本文選題：CT冠狀動脈造影 + CT冠狀靜脈造影��； 參考：《河北北方學(xué)院》2017年碩士論文

【摘要】：近年來隨著多層螺旋CT的迅速發(fā)展,CT對冠狀動脈粥樣硬化性心臟病(coronary artery atherosclerosis disease,CAD)患者動脈內(nèi)鈣化斑塊、軟斑塊,管腔內(nèi)狹窄的檢查技術(shù)趨于成熟,而隨著心臟電生理技術(shù)(包括導(dǎo)管射頻消融、人工起搏、心臟逆行灌注、心臟再同步化治療)不斷發(fā)展及普及,冠狀靜脈成像越來越受到人們的關(guān)注。因此一次CT檢查能提供冠狀動脈及靜脈的影像學(xué)信息,是如今CT檢查的一種趨勢,而靜脈成像的具體延遲時間尚未明確。本研究目的是通過Toshiba320排CT在前瞻性心電門控掃描模式下分別用兩種靜脈延遲采集方法對心臟進(jìn)行一次檢查完成冠狀動脈、靜脈的分別成像,比較兩種方法及心臟收縮、舒張期對冠狀靜脈的顯示質(zhì)量和顯示率的影響。從而建立一種可對心臟進(jìn)行一次檢查完成冠狀動脈、靜脈的分別成像的方法。實(shí)驗方法是將50例臨床需要進(jìn)行冠狀動、靜脈CT造影的患者隨機(jī)分為兩組,連續(xù)掃描組:22例患者連續(xù)掃描5個心動周期,前面3個心動周期用于冠狀動脈成像,最后1-2個心動周期用于冠狀靜脈重建;延遲5s組:28例先掃描1-2個心動周期用于冠狀動脈成像,延遲5s后再掃描1-2個心動周期用于冠狀靜脈重建,靜脈重建時相選擇代表心臟收縮的時相35%R-R間期及代表心臟舒張時相的75%R-R間期,將重建后的數(shù)據(jù)傳至HP LP3065 Monitor后處理工作站,由兩名有經(jīng)驗的放射科醫(yī)生在雙盲下用曲面重建(curved planar reformation,CPR)、容積再現(xiàn)(volume rendering,VR)、多平面重建(multiplanar reformation,MPR)、最大密度投影(maximum intensity projection,MIP)技術(shù)測量冠狀靜脈竇(coronary sinus,CS)、心大靜脈(great cardiac vein,GCV)、心中靜脈(middle cardiac vein,MCV)、左室后靜脈(Left ventricular posterior vein,LPV)管腔的CT值及管徑的大小。分別用t檢驗(95%可信區(qū)間)和卡方檢驗比較兩種掃描模式靜脈顯示質(zhì)量和顯示率,及心臟收縮和舒張期對冠狀靜脈管徑的影響。顯示率評分標(biāo)準(zhǔn):血管對比差,邊緣毛糙為小于等于2分;血管對比好,部分區(qū)域顯示不清或邊緣毛糙為3分;冠狀靜脈竇及一級屬支對比度好,管壁光滑為4-5分。評分≥3分者占總數(shù)的比例為顯示率。運(yùn)用血管分析法分別于收縮期和舒張期測量冠狀竇口(Coronary sinus orifice,CSO)及心大靜脈(GCV)、心中靜脈(MCV)、及左室后靜脈(LPV為多支者選取較粗大一支分析)等屬支匯入處的平均管徑、橫截面積,35%、75%R-R間期管腔內(nèi)的CT值。評價上述測量值在心臟收縮期與舒張期的變化規(guī)律,并計算其變化率[變化率=(收縮期值-舒張期值)/收縮期值×100%]。實(shí)驗結(jié)果顯示為延遲5s的掃描方案75%R-R間期靜脈竇、心大靜脈、心中靜脈、左室后靜脈CT值分別是(280.23±89.86)HU、(249.77±98.70)HU、(228.86±82.34)HU、(252.36±82.74)HU;35%R-R間期靜脈CT值分別為(258.86±81.43)HU、(260.09±91.00)HU、(262.23±90.25)HU、(264.95±65.60HU。連續(xù)掃描5個心動周期的掃描方案75%間期靜脈竇、心大靜脈、心中靜脈、左室后靜脈CT值分別是(347.38±107.52)HU、(333.39±89.63)HU、(302.07±97.40)HU、(326.46±110.13)HU;35%R-R間期靜脈CT值分別為(325.67±100.82)HU、(342.50±89.07)HU、(330.26±102.07)HU、(319.54±101.52)HU。上述數(shù)據(jù)表明延遲5s的靜脈掃描方案較連續(xù)掃描5個心動周期的靜脈管腔內(nèi)CT值更高,差異具有統(tǒng)計學(xué)意義(P0.05)。靜脈竇及其屬支管徑、面積收縮期均大于舒張期,差異具有統(tǒng)計學(xué)意義(P0.05)。靜脈竇在舒張期(75%R-R間期)的CT值高于收縮期(35%R-R間期),差異具有顯著統(tǒng)計學(xué)意義(P0.001)。而心中靜脈及左室后靜脈在收縮期(35%R-R間期)CT值較高,差異具有顯著統(tǒng)計學(xué)意義(P0.01)。心中靜脈的CT值在收縮期和舒張期之間無明顯差異(P0.05)。冠狀靜脈系統(tǒng)在兩種掃描方法的總體顯示率為:冠狀竇、心大靜脈、心中靜脈在收縮期及舒張期的顯示率均為100%,左室后靜脈在收縮期及舒張期的顯示率均為90%,數(shù)據(jù)顯示冠狀竇、心大靜脈、心中靜脈、左室后靜脈在收縮期及其舒張期的顯示率均較高。結(jié)論,320排CT前瞻性心電門控冠狀動、靜脈成像時連續(xù)采集方案和延遲5s采集方案冠狀靜脈總體顯示率均較高,但是延遲5s采集方案可以得到更高的冠狀靜脈顯示質(zhì)量;此外,靜脈竇及其屬支在收縮期的管徑及面積明顯大于舒張期。
[Abstract]:In recent years, with the rapid development of multislice spiral CT, CT has tended to mature in coronary atherosclerotic heart disease (coronary artery atherosclerosis disease, CAD) patients with intravascular calcified plaque, soft plaque, and intravascular stenosis, and with cardiac electrophysiological techniques (including catheter radiofrequency ablation, artificial pacing, retrograde perfusion of the heart) Cardiac resynchronization therapy is developing and popularizing, coronary vein imaging is getting more and more attention. Therefore, one CT examination can provide imaging information of coronary artery and vein, which is a trend of CT examination today, and the specific delay time of venous imaging is not clear. The purpose of this study is to look forward to Toshiba320 by CT. Under the ECG gated scanning mode, two kinds of venous delay acquisition methods were used to perform a single examination of the coronary arteries and veins, respectively, to compare the two methods and the effects of cardiac contractions and diastolic phase on the display quality and display rate of the coronary veins. The method of imaging respectively. The experimental method was to divide 50 patients with coronary artery and vein CT angiography into two groups randomly. Continuous scan group: 22 patients scanned 5 cardiac cycles continuously, the first 3 cardiac cycles were used for coronary angiography, the last 1-2 cardiac weeks were used for coronary vein reconstruction, and delayed 5S group: 28 cases first scanned. 