【摘要】：目的：以數(shù)字減影血管造影（DSA）金標準為基礎，規(guī)范多層螺旋CT門靜脈造影(MSCTP)的成像方法。 方法：采用健康中國貴州成年小型豬16只為研究對象,以門靜脈最佳顯示層面為中心，在全麻下采用同層動態(tài)掃描方式行16層螺旋CT動態(tài)掃描,成像速度1幀/s,循環(huán)45次。運用灌注軟件包分析，生成時間-密度曲線，獲得門靜脈強化峰值所對應的最佳顯影時間點（TTP）。待動物體內(nèi)造影劑代謝完全后，利用TTP，行MSCT門靜脈血管造影（MSCTP），并使用最大密度投影（MIP）及多平面容積重建（MPVR），可以清晰顯示門脈主干及屬支，并測量門靜脈主干及屬支直徑。采用DSA行間接門靜脈造影電影采集，測量門靜脈最佳顯影時間及門脈主干、屬支管徑。對比分析MSCTP及DSA兩種技術(shù)下測量門靜脈系統(tǒng)最佳顯影時間及管徑。 結(jié)果：（1）MSCTP與DSA門靜脈TTP分別為39.73±8.27s與14.40±0.75s，MSCTP測得的TTP明顯長于DSA（p 0.05），但二者具有良好的相關(guān)性（r=0.749，p 0.05）。（2）MSCTP測得的門靜脈主干管徑（PVD）、腸系膜靜脈管徑（SMVD）及脾靜脈管徑（SPVD）分別為8.50±0.801mm、7.13±0.71mm、5.54±0.89mm，DSA測得的相應管徑分別為7.65±1.17mm、5.74±1.05mm、5.03±0.98mm，MSCTP測定的相應管徑值均高于DSA（p 0.05）；但兩種技術(shù)下測得的對應管徑值具有良好相關(guān)性（r=0.700，0.624and0.958，respectively，all p 0.05）。 結(jié)論：多層螺旋CT動態(tài)掃描可優(yōu)化門靜脈CT成像技術(shù)，MSCTP將有助于門靜脈系統(tǒng)的形態(tài)學分析，為肝硬化門脈高壓相關(guān)研究提供規(guī)范化MSCTP技術(shù)。 目的：(1)探討以CT動態(tài)增強掃描中門靜脈強化達峰時間（TTP）為基礎的在肝纖維化及肝硬化的規(guī)范門靜脈成像掃描時間窗。(2)應用規(guī)范化門靜脈成像，探討門靜脈系統(tǒng)管徑對實驗性肝纖維化及肝硬化的診斷價值。(3)分析肝纖維化及肝硬化過程中門靜脈系統(tǒng)管徑與肝儲備功能的相關(guān)性。 材料與方法：使用健康中國小型豬16只，采用四氯化碳(CC14)制造肝纖維化及肝硬化模型。實驗動物正常（第0周）至自建模開始后第5周、第9周、第16周及第21周接受CT動態(tài)增強掃描，獲得門靜脈強化程度達到峰值時間，以此確定門靜脈最佳成像時間，并以此為門靜脈成像延遲時間行門靜脈成像掃描，并測量門靜脈主干管徑（PVD）、腸系膜上靜脈管徑（SMVD）、脾靜脈管徑（SVD），同時統(tǒng)計分析上述參數(shù)在疾病發(fā)展過程中的變化規(guī)律及診斷價值。造模開始后第0、5、9、16、21周同時進行肝穿刺活檢及肝儲備功能生化指標檢測。 結(jié)果：（1）TTP在從肝臟正常進展到肝纖維化再到肝硬化病程中的變化規(guī)律：在實驗動物肝纖維化與肝硬化發(fā)展過程中，門靜脈達峰時間（TTP）隨疾病進展逐漸延長(r=0.234; p0.05)，并在肝正常，肝纖維化及肝硬化中存在明顯差異(p＜0.05)。（2）肝纖維化與肝硬化的規(guī)范化門靜脈成像時間臨界點：CT規(guī)范化門靜脈成像時間，肝纖維化期掃描延遲時間窗為約為40.5-47秒；肝硬化時延遲時間最短約為47秒。（3）規(guī)范化CT門靜脈成像時間窗在肝纖維化及肝硬化中的應用：在實驗動物肝纖維化與肝硬化發(fā)展過程中，PVD（r=0.613）、SMVD（r=0.424）、SVD（r=0.272）逐漸增粗，其中SVD增大最為明顯（p＜0.05）。（4）規(guī)范化門靜脈成像門靜脈系統(tǒng)管徑與肝儲備功能的相關(guān)性：SVD與肝儲備功能各項指標均相關(guān)（r=-0.419、0.359、0.35，，respectively; all p0.05）；PVD、SMVD與肝功能各項指標不相關(guān)或不完全相關(guān)。(5)在診斷肝纖維化ROC曲線中，僅SVD有診斷意義，其曲線下面積為0.883；PVD和SVD均對診斷肝硬化有意義，其ROC曲線下面積依次0.744和0.752，其中SVD曲線下面積較大(p 0.05)。 結(jié)論：CT動態(tài)增強掃描獲得的TTP有助于規(guī)范CT門靜脈成像掃描時間窗，規(guī)范化門靜脈成像SVD對診斷肝纖維化及肝硬化具有重要價值。
[Abstract]:Objective: To study the imaging method of multi-slice spiral CT portography (MSCTP) based on the digital subtraction angiography (DSA) gold standard. Methods: 16 adult small-scale pigs in Guizhou were used as the research object. The optimal display level of portal vein was the center. The dynamic scanning of 16-layer spiral CT was performed by the same layer dynamic scanning mode under general anesthesia. The imaging speed was 1 frame/ s, and the circulation was 45. times. The time-density curve is generated by using the perfusion software package to obtain the optimal developing time point (TTP) corresponding to the peak value of the portal vein.) After the metabolism of the contrast agent in the body of the animal is complete, using the TTP, the MSCT portal vein angiography (MSCTP) and the maximum density projection (MIP) and the multi-plane volume reconstruction (MPVR), the main stem and the branch of the portal vein can be clearly displayed, and the portal trunk and the branch of the portal vein are measured. Path: The optimal development time of the portal vein and the trunk of the main stem of the portal vein were measured by means of DSA line indirect portal venography. Method for measuring the optimal developing time and tube of portal vein system under two kinds of techniques: MSCTP and DSA Results: (1) The portal TTP of MSCTP and DSA was 39.73, 8.27s and 14.40-0.75s, and the TTP measured by MSCTP was significantly longer than that of DSA (p-0.05), but both had good correlation (r = 0.749, p-0). (2) The diameter of the portal vein (PVD), the diameter of the mesenteric vein (SMVD) and the diameter of the splenic vein (SPVD) measured by the MSCTP were 8.50, 0.801mm, 7.13, 0.71mm, 5.54 and 0.89mm, respectively. The corresponding pipe diameters measured by the DSA were 7.65, 1.17mm, 5.74, 1.05mm, 5.03 and 0.9. The value of the corresponding pipe diameter measured by MSCTP was