本文選題：小腸CT造影 + 腸系膜上靜脈�。� 參考：《天津醫(yī)科大學》2017年碩士論文

【摘要】：目的:研究在增強CT檢查中SMV與小腸腸壁增強效應的關(guān)系,探索新型的對比劑追蹤SMV技術(shù)完成增強CTE掃描的可行性,并將其與傳統(tǒng)的主動脈上對比劑追蹤技術(shù)的三期CTE圖像做對比。方法:通過對無小腸病變的患者進行增強CT掃描,監(jiān)測SMV與小腸腸壁的CT值以得到二者增強效應強度-時間的關(guān)系,確定掃描閾值,并對比劑追蹤SMV自動觸發(fā)掃描技術(shù)完成單期CTE增強檢查,同時回顧分析行傳統(tǒng)三期CTE增強檢查的無小腸病變的患者的圖像,并將這兩種方法所得圖像進行比較。內(nèi)容:(1)選擇無小腸病變者對其進行上腹部單期增強CT檢查,在檢查過程中,由經(jīng)驗豐富的放射科技師選定一個能顯示十二指腸腸壁及腸系膜上靜脈的層面,并設(shè)置ROI分別置于十二指腸腸壁及SMV內(nèi)作為監(jiān)測點,在注射對比劑后35s~55s對此層面進行連續(xù)掃描,平均間隔時間為1s,得出各個時間點上十二指腸腸壁與SMV的CT值,得出二者增強效應強度-時間的關(guān)系,并根據(jù)此關(guān)系得出腸壁增強效應最強時所對應的SMV的CT值,確定掃描閾值。(2)選擇多名無消化道出血癥狀者對其進行增強CTE檢查,不同于傳統(tǒng)增強CT掃描將ROI置于主動脈中,而是將其置于SMV內(nèi),設(shè)定相應閾值并利用自動觸發(fā)技術(shù),完成CTE增強掃描并獲取圖像,將圖像數(shù)據(jù)傳至后處理工作站完成圖像的重建并測量、記錄各組段腸壁的CT值以評價其增強效應的強弱。(3)回顧分析多名曾行三期增強CTE且診斷陰性者,其掃描技術(shù)為利用傳統(tǒng)的主動脈追蹤技術(shù),將ROI置于膈下1cm的腹主動脈內(nèi),設(shè)定相應閾值,利用自動觸發(fā)掃描技術(shù)完成動脈期、腸道期及門脈期三期增強CTE掃描并獲取圖像,將圖像數(shù)據(jù)傳至后處理工作站完成圖像的重建并分別測量、記錄動脈期、腸道期及門脈期三個期相下各組段腸壁的CT值以評價其增強效應的強弱,并與(2)中單期增強CTE所得圖像數(shù)據(jù)進行統(tǒng)計學分析,同時由兩名以上有多年腹部CT診斷經(jīng)驗的副主任(或以上職稱)醫(yī)師對(2)及(3)中所得圖像的診斷效能進行雙盲對比。結(jié)果:(1)CTE受檢者的SMV到達峰值的平均時間為注射對比劑后45.83±6.037s,十二指腸腸壁到達峰值平均時間為注射對比劑后40.24±8.907s,二者時間上的差異無統(tǒng)計學意義(P0.05)。十二指腸腸壁CT值到達峰值的時間點前4s(GE Lightspeed VCT 64排螺旋CT掃描機從觸發(fā)到開始掃描所用反應時間為4s)所對應的SMV的CT值平均為65.87±8.246HU。(2)CTE診斷為陰性的受檢者使用SMV上對比劑追蹤技術(shù)進行單期增強掃描所得各組段腸管腸壁平均CT值分別為:十二指腸115.63±15.38HU、空腸108.57±12.82HU、回腸90.35±13.34HU,各組段腸道CT值差異無統(tǒng)計學意義(P0.05)。(3)CTE診斷為陰性受檢者使用主動脈上對比劑追蹤技術(shù)進行三期增強掃描所得十二指腸、空腸、回腸腸壁平均CT值于動脈期分別為65.68±15.36HU、64.61±20.23HU、60.18±12.25HU;腸道期分別為為117.66±29.87HU、110.37±24.92HU、87.54±18.19HU;門脈期分別為85.76±30.09HU,、78.03±15.43HU、68.56±14.42HU。十二指腸、空腸及回腸腸壁的CT值均是腸道期高于動脈期和門脈期,且差異有統(tǒng)計學意義(P0.05),而動脈期和門脈期差異無統(tǒng)計學意義(P0.05);SMV法所得各組段腸壁CT值與主動脈法所得的腸道期的腸壁CT值間的差異無統(tǒng)計學意義(P0.05),且由兩名經(jīng)驗豐富的放射科診斷醫(yī)師用雙盲法比較這二者圖像質(zhì)量無差異。結(jié)論:使用對比劑追蹤SMV技術(shù)進行CTE單期增強掃描是可行的,而且此方法所得圖像質(zhì)量與傳統(tǒng)三期CTE中對比度最好的腸道期圖像一樣好。
[Abstract]:Objective: To investigate the relationship between SMV and intestinal wall enhancement in enhanced CT, and explore the feasibility of a new contrast agent tracking SMV technique to enhance the CTE scan, and compare it with the three phase CTE images of the traditional aorta contrast agent tracking technique. Method: enhanced CT scan for patients with non intestinal lesions and SMV monitoring SMV The relationship between the CT value of the intestinal wall and the intestinal wall of the small intestine was obtained to obtain the relationship between the two enhancement effect intensity time, the scanning threshold was determined, and the contrast agent tracking SMV automatic trigger scanning technique was used to complete the single phase CTE enhancement examination. Meanwhile, the images of the patients with the traditional three phase CTE enhanced examination of the non intestinal lesions were analyzed, and the images obtained by the two methods were compared. (1) a single phase enhanced CT examination of the upper abdomen was performed on the patients without small intestinal lesions. During the examination, an experienced radiologist selected a level that could display the duodenum and the superior mesenteric vein, and set the ROI in the duodenum wall and SMV as the monitoring point, and after the injection of contrast agent, the 35s~55s layer was taken. Continuous scanning, the average interval time is 1s, the CT value of the duodenum wall and SMV at each time point is obtained, and the relationship between the two enhancement effect intensity time is obtained. According to this relationship, the CT value of the corresponding SMV when the strongest intestinal wall enhancement effect is strongest and the scanning threshold is determined. (2) select multiple symptoms of no digestive