体层摄影术,X线计算机%对比研究%肺动脉
體層攝影術,X線計算機%對比研究%肺動脈
체층섭영술,X선계산궤%대비연구%폐동맥
Tomography,X-ray computed%Comparative study%Pulmonary artery
目的 探讨肺动脉干监测方案在双源CT头颈部联合双能量CTA成像中的应用价值.方法 60例行头颈部双能量CTA的患者按照随机数字表法分为2组,A组(优化方案组,30例)监测点位于肺动脉主干、阈值150 HU、触发延迟时间为8～9s,螺距0.9,碘海醇(350 mg I/ml)60 ～65 ml;B组(常规方案组,30例)监测点位于主动脉弓、阈值100 HU、触发延迟时间为5 s,碘海醇(350 mg I/ml)60～70 ml.体质量＜75 kg的患者注射流率为4.0 ml/s,体质量≥75 kg或体质量指数(BMI) ≥27 kg/m2者注射流率采用4.5 ml/s,对比剂注射完后以相同流率追加注射40 ml生理盐水.测量2组患者两侧颈总动脉、颈内外动脉、椎基底动脉、大脑中动脉水平段、注射对比剂侧锁骨下静脉、颈静脉近中远段、直窦、上矢状窦的强化CT值.2名有经验的医师采用双能量自动去骨软件、Inspace软件和3D后处理软件,行VR、MIP、CPR成像,双盲法评价CTA图像质量,评价注射对比剂侧锁骨下静脉对比剂残留伪影、头颈部静脉回流等对动脉显影的影响.应用独立样本t检验比较2组图像的CT值、图像质量评分分值等,应用卡方检验比较2组图像对比剂残留伪影、颈根部动脉起始处缺如段数、颈静脉回流严重程度等.结果 两组动脉各段CT值为372 ～414 HU,差异均无统计学意义(P值均＞ 0.05).A组左、右两侧颈静脉内近、中、远段强化CT值[分别为(95±36)、(95±36)HU,(131±58)、(133±57)HU,(174±68)、180±66) HU]明显低于B组[分别为(135±58)、(137±59)HU,(170±58)、(181±58) HU,(218±62)、(224±68) HU],两组间比较,差异有统计学意义(t值为-3.30 ～-2.54,P值均＜0.05).A组注射对比剂侧锁骨下静脉对比剂残留伪影例数(5例)及颈根部动脉起始处缺如段数(11段)少于B组(12例,24段),差异有统计学意义(x2值分别为4.02、5.65,P值均＜0.05).颈内静脉显影程度A组颈总动脉分叉以下轻微5例、严重1例,分叉以上轻微15例、严重9例；B组分叉以下显影轻微9例、严重6例,分叉以上显影轻微12例、严重17例,优化方案能显著减少颈内静脉对颈部动脉显示的干扰(x2分别为6.79、6.37,P值均＜0.05).图像质量评分A组(3.84±0.40)分高于B组(3.64±0.63)分,差异具有统计学意义(=4.26,P＜0.05).结论 肺动脉干监测结合60 ～65 ml对比剂优化双能量头颈部CTA成像方案可以显著减轻颈静脉回流和注射对比剂侧锁骨下静脉对比剂残留伪影,获得良好的图像质量,有一定的临床应用价值.
