【摘要】：目的：近年來(lái),泌尿系統(tǒng)成像技術(shù)不斷得到更新,在各種檢查中MSCT尿路成像由于其掃描速度快,圖像分辨率高,加之強(qiáng)大的后處理功能,使其成為泌尿系統(tǒng)疾病檢查中最主要的方法。傳統(tǒng)的MSCT尿路成像包括平掃,皮質(zhì)期、髓質(zhì)期和排泄期的4期掃描,解決了很多臨床實(shí)際問(wèn)題,然而其致命的缺點(diǎn)就是掃描范圍大、分期多,患者接受的X線輻射劑量高。本研究旨在通過(guò)改進(jìn)掃描方案,最大限度的減少輻射劑量,探討其在臨床疾病診斷中的應(yīng)用價(jià)值。 方法：本研究分為3個(gè)部分： 1.回顧性分析了各個(gè)掃描時(shí)相在泌尿系統(tǒng)占位性病變中的診斷價(jià)值。選取我院2011年1月到2011年9月之間進(jìn)行傳統(tǒng)MSCT泌尿系統(tǒng)成像檢查并手術(shù)病理證實(shí)的患者38例,其中男22例,女18例,年齡15-88歲,中位年齡64歲。通過(guò)不同的三期或者二期圖像組合對(duì)患者進(jìn)行診斷,并將其結(jié)果與病理學(xué)結(jié)果進(jìn)行對(duì)照。 2.分組研究泌尿系統(tǒng)低劑量掃描技術(shù)的價(jià)值。選取我院泌尿外科患者20例,按照掃描時(shí)Kv值的不同分成4組,對(duì)所得圖像進(jìn)行質(zhì)量評(píng)估,并對(duì)各組患者所接受的X線的輻射劑量進(jìn)行統(tǒng)計(jì)學(xué)比較。 3.改良“分離團(tuán)注法”研究中,選取我院泌尿外科住院病人10例,掃描的X線參數(shù)為160Kv/120mAs,造影劑總量設(shè)為90ml,按照第一次團(tuán)注20ml,第二次團(tuán)注70m1分配。連續(xù)獲取平掃-排泄聯(lián)合圖像、皮質(zhì)-排泄聯(lián)合期及腎實(shí)質(zhì)-排泄聯(lián)合期圖像并對(duì)圖像質(zhì)量進(jìn)行評(píng)估。 4.本研究分為三個(gè)部分,其中第一部分和第三部分均為計(jì)數(shù)資料,差異顯著,無(wú)需統(tǒng)計(jì)學(xué)比較。第二部分低劑量MSCT泌尿系統(tǒng)成像部分,其數(shù)據(jù)為多個(gè)獨(dú)立樣本的均數(shù)的比較,選擇完全隨機(jī)方差分析法進(jìn)行統(tǒng)計(jì)學(xué)比較。數(shù)據(jù)統(tǒng)計(jì)使用安裝版的SPSS17.0軟件進(jìn)行統(tǒng)計(jì),檢驗(yàn)標(biāo)準(zhǔn)取α=0.05。 結(jié)果：1.回顧性分析部分,首先通過(guò)(平掃+皮質(zhì)+實(shí)質(zhì))三期圖像診斷,所納入26例腎腫瘤患者影像診斷與病理診斷完全符合,4例腎盂癌僅有2例能做出定性診斷,8例輸尿管膀胱癌中有2例未能做出明確診斷。第二步通過(guò)(平掃期+皮質(zhì)期+排泄期)三期圖像的組合進(jìn)行診斷,26例腎腫瘤中僅17例可以做出定性診斷,4例腎盂癌、8例輸尿管及膀胱癌均明確診斷。第三步通過(guò)(皮質(zhì)+排泄)的兩期圖像組合診斷,輸尿管和膀胱癌8例,全部符合病理,腎盂癌有2例診斷錯(cuò)誤,腎實(shí)質(zhì)腫瘤則僅有12例的診斷符合病理。 2.低劑量掃描實(shí)驗(yàn)部分。第1組做為常規(guī)劑量組,其X線參數(shù)為160Kv/120mAs,本組中所納入的5例患者的圖像評(píng)分均為5分,患者所接受CTPlvol平均值為11.574±0.36mGy。第2組圖像X線參數(shù)在120kv/120mAs,所納入的5例患者的圖像中有4例達(dá)到4分的標(biāo)準(zhǔn),僅1例評(píng)分為5分,患者所接受CTPlvol平均值為9.392±0.43mGy。第3組圖像的參數(shù)為80Kv/120mAs,5例患者的圖像僅有2例評(píng)分達(dá)到4分,其他3例均只能達(dá)到3分的標(biāo)準(zhǔn),患者所接受CTPlvol平均值為6.170±0.09mGy。第4組圖像X線參數(shù)為40Kv/120mAs,其中4例患者圖像評(píng)分為3分,另有1例患者圖像評(píng)分僅2分,患者所接受CTPlvol平均值為3.746±0.13mGy。將所得的4組CTPlvol數(shù)據(jù)輸入SPSS17.0軟件得P值=0.001,按照α=0.05的檢驗(yàn)標(biāo)準(zhǔn),認(rèn)為各組均數(shù)之間的差別具有統(tǒng)計(jì)學(xué)意義。 3.改良“分離團(tuán)注法”研究。本研究共納入的10例患者,分別對(duì)其腎實(shí)質(zhì)及尿路系統(tǒng)圖像質(zhì)量進(jìn)行評(píng)分。10例患者的腎實(shí)質(zhì)圖像評(píng)分均在2分以上,共有9例患者的尿路系統(tǒng)評(píng)分在2分以上,僅有1例患者尿路系統(tǒng)圖像評(píng)分為1分。改良“分離團(tuán)注法”減少1期圖像的掃描,兩次團(tuán)注所用的造影劑分別為20ml及70ml,總的劑量為90ml。 結(jié)論：1.第一部分回顧性研究。對(duì)于腎實(shí)質(zhì)疾病,(平掃+皮質(zhì)+實(shí)質(zhì))三期圖像組合就能做出與病理吻合的診斷,可以考慮減少排泄期的掃描,至少減少X線輻射劑量至少25%。對(duì)于排泄系統(tǒng)腫瘤(平掃+皮質(zhì)+排泄)三期圖像已經(jīng)可以滿足臨床診斷需求,可以考慮減少腎實(shí)質(zhì)期掃描,至少減少X線輻射劑量至少25%。對(duì)于輸尿管及膀胱癌甚至可以考慮同時(shí)減少平掃及腎實(shí)質(zhì)期,減少X線輻射達(dá)50%。 2.通過(guò)降低掃描的管電壓值,可以大幅度較少患者所接受的X線輻射。本研究結(jié)果進(jìn)行綜合評(píng)價(jià),臨床上推薦使用80Kv的管電壓進(jìn)行MSCT泌尿系統(tǒng)成像的掃描,這個(gè)條件下圖像質(zhì)量雖有所下降,但其差別肉眼難以分辨,需要依賴CT值比較。且與常規(guī)劑量相比,X線的輻射劑量降低46.7%。 3.改良“分離團(tuán)注法”其圖像質(zhì)量高,包含的信息全面,并減少1期掃描,降低X線輻射至少25%。
