發(fā)布時(shí)間：2018-05-24 05:45

  本文選題：自動(dòng)法 + 手動(dòng)法��； 參考：《河北醫(yī)科大學(xué)》2012年碩士論文

【摘要】：第一部分256iCT和心動(dòng)超聲左心房容積定量測(cè)量準(zhǔn)確性研究 目的：探討256層螺旋CT對(duì)左心房體積測(cè)量的準(zhǔn)確性。 方法：①、手工制作四只不同大小的左心房模型,24小時(shí)之內(nèi)完成256層螺旋CT和心動(dòng)超聲兩種檢查。對(duì)256iCT后處理工作站自動(dòng)測(cè)量法、半自動(dòng)法、心動(dòng)超聲法與和真實(shí)容積之間進(jìn)行比較；②、選取60例行冠狀動(dòng)脈CTA檢查患者并在12小時(shí)內(nèi)進(jìn)行心臟超聲檢查,測(cè)量左心房容積。將60例患者按性別分組,對(duì)總體樣本組、男性組及女性組分析256iCT后處理工作站自動(dòng)測(cè)量法和心臟超聲法兩者之間的差別。 結(jié)果：1、左心房模型試驗(yàn)結(jié)果表明,CT自動(dòng)算測(cè)量法與真實(shí)容積之間無(wú)明顯差別(P0.05),半自動(dòng)法、超聲法與真實(shí)容積之間有明顯差異(P0.05)。2、60例臨床樣本組兩種測(cè)量方法之間差異明顯(P0.05),左房體積測(cè)量,采用超聲法較256iCT自動(dòng)測(cè)量法定量值低約24%,不同性別組分析結(jié)果與60例臨床樣本組基本一致。 結(jié)論：256層螺旋CT可以用于左心房容積定量測(cè)量,其結(jié)果客觀、準(zhǔn)確、可重復(fù)性強(qiáng)。該研究具有重要臨床價(jià)值。 第二部分利用256iCT對(duì)左心室解剖結(jié)構(gòu)和功能定量研究 目的：應(yīng)用256iCT對(duì)正常人左心室結(jié)構(gòu)和功能相關(guān)指標(biāo)進(jìn)行定量研究,分析各指標(biāo)與年齡和性別的關(guān)系。 方法：收集506例行256iCT冠狀動(dòng)脈CTA查體結(jié)果正常的患者影像資料；所有患者近6個(gè)月無(wú)心血管疾病病史。對(duì)原始圖像進(jìn)行多期重建,確定左心室舒張末期及收縮末期,分別對(duì)左心室舒張末期和收縮末期的室間隔厚度(Septal wall thickness, SWT)、左室后壁厚度(Posterior wall thickness, PWT)、左室寬徑(LV inner diameter LVID)、舒張末期容積(end-diastolic volume, EDV)、收縮末期容積(end-systolic volume, ESV)、每搏輸出量(stroke volume,SV)和射血分?jǐn)?shù)(ejection fraction, EF)進(jìn)行測(cè)量和計(jì)算,并進(jìn)行相關(guān)統(tǒng)計(jì)學(xué)處理。 結(jié)果：左心室舒張末期SWT、PWT、LVID95%參考值范圍分別為4.4-12.1mm,4.0-14.0rmm,28.1-60.8rmm。左心室收縮末期SWT、PWT、LVID95%參考值分別為：6.2-15.7mm,7.9-20.8mm,18.1-46.3mm。EDV、ESV、SV、EF95%參考值范圍分別為：55.9-165.7ml,20.9-75.9ml,25.8-98.6ml,39.8%-78.3%。收縮期LVID和舒張期LVID值不同年齡組之間差異有統(tǒng)計(jì)學(xué)差異(P0.05),并且隨著年齡增長(zhǎng)有增大趨勢(shì)。收縮期SWT、舒張期SWT、收縮期PWT、舒張期PWT以及EF值有隨著年齡增長(zhǎng)而增大的趨勢(shì),同時(shí)EDV、ESV、SV值隨著年齡增長(zhǎng)有減小的趨勢(shì),但以上各指標(biāo)在不同年齡組之間的差異均無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。不同性別組分析顯示除EF值無(wú)統(tǒng)計(jì)學(xué)差異以外,其余各指標(biāo)均有統(tǒng)計(jì)學(xué)差異(P0.05),且男性組各指參數(shù)均大于女性組。 結(jié)論：本研究初步制定了左心室形態(tài)、功能相關(guān)參數(shù)的正常參考值,為臨床診斷、危險(xiǎn)評(píng)級(jí)及預(yù)后判斷提供有意義信息。 第三部分利用256iCT對(duì)正常人左心房相關(guān)參數(shù)定量研究 目的：應(yīng)用256iCT對(duì)左心房結(jié)構(gòu)和功能相關(guān)參數(shù)定量研究。 方法：選擇506例行256iCT冠狀動(dòng)脈CTA檢查結(jié)果正常的患者影像資料,所有患者近6個(gè)月之內(nèi)無(wú)心血管疾病病史。