higher than that of DSA (p-0.05); however, the corresponding pipe-diameter values measured under the two techniques had a good correlation (r = 0.700, 0.6424 and 0.958, respectively, all p 0. Conclusion: The multi-slice spiral CT dynamic scan can optimize the portal CT imaging technique, and the MSCTP will be helpful to the morphological analysis of the portal vein system and to provide the standardized MS for the high-pressure related research of the portal vein of the liver cirrhosis. Objective: (1) To explore the standard portal vein for hepatic fibrosis and liver cirrhosis, which is based on the portal vein enhanced peak time (TTP) in the CT dynamic enhanced scan. imaging scanning time window. (2) The portal vein imaging was applied to investigate the effect of the diameter of the portal vein on the experimental liver fibrosis and the liver. Diagnostic value of sclerotherapy. (3) Analysis of hepatic fibrosis and portal system diameter and liver storage in the course of liver cirrhosis Correlation of preparation function. Materials and methods: using 16 healthy Chinese small pigs, and using carbon tetrachloride (CC14) to make liver Model of fibrosis and cirrhosis. The experimental animals were normal (Week 0) to Week 5, Week 9, Week 16, and Week 21 after the start of the modeling, and the CT dynamic enhanced scan was performed at Week 9, Week 16, and Week 21 to obtain a peak time for portal enhancement to determine The optimal imaging time of the portal vein was performed, and the portal vein image was scanned by the portal vein imaging delay time, and the main diameter of the portal vein (PVD), the superior mesenteric vein diameter (SMVD) and the splenic vein diameter (SVD) were measured, and the above parameters were statistically analyzed in the course of the disease development. The changes and diagnostic value of liver biopsy and liver storage were performed at 0, 5, 9, 16 and 21 weeks after the start of the model. The results were as follows: (1) The change of TTP in the course of liver fibrosis and the course of liver cirrhosis: in the course of the development of experimental animal's liver fibrosis and liver cirrhosis, the time of portal hypertension (TTP) was gradually prolonged with the disease progression (r = 0.234; p 0.05), and is present in normal liver, liver fibrosis and liver cirrhosis Significant difference (p <0.05). (2) The standard portal imaging time critical point of liver fibrosis and liver cirrhosis: CT normalized portal vein imaging time, liver fibrosis stage scanning delay time window of about 40. 5-47 seconds; liver cirrhosis The shortest delay time is about 47 seconds. (3) The application of the standardized CT portal imaging time window in the development of liver fibrosis and liver cirrhosis: In the course of experimental animal liver fibrosis and the development of liver cirrhosis, PVD (r = 0.613), SMVD (r = 0.424), and SVD (r = 0.272) gradually increase, in which the maximum value of SVD is the most (4) The correlation between the diameter of the portal vein system and the function of the liver reserve was observed (p <0.05). (4) The correlation between the diameter of the portal vein system and the function of the liver reserve was normalized (r =-0.419, 0.359, 0.35, spectively; all p0.05); PVD, SMVD and liver function (5) In the ROC curve of the diagnosis of hepatic fibrosis, only SVD had the diagnostic significance, the area under the curve was 0.883, the PVD and SVD were significant to the diagnosis of liver cirrhosis, the area under the ROC curve was 0.744 and 0.752, where the SVD curve Conclusion: The TTP of CT dynamic enhanced scan can be used to regulate the scanning time window of the portal vein of the CT, and to normalize the SVD of the portal vein to the diagnosis of the liver.
【學位授予單位】：川北醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2013
【分類號】：R816.5;R575.2

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