[Abstract]:Objective: In recent years, the imaging technology of urinary system has been continuously updated. In various examinations, MSCT urography is the most important method in the examination of urinary system diseases due to its rapid scanning speed, high image resolution and powerful post-treatment function. The traditional MSCT urography, including the 4-phase scan of the level scan, the cortical phase, the medullary phase and the excretion period, solves many clinical practical problems, but the fatal drawback is that the scan range is large, the stage is large, and the patient's received X-ray radiation dose is high. The purpose of this study is to minimize the radiation dose by improving the scanning protocol and to explore its application value in the diagnosis of clinical disease. Methods: The study was divided into three parts. score:1. A retrospective analysis of the diagnosis of various scanning phases in the diagnosis of urinary system occupying lesions We selected 38 patients with traditional MSCT urinary system imaging and operative pathology from January 2011 to September 2011, of which 22 male,18 female,15-88 years old, median age 64-year-old. The patient was diagnosed by a different three-phase or second-phase image combination and the results were compared with the pathological findings line control.2. Group study of low dose scans in the urinary system The value of the technique was selected.20 cases of urological surgery in our hospital were divided into 4 groups according to the different Kv values at the time of scanning, and the quality of the obtained images was evaluated, and the radiation dose of the X-ray received by each group of patients was measured. Statistical comparison.3. In the modified "separation group injection method" study,10 patients with urological surgery in our hospital were selected. The X-ray parameters of the scan were 160 Kv/120 mAs, and the total amount of the contrast agent was set to 90 ml. The first group was injected with 20 ml and the second group Note 70 m1 distribution. Continuous acquisition of the level-sweep-excretion joint image, the cortical-excretion joint period, and the renal parenchyma-excretion of the combined image and the map 4. The study is divided into three parts, in which the first part and the third part are count data and the difference is significant. No statistical comparison is required. The second part of the low-dose MSCT urinary system imaging section, the data of which is a comparison of the mean number of multiple independent samples, selects a complete