优化布加综合征64层螺旋CT血管造影扫描技术研究（可编辑）

优化布加综合征64层螺旋CT血管造影扫描技术研究（可编辑） 优化布加综合征64层螺旋CT血管造影扫描技术研究 A submittedto thesis , ZhengzhouUniversity forthe ofMaster degree of64―-slice CT scanning angiography Optimizationspiral ofBudd―Chiari syndrome technique ， , , , By:YinshiZheng , Gao Supervisor:Prof (Jianbo j Radiology , of ThefirstAffiliated ZhengzhouUniversity Hospital 2011 April 7, ， , ， ， 原创性声明 本人郑重声明:所呈交的学位论文，是本人在导师的指导下，独立进行研 除文中已经注明引用的内容外，本论文不包含任何其他个究所取得的成果。 人 或集体已经发 表 关于同志近三年现实表现材料材料类招标技术评分表图表与交易pdf视力表打印pdf用图表说话 pdf 或撰写过的科研成果。对本文的研究做出重要贡献的个人和集 体，均已在文中以明确方式标明。本声明的法律责任由本人承担。 醐锄1年上耶，日 靴敝储彩若咯 学位论文使用授权声明 本人在导师指导下完成的论文及相关的职务作品，知识产权归属郑州大学。 根据郑州大学有关保留、使用学位论文的规定，同意学校保留或向国家有关部 门或机构送交论文的复印件和电子版，允许论文被查阅和借阅;本人授权郑州 大学可以将本学位论文的全部或部分编入有关数据库进行检索，可以采用影印、 缩印或者其他复制手段保存论文和汇编本学位论文。本人离校后发表、使用学 位论文或与该学位论文直接相关的学术论文或成果时，第一署名单位仍然为郑 州大学。保密论文在解密后应遵守此规定。 学位论文作者: 嗍:1年j月了棚 场 摘要 优化布加综合征64层螺旋CT血管造 影扫描技术的研究 研究生 郑吟诗 导师 高剑波教授 郑州大学第一附属医院放射科 河南郑州450052 摘 要 背景和目的: 国内布加综合征 Budd(Chiari syndrome，BCS 集中在黄淮河中下游地区， 河南省特别是豫东地区是BCS高发区之一。近年来，随着影像技术的进步， 其发 subtraction 现率有逐步升高趋势。数字减影血管造影 digital angiography，DSA 一直被公认为是诊断血管疾病的金标准，但DSA属有创检查，操作复杂，费用 昂贵，且只能显示血管腔内情况，临床应用有一定限制。随着多层螺旋CT multi(slice spiralcomputed 诊断上的应用日益突出。MSCT血管造影 MSCT 晰显示BCS病变血管狭窄部位、程度、范围以及肝内外侧枝循环情况，并同时可 观察肝脏本身解剖学结构及基础疾病，从而指导临床治疗。但是，由于BCS本身 是一种复杂的静脉血管系统的病变，血液回流个人差异很大，目前MSCTA多采 用传统的肝三期扫描时相，有时获得的图像质量不佳，以至于影响诊断。 本研究的目的即是优化布加综合征MSCTA扫描技术，探讨最佳扫描时 相， 以期获得最佳扫描时相和优质的图像，同时降低造影剂用量及辐射剂量。 材料和方法: 层CT血管造影的患者，分为A、B、C---组，A组、B组采用新扫描方法【个体化 造影剂用量 总药量G 、双流速注射造影剂 4(0ml,s(80,13l2(0ml,s ,q 一20 摘要 4-14(44 岁，平均体重 65(16? B组49例，男32例，女17例，平均年龄 43(82 12(06 岁，平均体重 63(964-11(51 kg，造影剂用量100ml。 扫描设备采用GE 64排VCT，管电压:120Kv，管电流采用自动 LightSpeed 旋转时间:0(8s;噪声指数:8(10;层厚及层间距:5(0mm，准直器宽度: 非离子型对比剂欧乃派克 350mgI(mlJ ，A、B组注药采用双流速，先平扫，后 行多期增强扫描;扫描范围自膈顶上2(0cm至肝,脾下缘水平，采用 Smart(Prep触 发扫描技术，A、B组门静脉触发扫描，触发阈值100Hu;C组采用腹主动脉触发 扫描，触发阈值200Hu。 原始数据以标准算法重建，层厚0(625mm，重建间隔0(625mm。应用Adw4(4 Windows4(4，GEMedical 工作站 Advantage Systems 进行后处理，综合运用容 肝实质状况。 观察的主要内容包括门静脉、腹主动脉、肝静脉、下腔静脉血管显示满意 度，并分析门静脉、肝静脉、下腔静脉最佳扫描延迟时间。通过CTA与DSA的 对照，评价CTA图像质量及对于BCS诊断的准确率。 1 统计分析采用SPSS5(0软件包，检验水准Q O(05，计量资料进行卡方检验， 组问比较采用Bonferroni法。定性资料采用Kruskal(WallisH秩和检验。 结果: 1(三组门静脉、肝静脉、下腔静脉及腹主动脉峰值比较 A、B两组与C组间门静脉、肝静脉、下腔静脉及腹主动脉CT值均有明显差 P 0(001 ，A,B两组间无差别。 别 A、B组门静脉、肝静脉及下腔静脉平均CT值均明显高于C组。A、B 组门静 II 摘要 下腔静脉CT值与肝静脉CT值相近。 A、B组门静脉触发扫描期腹主动脉显影良好，平均CT值分别为: 259(钍63(6 Hu、 250(54-58(1 Hu，显然低于C组: 333(54-68(6 Hu。 2(A,B组最佳启动扫描时间及肝(门延迟扫描时间 上具有差异 P 0(044 0(05 ;肝静脉,下腔静脉最佳延迟时间分别约为: 的肝静脉及下腔静脉血管。 3(三组门静脉、肝静脉显示满意度比较 A、B组对于门静脉及肝静脉显示明显优于C组;A、B组门静脉、肝静脉均 显示清晰，末梢血管显示率高，门静脉可达乳9级，肝静脉可达4~7级。 门静脉比较:三组间比较胙10(232，P 0(006 0(05，有明显差异。组间比 管优良率均达95,以上。 肝静脉比较:三组间比较佧20(447，P -0(0001 0(05三组间有明显差别。 有明显差别。A、B组血管优良率均达90,以上，明显优于C组 63, 。 4(A、B组平均造影剂用量比较 芦O(027 0(05 。 5(CTA图像与DSA对比 A和B组诊断符合率均达100,，C组达80,;A和B组肝静脉及下腔静脉 显示符合率达95,以上，C组约达76,。 6(辐射剂量 B组增强扫描两期较三期平均可减少 7(844-1(07 mGy。 III 摘要 结论: 1( 64层螺旋CT血管造影对于BCS诊断有着非常肯定的意义，其扫描速度快， 成像清晰，诊断正确率高，并可清晰显示、明确诊断肝脏原发病变。 2( 个体化造影剂用量 1(8ml,kg 、双流速注射造影剂和门静脉触发扫描的扫 描方法，是一种更合理的布加综合征MSCTA扫描技术，多数2期可完成扫 描，在一定程度上减少了造影剂用量，减轻了肾毒性，相比于常规三期扫 描，降低了辐射剂量，并能够获得更优质的图像，更好的指导临床诊断和 …一 治疗。 ,’ ’ (一 关键词:布加综合征;多层螺旋CT血管造影;门静脉;双流速 W Abstract of64--sliceCT Optimizationspiralangiographyscanning of Budd??