本文選題：test + bolus�。� 參考：《南京醫(yī)科大學(xué)》2016年博士論文

【摘要】：目的：評價(jià)膝關(guān)節(jié)水平小劑量測試團(tuán)注法(test bolus)在低電壓,大螺距雙源CT下肢動脈成像中的應(yīng)用價(jià)值；對照標(biāo)準(zhǔn)螺距CTA,評價(jià)大螺距 下肢動脈CTA的圖像質(zhì)量和輻射劑量：對照DSA,分析低電壓,大螺距雙源CTA對下肢動脈硬化閉塞癥診斷的診斷效能。方法：60例懷疑下肢動脈病變的患者分為兩組：A組,30例患者,掃描方式為80kVp,大螺距(3.2),采用迭代重建(sinogram-affirmed iterative reconstruction SAFIRE)后處理圖像。B組,30例患者,120kVp,標(biāo)準(zhǔn)螺距(1.0),采用濾過反投影法重建(filtered back projection FBP)。A組患者采用膝關(guān)節(jié)水平小劑量test bolus技術(shù)決定掃描延遲時(shí)間,B組采用腹主動脈分叉上方團(tuán)注示蹤法(bolus tracking)決定掃描延遲時(shí)間。對比劑注射方案A組為,80ml對比劑,速率3ml/s。B組為100ml對比劑,速率為3ml/s。比較兩組的平均CT值,信噪比(signal-to-noise ratio SNR),對比信噪比(contrast-to-noise ratioCNR),圖像質(zhì)量評分和輻射劑量。以DSA為金標(biāo)準(zhǔn),比較兩組CTA診斷血管狹窄度的靈敏度,特異度,陽性預(yù)測價(jià)值,陰性預(yù)測價(jià)值和準(zhǔn)確率結(jié)果：A組主動脈分叉(aortic bifurcation AA),雙側(cè)股動脈(bilateral common femoral arteries CFA),雙側(cè)股淺動脈中段(bilateral mid-superficial femoral arteries SFA),雙側(cè)小腿中部(bilateral midealf CA)及平均CT值分別為554.03±83.08HU,569.23±74.95 HU,512.83±97.08 HU,395.95±54.63 HU,507.78±103.01HU,B組的AA,CFA,SFA,CA水平以及平均CT值分別為345.33±86.91 HU,320.55±66.52 HU,328.72±61.78 HU289.52±65.05 HU,317.54±62.03HU,A組的所有CT值均較B組高,且均具有統(tǒng)計(jì)學(xué)差異(所有PO.001)。B組的平均圖像噪聲較A組低(A組：11.24±3.79HU,B組：9.33±3.79HU,P0.001)。A,B兩組平均SNR分別為51.04±20.29,34.66±9.94,有統(tǒng)計(jì)學(xué)差異(P0.001),平均CNR分別為44.83±1 7.93,28.26±9.60,有統(tǒng)計(jì)學(xué)差異(P0.001)。兩組圖像質(zhì)量評分無統(tǒng)計(jì)學(xué)差異(P0.05)。兩組有效輻射劑量存在統(tǒng)計(jì)學(xué)差異(A組：0.76±0.06mSv,B組：4.29±0.63mSv,P0.001)。A組30例患者膝關(guān)節(jié)水平test bolus技術(shù)共獲得60條時(shí)問密度曲線,其中1例患者一側(cè)胭動脈閉塞,該側(cè)時(shí)間密度曲線來源于側(cè)枝循環(huán),30例患者半均峰值時(shí)間為28秒。對照DSA比較狹窄度,A組的靈敏度,特異度,陽性預(yù)測價(jià)值,陰性預(yù)測價(jià)值和準(zhǔn)確率分別為99%,92%,92%,99%,95%,B組的靈敏度,特異度,陽性預(yù)測價(jià)值,陰性預(yù)測價(jià)值和準(zhǔn)確率分別為98%,93%,93%,99%,96%),兩組間各值比較均沒有統(tǒng)計(jì)學(xué)差異(p0.05)。結(jié)論：低千伏,大螺距雙源CT下肢動脈成像可以大幅降低輻射劑量,同時(shí)對于下肢動脈硬化閉塞癥具有良好的診斷準(zhǔn)確性。采用膝關(guān)節(jié)水平test bolus技術(shù)來決定掃描延遲時(shí)間能夠有效保證低千伏,大螺距雙源CT下肢動脈成像獲得滿足診斷用圖像。
[Abstract]:Objective: to evaluate the value of low dose test bolus in low voltage, large pitch CT arterial imaging of lower extremity. To evaluate the image quality and radiation dose of large pitch lower extremity artery CTA, and to analyze the diagnostic efficacy of low voltage and large pitch dual source CTA in diagnosis of lower extremity arteriosclerosis obliteration. Methods Sixty patients with suspected arterial lesions of lower extremity were divided into two groups: group A (n = 30) and group A (n = 30). The scanning mode was 80kVpwith large pitch of 3.2kVp.Thirty patients in group B underwent iterative reconstruction of sinogram-affirmed iterative reconstruction SAFIRE) images (120kVp) with standard pitch of 1.0kVp.The patients in filtered back projection FBP).A group were reconstructed with filtered back projection FBP).A by using low-dose test bolus technique at knee joint level. The scan delay time was determined by bolus trackingmethod