本文選題：雙源CT + 主動脈瓣環(huán)直徑�。� 參考：《山東大學》2014年博士論文

【摘要】：目的：采用雙源CT (Dual-source CT, DSCT)的MinDose技術(shù)(MinDose-DSCT)一站式評價主動脈瓣病變病人的冠狀動脈、瓣葉形態(tài)、瓣環(huán)直徑及心功能,并與二維超聲心動圖(Two-dimensional transthoracic echocardiography,2D-TTE)、實時三維超聲心動圖(Real-time three-dimensional transthoracic echocardiography, RT-3DE)進行比較,探討Mindose-DSCT對主動脈瓣病變病人的術(shù)前評估價值。方法：回顧性分析2010年3月～2013年1月間于本研究中心就診的68例主動脈瓣膜病變需行主動脈瓣置換術(shù)病人。上述病人或因年齡≥60歲可疑冠狀動脈粥樣硬化性心臟病(CAD),或因年齡60歲但2D-TTE提示左室射血分數(shù)(Left ventricular ejection, LVEF)降低(55%)需要接受DSCT檢查以明確冠脈病變。排除標準為體重85Kg,有明顯心律失�；蛐穆瘦^快70次／分且不能降至70次／分以下及MinDose-DSCT或RT-3DE掃查獲取圖像失敗排除28例病人,共有40例病人(28名男性,12名女性；28名主動脈瓣狹窄病人,7名主動脈瓣關(guān)閉不全病人,5名主動脈瓣狹窄合并輕度以上關(guān)閉不全病人；平均年齡,61.3±13.6歲)納入研究。上述病人均在1星期內(nèi)接受TTE及DSCT檢查。所有病人均采用DSCT后處理工作站及改良二維雙平面法(Simpson's法)、四維自動左室定量分析(four-dimensional automatic left ventricular quantification,4D AUTO LVQ)分別計算LVEF。所有病人Mindose-DSCT于70%心動周期多平面重組圖像測量主動脈瓣環(huán)直徑,TTE于胸骨旁左室長軸切面測量主動脈瓣環(huán)直徑(aortic valve annulus diameter, AVAD)。 DSCT于不同軸位圖像觀察主動脈瓣葉數(shù)目、鈣化及脫垂情況,并可進而觀察并測量瓣周結(jié)構(gòu)。本研究經(jīng)醫(yī)院倫理委員會批準并簽署相關(guān)CT檢查知情同意書。 結(jié)果：40例病人檢查期間均無明顯心律失常,均成功接受MinDose-DSCT及TTE檢查并均獲得滿意圖像,均未發(fā)生明顯并發(fā)癥。所有患者行TTE及MinDose-DSCT檢查時的圖像質(zhì)量均可滿足心功能分析要求。 1.冠狀動脈及主動脈瓣觀察結(jié)果：MinDose-DSCT除可以比較清晰的顯示冠狀動脈情況,冠狀面、橫斷面以及矢狀面MPR圖像可以清晰的顯示主動脈瓣病變情況,特別是橫斷面觀察主動脈瓣與超聲心動圖相比具有顯著優(yōu)勢。瓣環(huán)、瓣葉數(shù)目、鈣化情況以及瓣葉脫垂情況一目了然。TTE觀察冠狀動脈非常受限,僅有部分病人(15/40例)可以比較清晰的顯示冠狀動脈開口,遠端走行及管腔情況無法顯示。2D-TTE僅可于大動脈短軸切面單平面觀察主動脈三個瓣葉,無法立體連續(xù)評估瓣葉詳細病變情況。RT-3DE雖然可以從不同角度進行切割多平面觀察主動脈瓣,但受圖像質(zhì)量影響真正能清楚顯示瓣葉結(jié)構(gòu)的僅為少數(shù)病人。 2. MinDose-DSCT,2D-TTE及4D AUTO LVQ評價LVEF的對照研究：40例主動脈瓣病變病人經(jīng)MinDose-DSCT檢查的LVEF測值與2D-TTE測值具有良好的相關(guān)性(r=0.87,P0.01)。MinDose-DSCT檢查的LVEF測值與RT-3DE測值具有更好的相關(guān)性(r=0.90,P0.01)。 3. MinDose-DSCT及2D-TTE評價AVAD的對照研究：MinDose-DSCT測值與2D-TTE測值相比偏大,但也具有很好的相關(guān)性(r=0.90,P0.01)。 結(jié)論：DSCT的MinDose技術(shù)可以在明顯降低輻射劑量、保證圖像診斷質(zhì)量的前提下一站式完成對主動脈瓣病變病人的冠狀動脈、AVAD及LVEF和主動脈瓣膜及瓣周解剖結(jié)構(gòu)的全面評價,具有較高的臨床應用價值。 目的：探討二代雙源CT MinDose技術(shù)與回顧性心電門控在評估主動脈瓣病變患者時的輻射劑量及圖像質(zhì)量。 方法：回顧性分析40例行MinDose-DSCT檢查的主動脈瓣病變患者及33例疑診CAD行常規(guī)后門控檢查體檢人員的影像學資料。主觀評價方法：將兩組圖像在隱匿患者信息和掃描參數(shù)的情況下由兩位有十年以上心血管影像診斷經(jīng)驗的醫(yī)師采用盲法分別獨立評價所有圖像。按照圖像的整體質(zhì)量及階梯狀偽影,血管增強一致性及冠狀動脈顯示情況等多個方面按照4分或3分的評分標準進行評價。客觀評價方法：由一位有十年以上心血管影像診斷經(jīng)驗的醫(yī)師評價圖像噪聲,計算信號-噪聲比率(signal-to-noise ratio, SNR)和對比-噪聲比率(contrast-to-noise ratio, CNR).綜合統(tǒng)計每一位檢查者接受檢查的輻射劑量。將兩組不同掃描方式檢查圖像質(zhì)量的平均得分及輻射劑量進行對比分析。兩位醫(yī)師之間的的診斷一致性采用kappa檢驗。P0.05有統(tǒng)計學意義。本研究經(jīng)醫(yī)院倫理委員會批準并簽署相關(guān)CT檢查知情同意書。 結(jié)果：所有病人均獲得滿意圖像質(zhì)量,MinDose-DSCT組與常規(guī)后門控兩組整體圖像評分(3-4分)均達到診斷標準,兩種方式之間無統(tǒng)計學差異(P0.05)。MinDose-DSCT組冠狀動脈節(jié)段評分為1.8±0.2,常規(guī)后門控組為1.64±0.3,兩種方式之間無統(tǒng)計學差異；階梯狀偽影評分在MinDose-DSCT組與常規(guī)后門控兩組之間無統(tǒng)計學差異；心血管強化的一致性評分MinDose-DSCT組與常規(guī)后門控兩組之間無統(tǒng)計學差異(P均0.05)。MinDose-DSCT組與常規(guī)后門控組圖像噪聲分別為19.3±2.1、17.5±1.8,兩組之間無統(tǒng)計學差異(P0.05)。MinDose-DSCT組平均有效輻射劑量明顯低于常規(guī)后門控組(3.2±0.4mSv vs.8.7m±0.3mSv, P=.000)。 結(jié)論：DSCT的MinDose技術(shù)可以在保證較好的圖像質(zhì)量前提下明顯降低受檢人員的輻射劑量。
[Abstract]:Objective : To evaluate the preoperative evaluation value of Mindose - DSCT ( MinDose - DSCT ) in patients with aortic valve disease by MinDose - DSCT .
28 aortic stenosis patients , 7 aortic valve insufficiency patients , 5 aortic stenosis with mild or more closed patients ;
The average age , 61.3 鹵 13.6 years were included in the study . All patients were examined by TTE and DSCT within 1 week . All patients were treated with DSCT post - treatment workstation and modified two - dimensional double - plane method ( Simpson ' s method ) , and four - dimensional automatic left ventricular quantification ( 4D AUTO LVQ ) was used to measure LVEF . All patients with Mindose - DSCT measured aortic annulus diameter at 70 % cardiac cycle multi - plane reconstructed image , and the aortic valve annulus diameter ( AVAD ) was measured by TTE in the long axis of left ventricular chamber . DSCT observed the number of aortic valve leaflets , calcification and prolapse in different axial images , and then observed and measured the perivalvular structure . This study was approved by the Ethics Committee of the Hospital and signed the relevant CT examination informed consent form .

