本文選題：冠狀動(dòng)脈成像 + X線計(jì)算機(jī)�。� 參考：《遼寧醫(yī)學(xué)院》2012年碩士論文

【摘要】：目的 探討不同心率及心律失常對(duì)心臟冠脈成像圖像質(zhì)量的影響及不同心率下最佳重建時(shí)相的選擇，并進(jìn)一步探討心電編輯技術(shù)在心律失常患者CT冠狀動(dòng)脈成像中的應(yīng)用價(jià)值。 方法 收集本院2010年4月至2011年3月間行128層螺旋CT掃描冠狀動(dòng)脈成像檢查（MSCTCA）的患者159例，其中男89例，女70例，年齡（32~86）歲，平均年齡（56±12）歲，平均心率為（64±14）bpm。 納入標(biāo)準(zhǔn)：無(wú)碘過(guò)敏史，無(wú)嚴(yán)重的心、肝及腎功能不全，檢查前心率大于70次/分（Beat Per Minute，bpm）的患者服用β-受體阻滯劑降低心率。 排除標(biāo)準(zhǔn)：孕婦和肝、腎功能不全和不能屏氣10s以上者；因患有精神疾病不能按指令屏住呼吸者等。所有患者均簽署檢查知情同意書。 按心律不同分為心律正常組A組及心律失常組B組，其中A組又分為正常心率A1組（HR≤65bpm），臨界心率A2組（65＜HR≤75bpm）及高心率A3組（HR＞75bpm），B組進(jìn)行心電編輯后為B’組。A1組40人，A2組38人，A3組38人，B組43人。所有的冠狀動(dòng)脈圖像質(zhì)量按~IV等級(jí)（4分，3分，2分，1分）分段進(jìn)行由兩名中級(jí)以上醫(yī)師進(jìn)行雙盲測(cè)評(píng)分，當(dāng)出現(xiàn)爭(zhēng)議時(shí)由第三名醫(yī)師中級(jí)以上進(jìn)行判定，記錄各支不同時(shí)相（10%~90%）的圖像質(zhì)量及其最佳重建重建時(shí)相。A組只評(píng)價(jià)RCA1~3，LAD1~3及LCX1~2，B組則分別評(píng)價(jià)心電編輯前后全部15段冠狀動(dòng)脈的評(píng)分。 所有數(shù)據(jù)采用spss17.0統(tǒng)計(jì)軟件包分析數(shù)據(jù)，計(jì)量資料用x S表示，采用T檢驗(yàn)或單因素方差分析；計(jì)數(shù)資料用例數(shù)或百分?jǐn)?shù)（%）表示，用卡方檢驗(yàn)；等級(jí)資料采用非參數(shù)秩和檢驗(yàn)，所有統(tǒng)計(jì)學(xué)結(jié)果均以α=0.05為檢驗(yàn)水準(zhǔn)，P＜0.05為差異有統(tǒng)計(jì)學(xué)意義，P＜0.01為差異有顯著統(tǒng)計(jì)學(xué)意義。 結(jié)果 1．不同心率組最佳重建時(shí)相的選擇 A1、A2、A3三組各主要分支平均質(zhì)量評(píng)分峰值集中在收縮末期（35%~45%）及舒張中期（65%~80%），成“雙峰樣”，A組中78例患者(67.24%)選擇舒張中期作為最佳時(shí)相，21例患者（18.10%）選擇收縮末期作為最佳時(shí)相，另有17例患者(14.65%）左冠狀動(dòng)脈和右冠狀動(dòng)脈圖像質(zhì)量不能在同一時(shí)相達(dá)到最佳，需分別采用兩個(gè)時(shí)相評(píng)估。 A1組的RCA、LAD、LCX平均圖像質(zhì)量評(píng)分分別在75%，75%，70%時(shí)相達(dá)到最高，A2組的RCA、LAD、LCX平均圖像質(zhì)量評(píng)分均在70%時(shí)相達(dá)到最高。A3組的LAD、LCX平均圖像質(zhì)量評(píng)分在70%及60%時(shí)達(dá)到最高，而RCA則在35%時(shí)相時(shí)達(dá)到最高。 2．不同心率組間各主要冠狀動(dòng)脈圖像質(zhì)量比較 A1組與A2組的主要冠狀動(dòng)脈分支評(píng)分的優(yōu)良率（評(píng)分≥3的比例），，分別為96.56%及94.36%，而A3組的優(yōu)良率僅為86.75%。兩兩比較三組的圖像質(zhì)量平均分，A1組與A2組各支間無(wú)明顯統(tǒng)計(jì)學(xué)差異（P＞0.05），A3組與A1組、A2組各支均有明顯統(tǒng)計(jì)學(xué)差異（P＜0.05） 3．心電編輯后B'組與編輯前B組及正常心率A1組的圖像質(zhì)量比較 B’組所有冠狀動(dòng)脈節(jié)段經(jīng)Wilcoxon配對(duì)法檢驗(yàn)與編輯前B組比較，其中右主干（RCA1）及左主干（LM）編輯前后圖像質(zhì)量差異無(wú)統(tǒng)計(jì)學(xué)意義（P＞0.05）；其他冠狀動(dòng)脈均有統(tǒng)計(jì)學(xué)差異（P＜0.01）。 B'組與A1組比較，兩組的質(zhì)量評(píng)分經(jīng)方差分析，LCX的統(tǒng)計(jì)學(xué)未見(jiàn)明顯差異（P＞0.05），RCA與LAD仍有統(tǒng)計(jì)學(xué)差異（P＜0.05），但兩組的RCA，LAD，LCX的優(yōu)良率經(jīng)卡方檢驗(yàn)并無(wú)統(tǒng)計(jì)學(xué)差異（P＞0.05）。 結(jié)論 第一：心率及心律仍是冠狀動(dòng)脈圖像質(zhì)量的主要影響因素。心率越高圖像質(zhì)量越差，其中RCA最易受心率影響。心律失�；颊邎D像質(zhì)量普遍偏低，必要時(shí)需做心電編輯等后處理補(bǔ)救。 第二：MSCTCA最佳時(shí)相呈“雙峰”樣分布。HR＜75bpm時(shí)最佳重建時(shí)相多為舒張中期，HR≥75bpm時(shí)最佳重建時(shí)相多為收縮末期。部分心率較快患者需采用多期重建時(shí)相，大多數(shù)患者LAD最佳時(shí)相仍為75%，而LCX及RCA的最佳時(shí)相則多為55%~65%及35%~45%。 第三：心電編輯技術(shù)可明顯改善大多數(shù)因心律失常而產(chǎn)生的冠狀動(dòng)脈偽影，使圖像質(zhì)量滿足診斷要求，擴(kuò)大了MSCTCA檢查的適應(yīng)癥范圍，但心電編輯對(duì)頻發(fā)的期前收縮及快速房顫等復(fù)雜的心律失常仍有一定局限性，應(yīng)針對(duì)具體情況綜合考慮。
[Abstract]:objective
To explore the effect of cardiac arrhythmia and arrhythmia on the image quality of coronary artery imaging and the selection of optimal reconstruction phase under the heart rate, and to further explore the application value of ECG editing technique in coronary artery imaging of CT for arrhythmia patients.
Method
159 cases of 128 slice spiral CT scan coronary angiography (MSCTCA) were collected from April 2010 to March 2011 in our hospital. There were 89 men, 70 women, age (32~86) years, average age (56 + 12) years, and the average heart rate was (64 + 14) bpm..
Inclusion criteria: a history of anaphylaxis without iodine, no serious heart, liver and renal insufficiency, and a patient with a pre test heart rate greater than 70 Beat Per Minute (BPM) taking beta blocker to reduce heart rate.
Exclusion criteria: pregnant women and liver, kidney dysfunction, and inability to hold breath or more than 10s; people who have mental illness can not hold their breath according to instructions. All patients sign informed consent.
According to the different rhythm of the heart rhythm, the A group and the arrhythmia group B group were divided into the normal heart rate group (HR < 65bpm), the critical heart rate A2 group (65 < HR < < 75bpm) and the high heart rate A3 group (HR > 75bpm). The group carried out the electrocardiographic editing group of 40 persons, 38 people, 38 people, 43 people. At the level (4, 3, 2, 1), a double blind score was carried out by two intermediate doctors and above. When there was a dispute, third doctors and above were judged, the image quality of each branch (10%~90%) and the best reconstruction and reconstruction phase.A were evaluated only by RCA1~3, LAD1~3 and LCX1~2, and the B group evaluated the editors before and after editors respectively. All 15 segments of coronary artery score.