確定左心室收縮末期和舒張末期,分別測(cè)量左心房最大容積(Left atrial maximal volume LAVmax)、左心房最小容積(Left atrial minimal volume, LAVmin)、左心房最大前后徑(Left atrial maximal anterior posterior diameter, LADmax)、左心房最小前后徑(Left atrial minimal anterior posterior diameter, LADmin),左心房前壁厚度(Left atrial wall thickness, LAT),并計(jì)算出左心房容積指數(shù)(Left atrial volume index, LAVI)和左心房射血分?jǐn)?shù)(Left atrial ejection fraction, LAEF),進(jìn)行相關(guān)統(tǒng)計(jì)學(xué)處理。 結(jié)果：正常人LAVmax、LAVmin、LADmax、LADmin、LAT、LAVI以及LAEF的95%醫(yī)學(xué)參考值范圍分別為：15.64-82.78ml、9.78-51.34ml、25.75-50.87mm、20.99-45.34mm、1.17-3.15mm、18.90-39.32ml/m224.13%-53.11%。不同年齡組之間LAVmax、LAVmin、LADmin有統(tǒng)計(jì)學(xué)差異(P0.05),40歲以上人群大于40歲以下人群。不同性別之間LAVmax、LAVmin有統(tǒng)計(jì)學(xué)差異(P0.05),男性大于女性,其余各參數(shù)男女之間均無(wú)差異(P0.05)。LAVmax、LAVmin與年齡相關(guān),隨著年齡增長(zhǎng)有增大趨勢(shì)(P0.05)。LAVI、LAEF在不同年齡、性別之間均無(wú)明顯差異。 結(jié)論：本研究初步建立了正常人左心房相關(guān)參數(shù)的醫(yī)學(xué)參考值,為臨床評(píng)估左心房解剖結(jié)構(gòu)和功能提供了參考標(biāo)準(zhǔn)。
[Abstract]:Part 1 accuracy of quantitative measurement of left atrial volume by 256iCT and echocardiography
Objective: To investigate the accuracy of 256 slice spiral CT in measuring left atrial volume.
Methods: (1) four different sizes of left atrium models were made by hand, and two kinds of spiral CT and echocardiography were completed within 24 hours. Automatic measurement of 256iCT post processing workstation, semi-automatic method, echocardiography and real volume were compared. (2) 60 cases of coronary artery CTA examination were selected and entered within 12 hours. The volume of left atrium was measured by echocardiography. 60 patients were grouped by sex, and the differences between the 256iCT post processing workstation and the echocardiography were analyzed for the overall sample group, the male group and the female group.
Results: 1, the results of the left atrial model test showed that there was no significant difference between the CT automatic measurement and the real volume (P0.05), the semi-automatic method, the ultrasonic method and the real volume (P0.05), the difference between the two methods of the clinical sample group was obvious (P0.05), the volume measurement of the left atrium, and the ultrasonic method compared with the 256iCT automatic measurement method. The quantitative value was about 24% lower than that of the 60 clinical samples.
