双源 Flash 后处理软件在支气管动脉评价中的应用

目的：探讨双源 Flash 后处理软件(Bone Reading)应用于支气管动脉(BA)CTA 后处理重建中的可行性及时间效率分析。方法由2位放射科医生对70例临床拟诊断为支气管动脉扩张患者的 CTA 影像资料进行评价。首先,利用多平面重组(MPR)、最大密度投影(MIP)及容积再现(VR)技术对支气管动脉的起源、数目、分支类型、走行分布及管腔直径进行评价及测量,记录相关数据及诊断时间;30 d 后再使用后处理软件(Bone Reading)对上述患者的影像资料重新进行评价。结果2位阅片者的诊断一致性无统计学差异,且有良好的相关性;后处理软件(Bone Reading)的使用在诊断时间上有统计学差异,平均减少诊断时间35%。结论后处理软件(Bone Reading)应用于 BA CTA 后处理重建是可行的,可以缩短后处理及诊断所需的时间。     

64层螺旋CT在小儿冠状动脉造影中的应用

目的 探讨64层螺旋CT(64-SCT)小儿冠状动脉造影的临床应用.方法 对21例小儿患者行64-SCT冠状动脉造影检查,对冠状动脉疾病进行诊断.所有患者均行彩色多普勒检查,6例同时行DSA检查.结果 21例行64-SCT小儿冠状动脉造影的患者中12例为冠状动脉发育异常,右冠状动脉双开口3例,左冠状动脉回旋支与右冠状动脉主干共干起源于主动脉右窦2例,左冠状动脉前降支与右冠状动脉共干起源于主动脉右窦2例,左冠状动脉前降支与左冠状动脉回旋支均直接起源于主动脉左窦2例,左冠状动脉起源于肺动脉1例,1例左右冠状动脉起源正常但所有冠状动脉均匀性迂曲增粗,1例左冠状动脉主干闭塞,右冠状动脉迂曲增粗并伴有多发侧枝循环.6例患者为川崎病伴发冠状动脉单发或多发瘤样扩张.3例患者未见明显异常.所有同时行DSA检查的患者,除左冠状动脉起源于肺动脉主干的1例患者DSA诊断左冠状动脉缺如外,其余5例其诊断结果与64-SCT诊断结果相吻合.结论 64-SCT是一种小儿冠状动脉疾病无创的、安全可靠的检查方法.     

梗阻性黄疸18F-FDGPET/MR成像中国专家共识

梗阻性黄疸病因复杂，定性和定位诊断具有挑战性。一体化正电子发射计算机断层成像/磁共振（Positron Emission Tomography/Magnetic Resonance, PET/MR）检查，通过PET与MR在梗阻性黄疸诊断中的优势互补，形成整合优势。在满足诊断需求的前提下，如何缩短PET/MR扫描时长、选择适宜的个性化扫描协议是临床关注的焦点。本文在文献复习和大量临床应用积累基础上，建立基于病灶是否具有显像剂聚集的简繁不同的MRI的成像协议和报告关键信息的专家共识。     

双源CT在急性胸痛诊断中的临床应用

目的探讨双源CT在急性胸痛诊断中的临床价值。方法对27例临床急性胸痛的患者行双源CT心胸联合血管造影检查。采用急性胸痛的扫描参数,应用高浓度的对比剂,注射流率为5ml/s,注射对比剂总量80~90ml,扫描时间15~17s,将原始数据利用Circulation软件对冠状动脉、肺动脉和主动脉进行曲面重建(CMPR)、最大密度投影(MIP)、容积再现技术(VRT)等图像重组。由2名有经验的放射科医生利用轴位图像及各种后处理图像对疾病进行诊断。5例主动脉夹层和2例冠状动脉狭窄的患者同时行心脏彩色多普勒检查,7例主动脉夹层和4例急性心肌梗死的患者同时行选择性血管造影检查,并与双源CT诊断结果进行对照分析。结果双源CT心胸联合造影检查诊断为冠状动脉斑块形成并管腔狭窄9例,其中4例并发急性心肌梗死,急性肺动脉栓塞的7例,主动脉夹层的10例(其中伴有冠状动脉多发斑块并管腔狭窄的1例,主动脉夹层术后复发的2例,主动脉夹层并壁间血肿形成的1例),降主动脉瘤并冠状动脉狭窄1例。同时行选择性血管造影的患者两者的诊断结果一致,但1例主动脉夹层伴冠状动脉狭窄的患者,双源CT一次造影能同时对两种疾病作出正确的诊断,但选择性血管造影分多次造影才作出正确的诊断。7例行心脏彩色多普勒检查的患者,5例主动脉夹层的患者CDFI诊断正确,但3例没发现破口,2例冠状动脉疾病的患者CDFI未见明显异常。结论双源CT心胸联合血管造影检查不但能对肺动脉、主动脉等大血管疾病作出正确诊断,而且能同时发现冠状动脉疾病,因此双源CT是急性胸痛的一种无创、可靠的检查方法。     