Results : There was no significant arrhythmia during the examination of 40 patients . All patients were successfully treated with MinDose - DSCT and TTE to obtain satisfactory images without significant complications . All patients underwent TTE and MinDose - DSCT examination to meet the requirement of cardiac function analysis .

1 . The observation of coronary artery and aortic valve : MinDose - DSCT can clearly show the condition of coronary artery disease , coronal plane , cross section and sagittal MPR image .

2.MinDose - DSCT , 2D - TTE and 4D AUTO LVQ were used to evaluate LVEF . The LVEF measured by MinDose - DSCT in 40 patients with aortic valvular disease had good correlation with 2D - TTE values ( r = 0.87 , P0.01 ) . The value of LVEF measured by MinDose - DSCT was better correlated with RT - 3DE ( r = 0.90 , P0.01 ) .

3 . MinDose - DSCT and 2D - TTE were used to evaluate AVAD : MinDose - DSCT value was larger than that of 2D - TTE , but also had good correlation ( r = 0.90 , P0.01 ) .

Conclusion : The MinDose technique of DSCT can significantly reduce the radiation dose , ensure the quality of image diagnosis , complete the comprehensive evaluation of coronary artery , AVAD and LVEF , aortic valve membrane and perivalvular anatomy of patients with aortic valve disease on the premise of image diagnosis quality , and has high clinical application value .

Objective : To study the radiation dose and image quality of the two - generation dual - source CT MinDose technique and the retrospective ECG gating in the assessment of patients with aortic valve disease .

Methods : The imaging data of 40 patients with aortic valvular disease and 33 suspected cases of suspected CAD were analyzed retrospectively . The subjective evaluation method was as follows : the two groups of images were evaluated by using blind method in the case of concealed patient information and scanning parameters . The objective evaluation method was as follows : 1 - bit more than ten years of cardiovascular image diagnosis experience in the evaluation of image noise , the signal - to - noise ratio ( SNR ) and contrast - to - noise ratio ( CNR ) . The average score of the image quality and the radiation dose were analyzed by combining two groups of different scanning methods . The diagnostic consistency between the two physicians was statistically significant . The study was approved by the hospital ethics committee and signed the relevant CT examination informed consent form .

Results : All patients had satisfactory image quality , MinDose - DSCT group had no statistical difference between the two groups ( P0.05 ) . The coronary segmental score of MinDose - DSCT group was 1.8 鹵 0.2 , and the normal control group was 1.64 鹵 0.3 . There was no statistical difference between the two methods .
There was no statistical difference between the MinDose - DSCT group and the conventional post - gated group .
There was no statistical difference between the MinDose - DSCT group ( 19.3 鹵 2.1 , 17.5 鹵 1.8 , P = 0.000 ) .

Conclusion : The MinDose technique of DSCT can significantly reduce the radiation dose of the subject under the precondition of ensuring better image quality .

【學位授予單位】：山東大學
【學位級別】：博士
【學位授予年份】：2014
【分類號】：R816.2;R654.2

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