-Chiari technique syndrome Yin??shi Postgraduate Zheng Prof(JianboGao Supervisor of FirstAffiliated DepartmentRadiology,the Hospital， ZhengzhouUniversity Zhengzhou，Henan，450052 Abstract and BackgroundPurpose Budd―Chiari onthemiddleandlowerreachesofthe syndrome BCS focuses YellowRiverandtheHuaiRiverin intheeasternofHenan China，especiallyparts hasbeenoneofthe occurrenceareas(Inrecent the province，which high years， with of ratesofBCS developmentimagetechnology,thediscovery displaygradually subtraction beenconsidered as increase(Di酉talangiography DSA hasextensively the standardfor vascular isall golden diagnosingdiseases(However,it expensive, andinvasive itcan showtheintravascular status， which complex technique，andonly limitstheclinical ofDSA(Withthe ofMulti-slice application rapiddevelopment hasbeen in ofBCS(MSCTA spiralCT MSCT ，itwidely applieddiagnosis showsthelesion of location，the angiography MSCTA notonlyclearly degree stenosisthe and also the and collateral(circulation，butdisplayshepaticanatomy clinical and itselfisa diseases，whichguides diagnosistreatment(However,BCS by of vesseldiseasewith differenceson blood type complex multiple intrahepatic circulation hasbeen the time,which conventional usuallydiagnosed by tri―phase of willleadtothedecreaseof of enhancing MSCT，which scanningphase accuracy this MSCTA ofBudd―Chiari Instudy,the imagingdiagnosis( scanningtechnique V Abstract the was toobtainbest syndromeoptimized scanningphase,gettechnicallyquality andreducethedoseofcontrastandradiation images effectively( Materialsandmethods four Onehundredand casesofBCS withclinicalorultrasoundwere diagnosed selectedfromMarch2010toOctober2010intheFirstAffiliated randomly Hospital of alltheCasesall MSCTAweredivided ZhengzhouUniversity,and by diagnosed into three C A，B groupsincludinggroups experimentalgroup andgroup control thenew group (111e groupsadopted scanning experimental contrast total agent’S dosage G ’dual-flowinjection 4(Oml,s-80,q2(0ml ,s-20,G, 2(0ml,s一20ml saline andportal physiological trigger the Control conventional groupadopted tri-phasescanningtechnique delay casesinA included14casesofmales time:25s,30s，65s-75s，130s,140s (25group and11casesoffemaleswith 43(32?10(33 oldand averageages years average 64(744-12(12 contrast total Was2(0 weights kg，and agent’S dosage ml,kg(Meanwhile， 49casesinB included32casesofmalesand17casesoffemaleswith group average 43(82+14(44oldand 65(16-t-10(67contrast ages years averageweights kg,and total Was1(8 casesinC included18 agent’S dosage ml,kg(Additionally,30group casesofmalesand12casesoffemaleswith 47(27?12(06oldand averageages years 63(96?11(51 contrasttotal WaslOOml( averageweights kg,and agent’S dosage Scan oftheGE64-slicesVCT 20 such嬲tube parameters kV ，tube voltage 1 oftable current Auto-mA rot撕on thicknessand 39(37mm,rot ，tubetime O(8s ，noiseindex 8(10 ，slice inthenew increment 5(0mm ，andcollimation 64x0(625mm wereadopted technical( scanning both SCanandcontrastenhanced Every scans， iodinated patientperformedplain contrast dual―flow medium 1OOml，350mgI(mlq adoptedinjectiontechnique using stellant theSCan Wassetfrom 2(0crn dual―syringeinjector Medrad，USA andrange abovethemidrifftothe Wasused subhepatic technology region(Smart―prepscanning oncontrastenhanced scan