All data were analyzed by SPSS17.0 statistical software package, and the measurement data were expressed in X S, using T test or single factor variance analysis, the number of use cases or percent (%) was expressed with the chi square test. The grade data were tested with non parametric rank and test, all statistical results were tested with alpha =0.05, P < 0.05 was statistically significant. Significance, P < 0.01 was significant statistically significant.
Result
The selection of the best reconstruction phase in 1. non concentric rate groups
The average mass score of A1, A2 and A3 three groups was concentrated at the end of systolic (35%~45%) and medium-term diastolic (65%~80%), "Shuangfeng like". In group A, 78 patients (67.24%) chose the middle diastolic phase as the best phase, 21 patients (18.10%) selected the end systolic phase as the best phase, and 17 patients (14.65%) left coronary artery and right coronal coronary artery. The quality of arterial images can not be optimal at the same time, and two time phases should be used respectively.
The average image quality score of RCA, LAD, and LCX in group A1 reached the highest level at 75%, 75% and 70% respectively. The average image quality score of RCA, LAD and LCX in A2 group reached the highest.A3 group of LAD, the LCX average image quality score reached the highest at 70% and 60%, while RCA then reached the highest when 35% phase.
2. comparison of image quality of main coronary arteries between different heart rate groups
The good rate of the main coronary artery branch score in group A1 and group A2 (the proportion of score above 3) was 96.56% and 94.36% respectively, and the good rate of group A3 was only the average score of image quality in the three groups of 86.75%. 22. There was no significant difference between the A1 group and the A2 group (P > 0.05), A3 and A1 groups and A2 groups had significant statistical differences (P < 0.05).
Comparison of image quality between B'group and pre edit B group and normal heart rate A1 group after 3. ECG editing
All coronary artery segments in B 'group were tested by Wilcoxon matching and before edited B group, and there was no statistical difference between the right main trunk (RCA1) and left main trunk (LM) before and after editing (P > 0.05), and the other coronary arteries were statistically different (P < 0.01).
Compared with group A1, the quality score of the two groups was not significantly different between the two groups by analysis of variance (P > 0.05), and there was still statistical difference between RCA and LAD (P < 0.05), but there was no statistical difference between the two groups of RCA, LAD, LCX (P > 0.05).
conclusion
First: heart rate and heart rhythm are still the main factors affecting the image quality of coronary artery. The higher the heart rate is, the worse the image quality is, and the RCA is the most susceptible to the heart rate. The image quality of the arrhythmia patients is generally low, and the post-processing remedies should be done when necessary.
Second: when the best phase of MSCTCA is "Shuangfeng" like.HR < 75bpm, the best reconstruction phase is mostly mid diastolic phase, and the best reconstruction phase is the end systolic phase when HR is more than 75bpm. Some patients with relatively fast heart rate need to adopt multiphase reconstruction phase, most of the patients with the best phase of LAD are still 75%, while the best phase of LCX and RCA is mostly 55%~65% and 35%~45%..
Third: electrocardiogram editing technology can obviously improve most of the coronary artifacts caused by arrhythmia, make the image quality meet the diagnostic requirements and expand the range of indications for MSCTCA examination. However, ECG editors still have some limitations on the complicated arrhythmia, such as frequent premature contraction and rapid atrial fibrillation, and should be integrated with specific conditions. Consider.
【學(xué)位授予單位】：遼寧醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2012
【分類號(hào)】：R816.2