目的 探討肺動脈榦鑑測方案在雙源CT頭頸部聯閤雙能量CTA成像中的應用價值.方法 60例行頭頸部雙能量CTA的患者按照隨機數字錶法分為2組,A組(優化方案組,30例)鑑測點位于肺動脈主榦、閾值150 HU、觸髮延遲時間為8～9s,螺距0.9,碘海醇(350 mg I/ml)60 ～65 ml;B組(常規方案組,30例)鑑測點位于主動脈弓、閾值100 HU、觸髮延遲時間為5 s,碘海醇(350 mg I/ml)60～70 ml.體質量＜75 kg的患者註射流率為4.0 ml/s,體質量≥75 kg或體質量指數(BMI) ≥27 kg/m2者註射流率採用4.5 ml/s,對比劑註射完後以相同流率追加註射40 ml生理鹽水.測量2組患者兩側頸總動脈、頸內外動脈、椎基底動脈、大腦中動脈水平段、註射對比劑側鎖骨下靜脈、頸靜脈近中遠段、直竇、上矢狀竇的彊化CT值.2名有經驗的醫師採用雙能量自動去骨軟件、Inspace軟件和3D後處理軟件,行VR、MIP、CPR成像,雙盲法評價CTA圖像質量,評價註射對比劑側鎖骨下靜脈對比劑殘留偽影、頭頸部靜脈迴流等對動脈顯影的影響.應用獨立樣本t檢驗比較2組圖像的CT值、圖像質量評分分值等,應用卡方檢驗比較2組圖像對比劑殘留偽影、頸根部動脈起始處缺如段數、頸靜脈迴流嚴重程度等.結果 兩組動脈各段CT值為372 ～414 HU,差異均無統計學意義(P值均＞ 0.05).A組左、右兩側頸靜脈內近、中、遠段彊化CT值[分彆為(95±36)、(95±36)HU,(131±58)、(133±57)HU,(174±68)、180±66) HU]明顯低于B組[分彆為(135±58)、(137±59)HU,(170±58)、(181±58) HU,(218±62)、(224±68) HU],兩組間比較,差異有統計學意義(t值為-3.30 ～-2.54,P值均＜0.05).A組註射對比劑側鎖骨下靜脈對比劑殘留偽影例數(5例)及頸根部動脈起始處缺如段數(11段)少于B組(12例,24段),差異有統計學意義(x2值分彆為4.02、5.65,P值均＜0.05).頸內靜脈顯影程度A組頸總動脈分扠以下輕微5例、嚴重1例,分扠以上輕微15例、嚴重9例；B組分扠以下顯影輕微9例、嚴重6例,分扠以上顯影輕微12例、嚴重17例,優化方案能顯著減少頸內靜脈對頸部動脈顯示的榦擾(x2分彆為6.79、6.37,P值均＜0.05).圖像質量評分A組(3.84±0.40)分高于B組(3.64±0.63)分,差異具有統計學意義(=4.26,P＜0.05).結論 肺動脈榦鑑測結閤60 ～65 ml對比劑優化雙能量頭頸部CTA成像方案可以顯著減輕頸靜脈迴流和註射對比劑側鎖骨下靜脈對比劑殘留偽影,穫得良好的圖像質量,有一定的臨床應用價值.
목적 탐토폐동맥간감측방안재쌍원CT두경부연합쌍능량CTA성상중적응용개치.방법 60례행두경부쌍능량CTA적환자안조수궤수자표법분위2조,A조(우화방안조,30례)감측점위우폐동맥주간、역치150 HU、촉발연지시간위8～9s,라거0.9,전해순(350 mg I/ml)60 ～65 ml;B조(상규방안조,30례)감측점위우주동맥궁、역치100 HU、촉발연지시간위5 s,전해순(350 mg I/ml)60～70 ml.체질량＜75 kg적환자주사류솔위4.0 ml/s,체질량≥75 kg혹체질량지수(BMI) ≥27 kg/m2자주사류솔채용4.5 ml/s,대비제주사완후이상동류솔추가주사40 ml생리염수.측량2조환자량측경총동맥、경내외동맥、추기저동맥、대뇌중동맥수평단、주사대비제측쇄골하정맥、경정맥근중원단、직두、상시상두적강화CT치.2명유경험적의사채용쌍능량자동거골연건、Inspace연건화3D후처리연건,행VR、MIP、CPR성상,쌍맹법평개CTA도상질량,평개주사대비제측쇄골하정맥대비제잔류위영、두경부정맥회류등대동맥현영적영향.응용독립양본t검험비교2조도상적CT치、도상질량평분분치등,응용잡방검험비교2조도상대비제잔류위영、경근부동맥기시처결여단수、경정맥회류엄중정도등.결과 량조동맥각단CT치위372 ～414 HU,차이균무통계학의의(P치균＞ 0.05).A조좌、우량측경정맥내근、중、원단강화CT치[분별위(95±36)、(95±36)HU,(131±58)、(133±57)HU,(174±68)、180±66) HU]명현저우B조[분별위(135±58)、(137±59)HU,(170±58)、(181±58) HU,(218±62)、(224±68) HU],량조간비교,차이유통계학의의(t치위-3.30 ～-2.54,P치균＜0.05).A조주사대비제측쇄골하정맥대비제잔류위영례수(5례)급경근부동맥기시처결여단수(11단)소우B조(12례,24단),차이유통계학의의(x2치분별위4.02、5.65,P치균＜0.05).경내정맥현영정도A조경총동맥분차이하경미5례、엄중1례,분차이상경미15례、엄중9례；B조분차이하현영경미9례、엄중6례,분차이상현영경미12례、엄중17례,우화방안능현저감소경내정맥대경부동맥현시적간우(x2분별위6.79、6.37,P치균＜0.05).도상질량평분A조(3.84±0.40)분고우B조(3.64±0.63)분,차이구유통계학의의(=4.26,P＜0.05).결론 폐동맥간감측결합60 ～65 ml대비제우화쌍능량두경부CTA성상방안가이현저감경경정맥회류화주사대비제측쇄골하정맥대비제잔류위영,획득량호적도상질량,유일정적림상응용개치.