scans，the experimentalgroupsadoptedtriggering by venouswhereasthecontrolmonitoredaorta abdominalis( monitoringportal group VI Abstract thereconstructedslice the standardizedand All data algorithm originaladopted ADW4(4 and wasboth thenweretransmittedto thicknessincrement 0(625 real，and workstationtodeal、 Irimthethree-dimensionalof imagesvessels， hepaticparenchyma of andcollateralcirculationthe rendering ， MIP by techniquesVR volume intensity intensityprojection ，MinlP minimumprojection ，MPVR imum volume reformation and reformation ，MPR multiplanarCPR curved Mutiplanar planerreformation ( The of abdominalis，hepaticvein H ?and iinage portalvein PV ，aorta quality timeof inferiorvena were the scanningpv,I-IV cava rYecompared，andoptimal inthree CT and andIVCwere diagnostic analyzed groups(Theimagequality were withDSAinthree ofHVandIVC groups( accuracy compared 1 sotb,vare the Allthedatawas SPSS5(0 analyzed significant by package，and leveloftestWassetas dataand intergroup adopted a 0(05(Quantitative comparison dataused testandBonferroni test(respectively(Thequalitative ehi(square Hrank(sumtest( Kruskal(?，a1】js Results IVCandAortaabdominalisin ofthe of凡HV 1(Comparisonpeakintensity ’ three groups between valueof andAortaabdominalis The CT PV,HV,IVC average had andcontrol difference 氏O(OO 1 ， however, experimentalgroups groupsignificant therewasnodifferencebetweenAandB groupspO(05 ( were valuesof andIVCof The CT pv,HV experimentalgroups average of CTvalueofPV thanthatcontrol 1 (Average significantlyhigher group P 0(OO and and andHVinA(BandC were210(7+28(1174(34-30(0 Hu,203(04-32(6 groups IVCin Huand145(34-23(8and125。3+24(0 valueof 161(94-35(2 Hu，respectively(CT three WassimilartothatofHV( groups Aortaabdominaliscouldbe showedatPV in clearly phaseexperimentalgroups， 259(4士63(6Huin Aand250(5+58(1Huin the CTvalueswere ， B group average group in whichwere lowerthanthat Hu ( groupC 333(5+68(6 significantly VII Abstract timeof time and scanning experimental delayedscanning 2(Optimal groups HV between andPV phase phase timesinAandB were51(9生6(7sand 47(5+9(6s， Optimalscanning groups therewasstatistical A B differencebetweenand respectively,and groups times 6(Osand ofHVandIVCwere80(8"4-1 尸生O(044 0(05 (Delayedscanning therewasno 1 after 88(2士20(5s，respectively,anddifference俨卸(19 0(05 (Scanning a timefromPV between24s,--34sin 46sin Aand35s,(- delay phaseranged group thebest ofHVand B 95,confidence group interval couldpredominantlyget image ?C( ofsatisfactionofPVandHVinthree 3(Comparison groups 111e ofPVandHVinthe Was to image experimentalgroupobviouslysuperior mat thecontrol the in PV 6--9orders andHV 4,7orders in group;and couldbe showed( experimentalgroups clearly ofPV(Therewere differencesthree Comparison significant among groups WasnodifferencebetweenAandB 位芦10(232，P 0(006 0(05 (There group the inAandC Wasstatistical difference 胆0(001，P 0(978 0(05 ，and groups inBandC thedifference significance 仔:4(694，P 0(030 0(05 ，meanwhilegroups was excellentrateof in statistical vessels significance?