【作者】 石惠；

【导师】 平学军；

【作者基本信息】 宁夏医科大学 ， 影像医学与核医学， 2011， 硕士

【摘要】 目的探讨冠状动脉CT成像扫描方案中各种扫描参数及相关技术因素与图像质量的关系,寻找影响图像质量的关键因素,探求相应的解决方案,以期制定可控的个性化的冠状动脉扫描方案,并制定规范化的图像质量控制标准,以保证图像质量,提高诊断率。资料与方法收集926例双源CT冠状动脉成像病例的CT检查资料,记录所有可能与图像质量相关的技术因素,包括扫描时平均心率、心率变化范围、采集心动周期数、FOV、Pitch值、对比剂用量、对比剂注射速率、触发阈值、触发时间、最佳收缩期、最佳舒张期等。并由两名有经验的影像诊断医师对冠状动脉成像的图像质量进行共同评分。运用多元线性回归的统计学方法分析各扫描参数与图像质量的关系,并分析各因素对图像质量的影响。统计学方法应用SPSS10.0统计学软件进行相关统计学分析。结果对926例CT冠脉成像的多种因素与图像质量进行多元线性回归分析,结果平均心率、心率变化及FOV与图像质量的相关性有统计学意义。平均心率及心率变化与图像质量呈负相关,FOV与图像质量呈正相关。心动周期、Pitch值、对比剂用量、对比剂注射速率、触发阈值、触发时间等与图像质量的相关性无统计学意义。结论①DSCT冠状动脉成像,在不使用?-受体阻滞剂控制心率的情况下,图像成功率为99.03%,图像优良率为95.68%。②当心率≤80bpm时大多数可以在收缩期和舒张期双期成像,而心率>80bpm时一般只能在收缩期成像。最佳相位窗从舒张期移至收缩期的转折点为心率是80bpm。③平均心率与DSCTCTA图像质量呈负相关关系,即随着心率增快,图像质量呈下降趋势。④心率变化与图像质量呈负相关关系;当心率变化>20次时,DSCT冠状动脉成像质量明显下降,甚至造成检查失败。⑤FOV与图像质量呈正相关关系,过小的FOV(≤160)下扫描,也会造成图像质量的一定程度的下降。目的探讨双源CT冠状动脉成像技术对冠状动脉先天变异(congenital coronary anomalies,CCA)诊断的应用价值,分析不同类型变异的最佳显示方法、影像学表现及临床意义。资料与方法收集3011例双源CT冠状动脉成像影像资料,运用多种后处理方法检出冠状动脉先天变异的病例,计算检出率,总结冠状动脉先天变异的最佳显示方法,并综合其临床资料分析不同类型变异的临床意义。结果3011例中共检出各种类型CCA 748例,检出率为24.84%。其中起源异常59例,检出率为1.96%,占总CCA 7.89%;走行异常682例,检出率为22.65%,占CCA 91.18%。终止异常共7例,检出率为0.23%,占CCA 0.93%。结论双源CT冠状动脉成像对冠脉先天变异显示及诊断准确性高,多数情况下可作为冠状动脉先天变异诊断的金标准;多种后处理方法中,VR图像显示异常起源的冠状动脉效果最佳;冠状动脉走形异常即MB-MCA是最常见的CCA;CCA中具有高度潜在危险的是冠状动脉起源异常。更多还原

【Abstract】 Objective To analyze the relationship between various affect factors and image quality, and to explore appropriate solutions.Materials and Methods We consecutively enrolled 926 patients in this study. To collect the scanning parameters of all cases ,such as average heart rate ,heart rate change, the data of cardiac cycle, FOV、Pitch values ,the volume and rate of iodinated contrast media, trigger threshold, trigger time et al and evaluate the images quality, analysis of the scan parameters and the relationship between image quality and affect factors.Results Of several factors, the average heart rate, heart rate, the FOV and the image quality was statistically significant correlation. Average heart rate or heart rate changes and the image quality were negatively correlated; FOV was positively correlated with the image quality. The others factors associated with the image quality were not statistically.Conclusion①Without usingβ-receptor blocking to control heart rate ,success rate of the DSCT coronary angiography image is 99.03%, good rate of image is 95.68%.②When the heart rate≤80bpm , we can get excellent images in the systolic and diastolic two phases; If heart rate> 80bpm we generally get excellent images only in the systolic phase. The turning point that the best reconstruction window moved from the systolic to diastolic is the heart rate 80bpm.③Average heart rate and the image quality was negatively correlated. Image quality decreased with faster heart rate.④Heart rate change and the image quality was negatively correlated. When the heart rate > 20bpm, DSCT coronary angiography significantly decreased, and even cause failure.⑤FOV was positively correlated with the image quality. Too small FOV (≤160mm) to scan, image quality can also cause a certain degree decreasing. Objective To investigate the diagnosis value of congenital coronary artery anomalies (CCA) with dual-source CT coronary angiography and analysis the best display method, imaging and clinical significance of different types of CCA.Materials and Methods The data of dual-source CT coronary Angiography (DSCTCA) from 3011 patients were analyzed. All CCA cases were depicted with various post-processing method. The depiction rate and CT findings of CCA were summarized and the clinical significance of different types of CCA was analysis integrating the clinical data.Results A total of 749 cases of CCA were found in the 3011 patients who undergoing DSCTCA,giving the detect rate of 24.84% (749/3011),including anomalies of origin of 59 cases(The depiction rate is 1.96% and the proportions is 7.89%),myocardial bridge of 682 cases (The depiction rate is 22.65% and the proportions is 91.18%),and abnormal termination of 7 cases (The depiction rate is 0.23% and the proportions is 0.93%).Conclusion DSCT coronary angiography could diagnose CCA perfectly. It could be used as the first choose of imaging tools for suspected CCA.Of many post-processing methods, VR image is the best to show CCA.MB-MCA is the most common CCA. Coronary artery origin anomalies are the CCA with high potential risk.更多还原