random variance score The statistical comparison of the disjunctive method is carried out. The data statistics use the SPSS17.0 software of the installation version to make statistics and test. Standard pick-up = Results:1. The clinical diagnosis and pathological diagnosis of 26 cases of renal tumor were completely in accordance with the three-phase image diagnosis (plain scan + cortex + substance). There were 2 cases of failure to make clear diagnosis. The second step was to make a diagnosis by the combination of the three-phase images (phase-scan + cortex period + drainage period). Only 17 of the 26 cases of renal tumor can make a qualitative diagnosis,4 cases of renal pelvis cancer and 8 cases of loss. In the third step,8 cases of ureter and bladder cancer were diagnosed by two-stage image combination (cortical and excrete), and all of them were in accordance with the pathology. The diagnosis of 12 cases was in accordance with the pathology. 2. The experimental part of low-dose scanning. The first group was the routine dose group, with the X-ray parameter of 160 Kv/120 mAs, and the image score of 5 patients included in this group was 5 points, and the average value of CTPvol accepted by the patient was 1. 1.574-0.36 mGy. The 2-group image X-ray parameter was 120 kv/120 mAs, and 4 of the 5 patients included in the image reached 4-point standard, only one score was 5 points, and the average value of CTPvol accepted by the patient was 9.392 to 0.43 mGy. The parameters of the image in the third group were 80Kv/ 120mAs, only 2 of the 5 patients had a score of 4, and the other 3 cases can only reach the standard of 3 points, and the average value of CTPvol accepted by the patient is as follows: 6.170-0.09 mGy. The 4-group image X-ray parameters were 40 Kv/120 mAs,4 of them had an image score of 3, and one patient had an image score of only 2, and the mean value of CTPvol accepted by the patient was 3.746 to 0.13 mGy. The resulting 4-group CTPvol data was input to the SPSS17.0 software to obtain a P-value of = 0.001, and each group was considered to be The difference between the numbers is of statistical significance. Method " study.10 patients included in this study respectively scored the renal parenchyma and the image quality of the urography system. The scores of the renal parenchymal images in 10 patients were above 2, and there were 9 patients with a urinary tract system score of 2 or more. One patient's urosystem image score was 1 point. The modified "separation group injection method" reduced the scan of the 1-phase image and the contrast media used for the two bolus injections were 20 ml, respectively. 鍙，

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