over the abdominal aorta bifurcation in group B. Contrast group A was 80 ml contrast agent, and 3ml/s.B group was 100ml contrast agent at a rate of 3 ml / s. The mean CT value, signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), image quality score and radiation dose were compared between the two groups. Using DSA as gold standard, the sensitivity, specificity and positive predictive value of CTA in the diagnosis of vascular stenosis were compared. Results negative predictive value and accuracy results of aortic bifurcation, bilateral common femoral arteries, bilateral mid-superficial femoral arteries of bilateral superficial femoral artery and bilateral midealf CAA of bilateral superficial femoral artery in group A were 554.03 鹵83.08HU569.23 鹵74.95 HUA 512.83 鹵97.08 HU395.95 鹵54.63 HUA 507.78 鹵103.01HUA, respectively. The average CT values of AACA-CFAA were 554.03 鹵83.08HUA, 512.83 鹵97.08 HUA, 507.78 鹵103.01HUA, the average CT values were 554.03 鹵83.08HUA, 512.83 鹵97.08 HUA, 395.95 鹵54.63 HUA, 507.78 鹵103.01HUA, respectively. The CT values of HUA group were 320.55 鹵66.52 HUU 328.72 鹵61.78 HU289.52 鹵65.05 HUA 317.54 鹵62.03HUA were higher than that of B group. The average image noise of all PO.001).B group was lower than that of A group (P < 11.24 鹵3.79 HUB group: 9.33 鹵3.79 HUA = 9.33 鹵3.79 HUA, P 0.001, P 0.001, P 0.001, P 0.001, P 0.001, P 0.001, P 0.001, P 0.001, P 0.001, P 0.001, P 0.001, P 0.001, P < 0.05). There was no statistical difference in image quality score between the two groups (P 0.05). There was statistical difference in effective radiation dose between the two groups. Group A: 0.76 鹵0.06mSvnb, group B: 4.29 鹵0.63mSvCv. Group A, 30 patients with knee joint horizontal test bolus technique obtained 60 time-asked density curves, including one patient with unilateral popliteal artery occlusion, 1 patient with popliteal artery occlusion. The lateral time density curve was derived from 30 patients with collateral circulation. The half average peak time was 28 seconds. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of DSA in group A were the sensitivity, specificity and positive predictive value of group B, respectively. The negative predictive value and accuracy rate were 98 / 93 and 993 / 995, respectively. There was no statistical difference between the two groups (p 0.05). Conclusion: lower extremity arteriography with large pitch and low voltage can significantly reduce the radiation dose and has good diagnostic accuracy for arteriosclerosis obliterans of lower extremity. Using the horizontal test bolus technique of knee joint to determine the scanning delay time can effectively guarantee the low kilovolt large pitch dual-source CT lower extremity arterial imaging to obtain the satisfied diagnostic image.
【學(xué)位授予單位】：南京醫(yī)科大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2016
【分類號】：R816.2;R543.5

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