本文選題：新雙源CT + 冠狀動(dòng)脈��； 參考：《鄭州大學(xué)》2012年碩士論文

【摘要】：第一部分新雙源GT Flash掃描在冠狀動(dòng)脈狹窄評(píng)估中的初步研究 目的 探討新雙源CT Flash掃描技術(shù)在冠狀動(dòng)脈狹窄診斷中的價(jià)值。 材料與方法 回顧性分析52例應(yīng)用新雙源CT Flash掃描技術(shù)行冠狀動(dòng)脈CT血管成像(CTA)患者的影像學(xué)資料,并與冠狀動(dòng)脈造影(CAG)檢查結(jié)果對(duì)照,評(píng)價(jià)其顯示冠狀動(dòng)脈狹窄的準(zhǔn)確性及有效輻射劑量(mSv)的高低。冠狀動(dòng)脈狹窄程度分為三組,也即輕度狹窄(≤50%)、中度狹窄(50%＜狹窄≤75%)及重度狹窄(＞75%)。根據(jù)美國(guó)心臟協(xié)會(huì)(American Heart Association, AHA)的冠狀動(dòng)脈分節(jié)標(biāo)準(zhǔn),從節(jié)段水平分析CTA診斷冠狀動(dòng)脈狹窄的敏感性、特異性、陽(yáng)性預(yù)測(cè)值、陰性預(yù)測(cè)值和準(zhǔn)確性。對(duì)所得結(jié)果行配對(duì)χ2檢驗(yàn),P0.05認(rèn)為有統(tǒng)計(jì)學(xué)意義。 結(jié)果 Flash CTA對(duì)冠狀動(dòng)脈狹窄病變?cè)\斷的敏感性、特異性、陽(yáng)性預(yù)測(cè)值、陰性預(yù)測(cè)值和準(zhǔn)確性分別為84.3%、95.7%、89.7%、93.2%和92.2%；有效輻射劑量為0.98±0.39mSv。Flash CT和CAG在診斷冠狀動(dòng)脈中、重度狹窄中差異無(wú)統(tǒng)計(jì)學(xué)意義(P值分別為0.344和0.453)；但二者在診斷冠狀動(dòng)脈輕度狹窄中差異有統(tǒng)計(jì)學(xué)意義(P=0.041)。 結(jié)論 Flash CTA作為無(wú)創(chuàng)性影像學(xué)診斷技術(shù),對(duì)冠狀動(dòng)脈狹窄的診斷具有較高的應(yīng)用價(jià)值,尤其是對(duì)中、重度冠狀動(dòng)脈狹窄的評(píng)價(jià),且有效輻射劑量明顯降低。 第二部分Flash CT (?)低管電壓結(jié)合IRIS重建技術(shù)在超重患者冠狀動(dòng)脈成像中的應(yīng)用 目的 探討Flash CT低管電壓結(jié)合IRIS重建技術(shù)在超重患者冠狀動(dòng)脈成像中的圖像質(zhì)量及輻射劑量。 材料與方法 100例體質(zhì)量指數(shù)(BMI)為25.0～30.0kg/m2的患者接受Flash CT檢查,按掃描管電壓完全隨機(jī)化分成A(120kVp)、B (100kVp)兩組,同時(shí)B組圖像經(jīng)IRIS重建獲得數(shù)據(jù)作為C組。A組：50例,管電壓120kVp； B組：50例,管電壓100kVp；C組：50例,由B組數(shù)據(jù)進(jìn)行IRIS重建獲得,其一般資料與B組相同。所有患者均采用前門(mén)控適應(yīng)性序列掃描。按血管節(jié)段對(duì)其圖像質(zhì)量進(jìn)行分級(jí),分析各個(gè)血管節(jié)段圖像的可評(píng)估性。測(cè)量主動(dòng)脈根部、左冠狀動(dòng)脈及右冠狀動(dòng)脈起始部血管腔內(nèi)CT值、噪聲(SD),并計(jì)算信噪比(SNR)、對(duì)比信噪比(CNR),記錄輻射劑量。 應(yīng)用兩獨(dú)立樣本t檢驗(yàn)比較A、B或A、C兩組患者掃描時(shí)一般資料及輻射劑量。應(yīng)用單因素方差分析比較3組圖像ROI內(nèi)的CT值、噪聲、SNR、CNR。冠狀動(dòng)脈段圖像質(zhì)量總體評(píng)分比較采用秩和檢驗(yàn),應(yīng)用χ2檢驗(yàn)比較不同圖像質(zhì)量評(píng)分在3組間的差異。采用Kappa檢驗(yàn)判斷2名評(píng)價(jià)者評(píng)分的一致性。 結(jié)果 冠狀動(dòng)脈段圖像質(zhì)量總體評(píng)分比較3組間差異無(wú)統(tǒng)計(jì)學(xué)意義(H=5.872,P＞0.05)。3組患者優(yōu)、良圖像比較差異有統(tǒng)計(jì)學(xué)意義(χ2=7.604,P＜0.05)；兩兩比較A、B兩組間差異有統(tǒng)計(jì)學(xué)意義(χ2=7.534,P＜0.0167),A組優(yōu)于B組；A、C兩組間差異無(wú)統(tǒng)計(jì)學(xué)意義(χ2=1.838,P＞0.0167)。3組患者血管腔強(qiáng)化CT值、噪聲、SNR, CNR差異均有統(tǒng)計(jì)學(xué)意義(P＜0.05)。兩兩比較,血管腔內(nèi)CT值B、C兩組高于A組；B組噪聲最大,CNR最低；C組SNR最高。A、C兩組ED分別為(8.6±1.3)mSv和(3.5±0.7)mSv,差異有統(tǒng)計(jì)學(xué)意義(t=—16.91,P＜0.05)。 結(jié)論 對(duì)于超體重患者運(yùn)用低管電壓結(jié)合IRIS重建技術(shù)進(jìn)行Flash CT冠狀動(dòng)脈檢查能夠獲得較好的圖像質(zhì)量,同時(shí)顯著降低輻射劑量。
[Abstract]:Part one preliminary study of new dual source GT Flash scanning in coronary artery stenosis assessment
objective
Objective to explore the value of new dual source CT Flash scanning in the diagnosis of coronary artery stenosis.
Materials and methods
The imaging data of 52 patients with coronary artery CT angiography (CTA) with new dual source CT Flash scan were retrospectively analyzed and compared with the results of coronary angiography (CAG). The accuracy of coronary artery stenosis and the high dose of effective radiation dose (mSv) were evaluated. The degree of coronary stenosis was divided into three groups, that is, mild stenosis (the degree of coronary artery stenosis). Less than 50%), moderate stenosis (50% < 75%) and severe stenosis (> 75%). According to the standard of coronary artery segmental American Heart Association (AHA), the sensitivity, specificity, positive pretest value, negative predictive value and accuracy of CTA diagnosis of coronary artery stenosis were analyzed from segment level. The results were paired chi 2 test, P 0.05 think there is a statistical significance.