tract bleeding to them. The enhanced CTE examination, unlike the traditional enhanced CT scan, placed the ROI in the aorta, but placed it in the SMV, set the corresponding threshold and use the automatic trigger technique to complete the CTE enhancement scan and obtain the image. The image data was passed to the post processing workstation to complete the reconstruction and measurement of the image, and the CT value of the intestinal wall of each segment was recorded to evaluate its enhancement effect. (3) review and analyze a retrospective analysis of a number of three phase enhanced CTE and negative diagnosis. The scanning technique was used to use the traditional aorta tracking technique to place ROI in the abdominal aorta of the 1cm under the diaphragm, set the corresponding threshold, complete the arterial phase by automatic trigger scanning technique, and enhance the CTE scan and obtain the image in the three stage of the intestinal phase and portal period. Like data to the post processing workstation, the images were reconstructed and measured respectively. The CT values of the intestinal wall of each group in the three phases of the arterial phase and the portal phase were recorded to evaluate the strength of the enhancement effect, and the data were statistically analyzed with the single phase enhanced CTE in the (2) period, and the diagnostic experience of the abdominal CT in the abdomen of more than two years was also made. The assistant director (or above title) doctors compared the diagnostic efficiency of the images obtained in (2) and (3). Results: (1) the average time of the SMV reaching the peak of the CTE subjects was 45.83 + 6.037s after the injection contrast, the average time of the peak of duodenal wall was 40.24 + 8.907s after the injection contrast agent, and the difference in the two time was not statistically significant. P0.05. The CT value of the duodenum wall of the duodenum reached the peak time point before 4S (GE Lightspeed VCT 64 spiral CT scanner from the trigger to the beginning of the scan the reaction time is 4S), the average of CT values of SMV (2) CTE diagnosed as negative with the contrast agent tracking technique for single phase enhanced scan The average CT value of intestinal intestinal wall was 115.63 + 15.38HU in duodenum, 108.57 12.82HU in jejunum and 90.35 in ileum. There was no significant difference in CT value of intestinal tract in each group (P0.05). (3) CTE diagnosed as negative subjects using aorta contrast agent tracking technique for three phase enhanced scan of duodenum, jejunum, ileum wall average The value of CT was 65.68 + 15.36HU, 64.61 + 20.23HU and 60.18 + 12.25HU in the arterial phase, and the intestinal period was 117.66 + 29.87HU, 110.37 + 24.92HU, 87.54 + 18.19HU, respectively, 85.76 + 30.09HU, 78.03 + 15.43HU, 68.56 + 14.42HU. duodenum, and the intestinal and ileum intestinal wall was higher than that of the arterial and portal phases. There was statistical significance (P0.05), but there was no significant difference between the arterial phase and the portal phase (P0.05). There was no significant difference between the CT value of the intestinal wall of each segment of the SMV method and the CT value of the intestinal wall in the enteric stage of the aorta (P0.05), and the two experienced radiologists compared the quality of the images with the double blind method. Theory: it is feasible to use contrast agent tracking SMV technique for CTE single phase enhanced scan, and the image quality obtained by this method is as good as the best enteric phase image in the traditional three phase CTE.
【學位授予單位】：天津醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R816.5

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