仁8(156，P 0(004 0(05 (The AandB werebothabove95,( group ofHV:Therewere differencesthree Comparison significant among groups Was betweenAandB nodifference 仔p20(447，P -O(000 group 1 0(05 (There statistical thedifferenceinAandC Was 四(008，P--0(927 0(05 ，and groups thedifferenceinBandC significance 肛1O(488，P 0(001 0(05 ，meanwhile groups Wasstatistical excellentrateofvessels significance 胙17(318，P -0(0001 0(05 (111e inAandB werebothabove Was toC group 90,，whichsuperiorgroup 63, ( of contrast betweentwo 4(Comparisonaverage agent’Sdosage experimental groups 111econtrast inAandB were126(24-16(3mlVs agent’Sdosage groups l16(64-17(8m1(andthereWas significantdifference P -O(027 0(05 ( ofCTA and ofDSA 5(Comparisonimagediagnosticaccuracy The accuraciesinAandB bothreached1 the diagnostic 00,，whereas groups VIII ---_-_?-______?-_-___-??----_-___-_-I?-____________?_--_-? ____-_-?―――_?-―__―― ―――――――――――――――――――――――――――――一 - 一 (―(――(―(―((―(((((―(―(――――――((―(――(((!!!鉴!墅苎!!((((((―――((((((――――(((((―――(――((――(―((一 ofHV was accuracies In inC 80,( addition,display accuracygrouponly diagnostic 76,( C was inAandB reachedabove andIVC 95,，whereas only groups group dose ( 6(Radiation could to enhanced enhanced scanning scanning，two??phase three-phase Compared inB reduceradiationdoseabout7(84a:1(07 group。 mGy Conclusion and has with 1(MSCTA image accuracydiagnosis rapidscanning,clear not showthe to ofBCS(In addition,MSCTAonly diagnosis importantsignificance butalso the disease( vasculardisease diagnosehepaticprimary clearly combinedwithindividualcontrast 2(The methods agent’Sdosage scanning isamorereasonable and scanning injectionportaltrigger 1(8ml,kg ，dual-flow thenew carlbe of MSCTA scanningtechniques scanningtechniqueBCS(Adopting tosomeextentreducesthe with scanning,which effectivelycompletedtwo??phase withtheconventional of doseofcontrastandtheincidence nephrotoxicity(Compared new Callreduceradiation technique doses，get scanningtechnique，the tri(phase andtreatmentmore and theclinical efficiently guide diagnosis highel"qualityimages words:Budd―Chiari tomography spiralcomputed syndrome BCS ;Multi-slice Key injection vein PV ;Dual-flow angiography MSCTA ;Portal IX 广 目 录 正文部分 中英文对照缩略词………………………………………………………I 优化布加综合征64层螺旋CT血管造影扫描技术的研究……((1 前 言…………………………………………………………………………………((1 日lJ 舌…………………………………………………………………………………”l 材料与方法……………………………………………………………3 结 果…………………………………………………………………………………((6 讨 论…………………………………………………………………………………10 6 结 论…………………………………………………………………………………1 7 参考文献…………………………………………………………(1 附图及说明………………………………………………………(20 综述部分 布加综合症MSCT血管成像技术研究现状……………………32 参考文献………………………………………………………………48 附录部分 个人简历……………………………………………………………53 致谢………………………………………………………………(54 中英文对照缩略词 中英文对照缩略词 英文全称 中文全称 英文缩写 CT 电子计算机断层摄影法 computedtomography vcT volumetric 容积CT tomography computed 一………一一‘。 +。螺旋CT SCr tomography spiralcomputed MDCT multi-detetor 多排螺旋CT computedtomography spiral multi-slice 多层螺旋CT MSCT tomography spiralcomputed multi-sliceCT 多层螺旋CT血 管成像 MSCTA spiralangiography subtraction 数字减影血管造 影术 DsA Digital angiography 小剂量同层动态测试法 TestBolus 智能追踪技术 Sman Prep 兴趣区 RoI ofinterest region curve 时间一密度曲线 TDC time-density 多平面重建 MPR reformation multiplanar 曲面重组 CPR Curvedreformation planer 多平面体积重建 MPVR volumetric rendering multi??projection imum 最大密度投影 MlP intensityprojection volume 容积再现 钐品 rendering 肝动脉 HA hepaticartery arterial 肝动脉期 HAP hepatic phase 门静脉 PV vein portal