Result
The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of Flash CTA for the diagnosis of coronary stenosis were 84.3%, 95.7%, 89.7%, 93.2% and 92.2%, respectively, and the effective radiation dose of 0.98 + 0.39mSv.Flash CT and CAG were not statistically significant in the diagnosis of severe stenosis (P value 0.344 and 0.453 respectively). There was significant difference between the two in the diagnosis of mild coronary artery stenosis (P=0.041).
conclusion
As a noninvasive imaging diagnosis technique, Flash CTA is of high value for the diagnosis of coronary artery stenosis, especially in the middle and severe coronary stenosis, and the effective radiation dose is obviously reduced.
The second part is the application of Flash CT (low) tube voltage combined with IRIS reconstruction in coronary artery imaging of overweight patients.
objective
Objective to investigate the image quality and radiation dose of Flash CT low tube voltage combined with IRIS reconstruction in coronary artery imaging of overweight patients.
Materials and methods
100 patients with body mass index (BMI) of 25 ~ 30.0kg/m2 received Flash CT examination. The scan tube voltage was completely randomized into A (120kVp), B (100kVp) two groups, and B group images were reconstructed by IRIS for.A group in C group: 50 cases, tube voltage, 50 cases, tube voltage, 50 cases. The general data were the same as those in the B group. All the patients were scanned by the anterior gate controlled adaptive sequence. The image quality was graded according to the segment of the vascular segment and the evaluation of each segment image was analyzed. The CT values, noise (SD), and the signal to noise ratio (SNR) were measured in the aorta root, the left coronary artery and the right coronary artery in the starting part of the coronary artery. A contrast signal to noise ratio (CNR) was used to record the radiation dose.
Two independent samples t test was used to compare the general data and radiation dose of A, B, A and C two groups. The single factor variance analysis was used to compare the CT values in the 3 groups of ROI, noise, SNR, and CNR. coronary artery segment image quality overall score was compared with the rank sum test, and the difference between the 3 groups was compared with the x 2 test. Kappa test was used to determine the consistency of the scores of the 2 evaluators.
Result
There was no statistically significant difference between the 3 groups (H=5.872, P > 0.05) in group.3, and there were significant differences in good images (x 2=7.604, P < 0.05), 22 compared to A, B two groups were statistically significant (x 2=7.534, P < 0.0167), A group was superior to B group, and there was no statistical difference between two groups of A and two groups (2 =1.838, P > 0.0167) the vascular cavity enhanced CT value, noise, SNR, CNR difference in group.3 were statistically significant (P < 0.05). 22 compared, the value of CT in the endovascular group was higher than that in the A group; the largest noise in the B group was (8.6 + 1.3) and (3.5 + 0.7) respectively, and the difference was statistically significant (16.91, 0.05).
conclusion
The use of low tube voltage combined with IRIS reconstruction for Flash CT coronary artery examination for patients with super weight can obtain better image quality and significantly lower the radiation dose.

【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2012
【分類(lèi)號(hào)】：R816.2

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