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 黃俊;程濤;;64層螺旋CT對(duì)冠狀動(dòng)脈疾病診斷價(jià)值的回顧性分析[J];安徽醫(yī)學(xué);2011年04期

2 厙鑫;董大偉;;CT冠脈成像對(duì)心肌橋的診斷及其意義[J];包頭醫(yī)學(xué)院學(xué)報(bào);2009年01期

3 呂訪賢;呂頑;李絮綠;莫鴻忠;龐統(tǒng)權(quán);;影響雙源CT冠脈成像圖像質(zhì)量的相關(guān)因素分析[J];當(dāng)代醫(yī)學(xué);2010年19期

4 高珊;劉克堅(jiān);邱強(qiáng);;冠心病診斷技術(shù)研究進(jìn)展[J];中華實(shí)用診斷與治療雜志;2010年04期

5 羅竹人;張同;申寶忠;王丹;王宇超;;64排螺旋CT冠狀動(dòng)脈成像對(duì)心肌橋的評(píng)估[J];哈爾濱醫(yī)科大學(xué)學(xué)報(bào);2010年02期

6 裴曉陽(yáng);張向隆;李松;顏雯;楊冀衡;;64層螺旋CT冠狀動(dòng)脈成像與冠狀動(dòng)脈造影對(duì)照研究[J];吉林醫(yī)學(xué);2011年20期

7 陳少源;方紅城;徐素玲;王磊;陳菲;張志杰;宋其琴;;雙源CT評(píng)價(jià)冠狀動(dòng)脈支架內(nèi)再狹窄的意義[J];臨床心血管病雜志;2010年09期

8 陳力秀;李若谷;關(guān)韶峰;方唯一;;動(dòng)態(tài)心電圖與平板運(yùn)動(dòng)試驗(yàn)對(duì)冠心病的診斷價(jià)值[J];中國(guó)臨床醫(yī)學(xué);2008年04期

9 于淑靖;李忠信;馬國(guó)軍;;64MSCT對(duì)冠狀動(dòng)脈支架通暢性評(píng)價(jià)的準(zhǔn)確性與支架材料的關(guān)系[J];中國(guó)臨床醫(yī)學(xué)影像雜志;2007年10期

10 王安明;史躍;朱麗麗;趙漢青;李皖隴;陳凱;高從敬;;雙源CT冠狀動(dòng)脈血管成像評(píng)價(jià)心肌橋與冠狀動(dòng)脈粥樣硬化性病變的關(guān)系[J];中國(guó)臨床醫(yī)學(xué)影像雜志;2010年08期

本文編號(hào)：2016104