【摘要】：【目的】探討心臟起搏器或植入型心律轉(zhuǎn)復(fù)除顫器導(dǎo)線穿孔患者心臟多層螺旋CT增強(qiáng)掃描的影像學(xué)表現(xiàn)和診斷價(jià)值�！痉椒ā糠治鼋�(jīng)臨床、多種影像學(xué)檢查及手術(shù)探查等證實(shí)的10例導(dǎo)線穿孔患者的心臟CT表現(xiàn),判斷導(dǎo)線穿孔與否、穿孔位置、有否合并心包積液、有無對(duì)比劑漏出至心包腔內(nèi)、導(dǎo)線及其頭端偽影�！窘Y(jié)果】10例患者中僅1例胸部X線可明確診斷,6例超聲心動(dòng)圖結(jié)合新發(fā)心包積液及起搏器程控參數(shù)診斷導(dǎo)線穿孔。心臟CT檢查含常規(guī)CT增強(qiáng)掃描5例,序貫式心電門控CT增強(qiáng)掃描及隨后的延遲增強(qiáng)掃描5例,CT診斷明確導(dǎo)線穿孔5例,可疑導(dǎo)線穿孔5例。穿孔位于右心尖7例,右室膈面2例,右心房后上壁1例。少至大量心包積液8例,無心包積液2例。5例行延遲增強(qiáng)掃描,均未發(fā)現(xiàn)對(duì)比劑延遲外漏至心包腔。10例行常規(guī)CT增強(qiáng)掃描患者(含5例心電門控掃描后的延遲增強(qiáng)掃描),所有患者導(dǎo)線及導(dǎo)線頭端均產(chǎn)生運(yùn)動(dòng)偽影;9例患者導(dǎo)線產(chǎn)生中、重度金屬偽影,1例患者導(dǎo)線未產(chǎn)生金屬偽影;8例患者導(dǎo)線頭端產(chǎn)生中、重度金屬偽影,2例患者導(dǎo)線頭端產(chǎn)生輕度金屬偽影。5例行心電門控CT增強(qiáng)掃描患者,導(dǎo)線及導(dǎo)線頭端均未產(chǎn)生運(yùn)動(dòng)偽影;2例患者導(dǎo)線產(chǎn)生輕度金屬偽影,3例患者導(dǎo)線未產(chǎn)生金屬偽影;4例患者導(dǎo)線頭端產(chǎn)生輕度金屬偽影,1例患者導(dǎo)線頭端產(chǎn)生中度金屬偽影�！窘Y(jié)論】多層螺旋CT增強(qiáng)掃描有助于明確導(dǎo)線穿孔,尤其是心電門控增強(qiáng)掃描因減輕導(dǎo)線及其頭端的運(yùn)動(dòng)偽影和金屬偽影,可提高診斷準(zhǔn)確率。
[Abstract]:[objective] to investigate the imaging features and diagnostic value of multilayer spiral CT in patients with cardiac pacemaker or implantable cardioverter defibrillator traverse perforation. The cardiac CT findings of 10 patients with perforation confirmed by various imaging examinations and surgical explorations were used to determine the perforation or not, the location of the perforation, the presence of pericardial effusion, and the leakage of contrast agents into the pericardial cavity. [results] only 1 case of 10 patients could be diagnosed by chest X-ray, 6 cases by echocardiography combined with new pericardial effusion and programmed parameters of pacemaker to diagnose wire perforation. Cardiac CT included conventional CT enhanced scan in 5 cases, sequential gated CT enhanced scan in 5 cases and delayed enhancement scan in 5 cases. CT diagnosis confirmed traverse perforation in 5 cases and suspicious traverse perforation in 5 cases. The perforations were located at the apical of the right heart in 7 cases, on the phrenic surface of the right ventricle in 2 cases and on the posterior superior wall of the right atrium in 1 case. As few as 8 cases of pericardial effusion, 2 cases of no pericardial effusion, 5 cases of delayed contrast enhanced scan, no delayed leakage of contrast agent into pericardial cavity. 10 cases of routine CT enhanced scanning (including 5 cases of delayed enhanced scan after ECG gated scan). Motion artifacts were produced in all patients with traverse and the head of the wire. In 9 cases, the metal artifacts were found in severe cases, while in 1 case, metal artifacts were not produced in the leads of the patients. In 8 cases, severe metal artifact was produced in the head end of the lead, and light metal artifact was produced in the head end of the lead in 2 cases. 5 cases were examined by ECG gated CT enhanced scan, and no motion artifacts were found in the lead and the head end of the lead. Light metal artifacts were produced in 2 patients' wires, and no metal artifacts were produced in 3 patients' wires. Light metal artifacts were produced at the head end of the lead in 4 cases and moderate metal artifacts at the head end of the lead in 1 case. [conclusion] Multi-layer spiral CT enhanced scanning is helpful to identify the perforation of the wire. Especially, ECG gated enhanced scan can improve the diagnostic accuracy by reducing the moving artifacts and metal artifacts of the wire and its head.
【作者單位】： 中山大學(xué)孫逸仙紀(jì)念醫(yī)院放射科;中山大學(xué)孫逸仙紀(jì)念醫(yī)院心內(nèi)科//廣東省心電生理和心律失常重點(diǎn)實(shí)驗(yàn)室;
【基金】：廣東省科技計(jì)劃項(xiàng)目(2015020210043)
【分類號(hào)】：R541;R816.2