Objective To explore the application value of pulmonary artery monitoring program for intracranial and cervical artery angiography with dual-energy CT.Methods Sixty patients performed intracranial and cervical artery angiography with dual-energy CT were divided into two groups according to the random number table.Group A (optimization group,30 patients):the monitoring points were located in the main pulmonary artery,with threshold 150 HU,trigger delay time 8-9 s,pitch 0.9,and the iohexol (350 mg I/ml) 60-65 ml.Group B (conventional group,30 patients):the monitoring points were located in aortic arch,with threshold 100 HU,trigger delay time 5 s,and the iohexol (350 mg I/ml)60-70 ml.Patients with the body weight less than 75 kg were injected with the flow rate of 4.0 ml/s,and those weight greater than 75 kg or with body mass index (BMI) greater than 27 kg/m2 were 4.5 ml/s,following 40 ml saline solution with the same flow rate respectively.All images were transferred to Siemens Syngo workstation for further processing and analysis.The attenuation values were measured on axial images in the common carotid artery,internal and external carotid artery,vertebral and basilar artery,the horizontal segment of the middle cerebral artery,the subclavian vein of injection side,the proximal,middle and distal segment of jugular vein,the straight sinus and the superior sagittal sinus.Two experienced observers blinded independently evaluated the image quality of CTA,the impact of contrast material residues artifacts of subclavian vein of injected side and the affect of venous return factors on arterial image display.Images of volume rendering technique(VR),the maximum intensity projection (MIP),and curved planar reformation (CPR) were reconstructed using dual energy bone removal and Inspace and 3D software.The mean intraluminal attenuation of contrast material (HU),the volume of contrast material and the mean image quality scores were compared with t test between the two groups.Chi-square test was used to compare of image contrast agents residual artifacts,the absence segments of the root of the neck artery,and the degree of the jugular vein return in two groups.Results The mean CT values were 372-414 HU for each segment of artery showing no significant differences between two groups (P ＞ 0.05).In group A,the CT values of the jugular vein in proximal,middle,distal segment of the two sides were (95 ± 36),(95 ± 36),(131 ±58),(133 ± 57),(174 ± 68),and (180 ± 66) HU respectively.In group B,CT values were (135 ± 58),(137 ±59),(170 ±58),(181 ±58),(218 ±62),and (224 ±68) HU.The CT value of jugular venous in group A was significantly lower than that in group B (t =-3.30--2.54,P ＜ 0.05).Case numbers of contrast agent residual artifacts of injection side subclavian vein and the absence segments of root of the neck artery at the beginning in group A (5,11) were less than that in group B (12,24) (x2 =4.02,5.65,P ＜0.05).The degree of the jugular vein return in group A were lesser severely than that in group B (x2 =6.79,6.37,P ＜0.05).Below the level of carotid artery bifurcation:slight 5 patients,severe 1 patient in group A vs.slight 15 patients,severe 9 patients in group B.Above the level of carotid artery bifurcation:slight 9 patients,severe 6 patients in group A vs.slight 12 patients,severe 17 patients in group B.Image quality scores of group A (3.84 ± 0.40) was higher than that of group B (3.64 ± 0.63) (t =4.26,P ＜0.05).Conclusions Pulmonary Artery Monitoring combines with 60-65 ml contrast material optimization scheme for intracranial and cervical artery angiography with dual energy CT can significantly reduce the degree of jugular venous return and contrast material residues artifacts of subclavian vein of injected side.This technique is helpful to improve the work efficiency and image quality.
