardiovascular stenosis in children, the characteristics of the pulmonary lesions in the lungs were observed on the lung window and MinIP (Minimum intensity projection). Results the Flash scan of 99 children was flat. The average DLP was (7.32 + 6.19) mGy*cm and the average ED was (0.39 + 0.20) mSv. to meet the diagnostic requirements; two doctors in the overall evaluation of image quality had high consistency (K=0.754, P0.05) in.99 cases, and 104 airway strictures were diagnosed as tracheobronchial stenosis, of which 38 cases were caused by pulmonary hypertension ( 36.5%) 32 cases (30.8%) were caused by coarctation of the aorta, 14 cases of right aortic arch (13.5%), 12 cases of innominate artery compression (11.5%), 6 cases of pulmonary artery sling (5.8%), 1 cases (1%) of double aortic arch and 1 cases (1%) in left atrium. Different types of congenital heart disease caused by different types of congenital heart disease, the P value is less than 0.0001, the difference is statistically significant, in which the stenosis of the airway caused by the congenital heart disease occurs in the third segment, that is, the left main bronchus is more. Conclusion the double source CT prospective ECG gated large pitch scan (Flash mode) scan can simultaneously display the abnormal structure and the malformation of the heart and the heart. Airway stenosis and secondary pulmonary lesions can provide evidence for clinical diagnosis and treatment.

【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R725.4;R816.92

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