Conclusion: the 256 slice spiral CT can be used for quantitative measurement of left atrial volume. The results are objective, accurate and reproducible. This study has important clinical value.
The second part is a quantitative study of left ventricular anatomy and function using 256iCT.
Objective: to quantitatively study the structure and function of left ventricle in normal subjects by 256iCT, and analyze the relationship between each index and age and sex.
Methods: the imaging data of 506 patients with normal coronary artery CTA findings in 256iCT were collected; all patients had no history of cardiovascular disease for nearly 6 months. Multiphase reconstruction of the original images was carried out to determine the end diastolic and end systolic stage of left ventricular diastolic and end systolic thickness (Septal wall thickness, S) WT), the thickness of the left ventricular posterior wall (Posterior wall thickness, PWT), the width of the left ventricle (LV inner diameter LVID), the end diastolic volume (end-diastolic volume, EDV), the end systolic volume, and the measurement and calculation of the per stroke output and the ejection fraction, and related statistics. Handle.
Results: the reference ranges of left ventricular end diastolic SWT, PWT, and LVID95% were 4.4-12.1mm, 4.0-14.0rmm, 28.1-60.8rmm. left ventricular end systolic SWT, PWT, and LVID95% reference values respectively: 6.2-15.7mm, 7.9-20.8mm, 18.1-46.3mm.EDV. There was a statistical difference between ID and diastolic LVID values in different age groups (P0.05), and increased with age. Systolic SWT, diastolic SWT, systolic PWT, diastolic PWT and EF value increased with age, while EDV, ESV, SV values decreased with age, but the above indexes were different There was no statistical difference between the age groups (P0.05). The analysis of different sex groups showed that there were statistical differences except the EF value (P0.05), and the parameters of each finger in the male group were all larger than those of the female group.
Conclusion: the normal reference value of left ventricular shape and function related parameters is preliminarily established in this study, which provides meaningful information for clinical diagnosis, risk rating and prognosis judgment.
The third part is a quantitative study of left atrial related parameters in normal subjects using 256iCT.
Objective: to quantitatively study the parameters related to the structure and function of left atrium by 256iCT.
Methods: the imaging data of 506 patients with normal 256iCT coronary artery CTA examination were selected. All patients had no history of cardiovascular disease within nearly 6 months. The left ventricular end systolic and terminal diastolic volume (Left atrial maximal volume LAVmax) and the minimum volume of left atrium (Left atrial minimal volume) were measured respectively. The maximum left atrium diameter (Left atrial maximal anterior posterior diameter, LADmax), the minimum left atrium anterior and posterior diameter (Left atrial minimal anterior), left atrial anterior wall thickness, and left atrium volume index (LAVmin), and left atrium volume index (left atrial volume index), and left atrium volume index (left atrium volume index), and left atrium volume index (left atrium volume index), and left atrium volume index (left atrium volume index), and left atrium volume index (left atrium volume index) were calculated. Left atrial ejection fraction (LAEF) was used for statistical analysis.
Results: the 95% medical reference values of normal people LAVmax, LAVmin, LADmax, LADmin, LAT, LAVI and LAEF are respectively 15.64-82.78ml, 9.78-51.34ml, 25.75-50.87mm, 20.99-45.34mm, 1.17-3.15mm, and there are statistical differences. The population over 40 years old is more than 40 years old. There were statistical differences in LAVmax and LAVmin (P0.05) between male and female (P0.05). There was no difference between male and female in male and female (P0.05).LAVmax, LAVmin was associated with age, and increased with age (P0.05).LAVI, and there was no significant difference between sex and sex at different ages.
Conclusion: This study preliminarily establishes the medical reference values of left atrial related parameters in normal people, and provides a reference standard for clinical assessment of the anatomical structure and function of left atrium.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2012
【分類號(hào)】：R816.2

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