【相似文獻(xiàn)】

相關(guān)期刊論文 前10條

1 郝慧敏,侯巧云;淺述96例CT增強(qiáng)掃描護(hù)理體會(huì)[J];河南實(shí)用神經(jīng)疾病雜志;2000年06期

2 秦勝碧,羅才旭;縣級(jí)醫(yī)院CT增強(qiáng)掃描的護(hù)理體會(huì)[J];川北醫(yī)學(xué)院學(xué)報(bào);2001年03期

3 魏秀芳,郎玉玲,潘宏;CT增強(qiáng)掃描中的護(hù)理[J];牡丹江醫(yī)學(xué)院學(xué)報(bào);2002年03期

4 莊光華,崔風(fēng)玉;高�；颊逤T增強(qiáng)掃描的護(hù)理體會(huì)[J];山東醫(yī)藥;2003年14期

5 張萍,魏金枝,盧占興,張廷,艾萍,熊莉;CT增強(qiáng)掃描中實(shí)施心理干預(yù)的效果觀察[J];華北煤炭醫(yī)學(xué)院學(xué)報(bào);2003年04期

6 戴燕雪;健康教育對(duì)患者接受CT增強(qiáng)掃描的影響[J];齊魯護(hù)理雜志;2003年01期

7 王寧蘭;腦占位CT增強(qiáng)掃描前后的護(hù)理[J];實(shí)用醫(yī)技雜志;2003年01期

8 周良,高燕萍;老年人CT增強(qiáng)掃描的護(hù)理體會(huì)[J];中國基層醫(yī)藥;2003年12期

9 韓淑容;CT增強(qiáng)掃描的護(hù)理體會(huì)[J];現(xiàn)代醫(yī)藥衛(wèi)生;2004年22期

10 王國香,田維澤,國京芳,江志勇,董學(xué)萍;老年病人SCT增強(qiáng)掃描的護(hù)理[J];實(shí)用心腦肺血管病雜志;2005年06期

相關(guān)會(huì)議論文 前10條

1 李鷹;;MRI增強(qiáng)掃描患者檢查的護(hù)理[A];中華護(hù)理學(xué)會(huì)全國門、急診護(hù)理學(xué)術(shù)交流暨專題講座會(huì)議論文匯編[C];2009年

2 陳洪玲;;淺談護(hù)理工作在64層螺旋CT增強(qiáng)掃描中的重要性[A];2009中華醫(yī)學(xué)會(huì)影像技術(shù)分會(huì)第十七次全國學(xué)術(shù)大會(huì)論文集[C];2009年

3 尤志軍;;MRI增強(qiáng)掃描中副反應(yīng)原因及預(yù)防措施[A];2009中華醫(yī)學(xué)會(huì)影像技術(shù)分會(huì)第十七次全國學(xué)術(shù)大會(huì)論文集[C];2009年

4 陳洪玲;;護(hù)理工作在64層螺旋CT增強(qiáng)掃描中的應(yīng)用探討[A];2010中華醫(yī)學(xué)會(huì)影像技術(shù)分會(huì)第十八次全國學(xué)術(shù)大會(huì)論文集[C];2010年

5 舒曉靈;;人性化護(hù)理在老年患者CT增強(qiáng)掃描中的應(yīng)用探討[A];2010中華醫(yī)學(xué)會(huì)影像技術(shù)分會(huì)第十八次全國學(xué)術(shù)大會(huì)論文集[C];2010年

6 焦興華;張朝利;王宗燁;費(fèi)軍;耿振林;;心理護(hù)理在CT增強(qiáng)掃描中的作用——附121例[A];中國人民解放軍醫(yī)學(xué)會(huì)第九屆放射診療專業(yè)學(xué)會(huì)論文集[C];2005年

7 張家福;;CT增強(qiáng)掃描對(duì)肺孤立性病灶的診斷價(jià)值[A];中華醫(yī)學(xué)會(huì)第十三屆全國放射學(xué)大會(huì)論文匯編（下冊）[C];2006年

8 陳霖;;CT增強(qiáng)掃描中靜脈注射的幾點(diǎn)護(hù)理體會(huì)[A];中華醫(yī)學(xué)會(huì)第十三屆全國放射學(xué)大會(huì)論文匯編（下冊）[C];2006年

9 趙云;汪令生;瞿凱旋;;MSCT增強(qiáng)掃描溫馨靜脈流程探索[A];全國靜脈輸液治療護(hù)理學(xué)術(shù)交流會(huì)議論文匯編[C];2012年

10 劉丹;;對(duì)小兒CT增強(qiáng)掃描中不良反應(yīng)的觀察及干預(yù)措施[A];2013年河南省神經(jīng)系統(tǒng)疾病護(hù)理新進(jìn)展學(xué)術(shù)會(huì)議論文集[C];2013年

相關(guān)重要報(bào)紙文章 前1條

1 古建;什么是增強(qiáng)掃描[N];醫(yī)藥養(yǎng)生保健報(bào);2006年

相關(guān)博士學(xué)位論文 前1條

1 李海鷗;低劑量胰腺CT灌注成像聯(lián)合雙能量增強(qiáng)掃描在胰腺癌診斷中的應(yīng)用[D];山東大學(xué);2015年

相關(guān)碩士學(xué)位論文 前3條

1 黃晶;脊柱磁共振增強(qiáng)掃描對(duì)兒童格林—巴利綜合征的診斷價(jià)值[D];重慶醫(yī)科大學(xué);2013年

2 羅麗;T_1W/WATS/FFE增強(qiáng)掃描聯(lián)合DWI評(píng)估胰腺癌價(jià)值的研究[D];瀘州醫(yī)學(xué)院;2011年

3 瑪依拉·夏侃;乳腺磁共振增強(qiáng)掃描后Ⅱ型曲線的臨床意義[D];新疆醫(yī)科大學(xué);2013年

，

本文編號(hào)：2322508