1-2 cardiac cycles were used for coronary angiography and 1-2 cardiac cycles after delayed 5S were used for coronary vein reconstruction. The phase selection represented the time phase of the heart contraction and the 75%R-R interval representing the diastolic phase of the heart. The reconstructed data were transmitted to the HP LP3065 Monitor post processing workstation, and two experienced patients were placed. Curved planar reformation (CPR), volume rendering (VR), multiplane reconstruction (multiplanar reformation, MPR), the maximum density projection (maximum intensity), the heart vein (CPR), the heart vein (the heart vein), the heart vein (the heart vein), the heart vein (the vein (the heart vein), the heart vein (the heart vein), the heart vein (the heart vein), the heart vein (the heart vein) Middle cardiac vein, MCV), the CT values and diameter of the left ventricular posterior vein (Left ventricular posterior vein, LPV). Compared with the t test (95% confidence interval) and chi square test, the quality and display rate of the two scanning patterns, and the effect of cardiac contractile and diastolic phase on the diameter of the coronary veins. Contrast poor, the marginal roughness was less than 2 points, the blood vessel contrast was good, the part of the region was unclear or the marginal roughness was 3; the coronary sinus and the first grade branch was well contrasted, the wall of the tube was 4-5. The ratio of the score of the score of the total of 3 points was measured by the blood vessel analysis at the systolic and diastolic phase of the coronary sinus (Coronary sin). Us orifice, CSO) and the cardiac vein (GCV), the heart vein (MCV), and the left ventricular posterior vein (LPV for the larger one selection), the average diameter, the cross section area, the CT in the 35%, 75%R-R interval, and the changes of the measured values in the systolic and diastolic phase of the heart, and calculated the rate of change = (rate of change = ( Systolic value - diastolic value) / systolic value * 100%]. experimental results showed that the 75%R-R interphase venous sinus of the delayed 5S scan, the large vein of the heart, the heart vein, and the CT of the left posterior vein were (280.23 + 89.86) HU, (249.77 + 98.70) HU, (228.86 + 82.34) HU, (252.36 + 82.74) HU, and 35%R-R interval venous CT values were (258.86 + 81.43) HU, respectively (260.09 +). 91) HU, (262.23 + 90.25) HU, (264.95 + 65.60HU. continuous scanning of 5 cardiac cycles, 75% interphase venous sinus, cardiac vein, heart vein, and left ventricle vein, CT value respectively (347.38 + 107.52) HU, (333.39 + 89.63) HU, (302.07 + 97.40) HU, (326.46 +) HU, 35%R-R interval venous CT value respectively 7) HU, (330.26 + 102.07) HU, (319.54 + 101.52) HU., the above data showed that the venous scanning scheme of delayed 5S was higher than that in the venous catheter of 5 consecutive cardiac cycles. The difference was statistically significant (P0.05). The venous sinus and its branch diameter were larger than the diastole, and the difference was statistically significant (P0.05). Venous Dou Zaishu. The CT value of the 75%R-R interval (35%R-R interval) was higher than that of the systole (35%R-R interval). The difference was statistically significant (P0.001), but the CT value of the heart vein and the left posterior vein in the systole (35%R-R interval) was higher (P0.01). The CT value of the heart vein was not significantly different between the systolic and diastolic phase (P0.05). The overall display rate of the two scanning methods was: the coronary sinus, the great heart vein, the display rate of the heart vein in systolic and diastolic time were 100%, the display rate of the left posterior vein in systolic and diastolic phase were 90%. The data showed that the coronary sinus, the great heart vein, the heart vein, the left posterior vein were displayed in the systolic and diastolic period. Conclusion: 320 rows of CT prospective cardiac valve controlled coronary movement, continuous acquisition and delayed 5S acquisition were all higher in the coronary vein, but delayed 5S acquisition could obtain higher quality of coronary vein display; in addition, the diameter and area of venous sinus and its branch in systole were obviously greater than diastolic phase.

【學(xué)位授予單位】：河北北方學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R541.4;R816.2

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