双源CT冠状动脉造影的初步研究

目的 探讨双源CT在冠状动脉造影中的临床应用.方法 51例患者同时行双源CT冠状动脉血管造影(DSCTA)及选择性冠状动脉血管造影(CAG) 检查,分析DSCTA的敏感性、特异性及准确率.结果 51例患者[平均心率(77.7±5.8)次/min]均成功完成了双源CT冠状动脉血管造影,并清晰显示冠状动脉各主干及部分分支,51例患者的166支冠状动脉伴有不同程度的狭窄或闭塞,150支冠状动脉狭窄程度与CAG诊断结果相同,得出DSCTA的敏感性、特异性、阳性预测值、阴性预测值及准确率分别为100%,90%,90.4%,100%,94.8%.结论 双源CT对冠状动脉疾病的诊断准确率接近选择性冠状动脉造影,是一种准确可靠的检查方法.     

前瞻性心电门控双源CT冠状动脉成像在高心率患者中应用的可行性研究

Objective To explore the optimal reconstruction windows in patients with heart rate (HR) over 91 (beats per minute) bpm, and to explore the feasibility of prospective ECG-gated DSCT coronary angiography.Methods Two hundred and thirty-two patients[body mass index (BMI):23-25 kg/m2, with stable HR, and average HR ≥91 bpm]with suspected or known coronary artery disease underwent retrospective ECG-gated DSCT coronary angiography.They were divided into 3 groups (A-C) according to the average HR of scanning.Images were reconstructed from 29% to 80% of the R-R interval in 3% increments.Two independent readers assessed the overall image quality by a five-point scale and determined the optimal reconstruction windows of each coronary segment and the ranges.Coronary arteries were segmented according to the guideline of the American Heart Association (AHA).The degree of interobserver agreement was determined by Kappa statistics.Results Three thousand three hundred and fortythree segments were considered to have diagnostic image quality in 232 patients.The ranges of optimal reconstruction windows of images were concentrated on 81%-61% and 51%-31%.In group A(91-95 bpm), there were 1183 segments in 83 patients, and the according proportions were 5.49%, 94.51%,respectively; In group B(96-100 bpm), there were 986 segments in 68 patients, and the according proportions were 0.20%, 99.80%, respectively; In group C(≥ 101 bpm), there were 1174 segments in 81 patients, and the according proportions were 0.17%, 99.83%, respectively.The optimal construction windows in 3274 segments out of 3343 segments in 232 patients were concentrated in 41%, ranged from 51%-31%.The image quality assessment in 3343 segments in 232 patients have a high inter-observe agreement (Kappa=0.883,P <0.05).Conclusion The optimal reconstruction windows of patients with stable HR(≥91 bpm) was concentrated in 41%, ranged from 51%-31%.When nothing except the window of data acquisition is considered, the prospective ECC,-gated DSCT coronary angingraphy can be used in patients with stable HR(≥91 bpm).     

前瞻性心电门控双源CT冠状动脉成像在高心率患者中应用的可行性研究

Objective To explore the optimal reconstruction windows in patients with heart rate (HR) over 91 (beats per minute) bpm, and to explore the feasibility of prospective ECG-gated DSCT coronary angiography.Methods Two hundred and thirty-two patients[body mass index (BMI):23-25 kg/m2, with stable HR, and average HR ≥91 bpm]with suspected or known coronary artery disease underwent retrospective ECG-gated DSCT coronary angiography.They were divided into 3 groups (A-C) according to the average HR of scanning.Images were reconstructed from 29% to 80% of the R-R interval in 3% increments.Two independent readers assessed the overall image quality by a five-point scale and determined the optimal reconstruction windows of each coronary segment and the ranges.Coronary arteries were segmented according to the guideline of the American Heart Association (AHA).The degree of interobserver agreement was determined by Kappa statistics.Results Three thousand three hundred and fortythree segments were considered to have diagnostic image quality in 232 patients.The ranges of optimal reconstruction windows of images were concentrated on 81%-61% and 51%-31%.In group A(91-95 bpm), there were 1183 segments in 83 patients, and the according proportions were 5.49%, 94.51%,respectively; In group B(96-100 bpm), there were 986 segments in 68 patients, and the according proportions were 0.20%, 99.80%, respectively; In group C(≥ 101 bpm), there were 1174 segments in 81 patients, and the according proportions were 0.17%, 99.83%, respectively.The optimal construction windows in 3274 segments out of 3343 segments in 232 patients were concentrated in 41%, ranged from 51%-31%.The image quality assessment in 3343 segments in 232 patients have a high inter-observe agreement (Kappa=0.883,P <0.05).Conclusion The optimal reconstruction windows of patients with stable HR(≥91 bpm) was concentrated in 41%, ranged from 51%-31%.When nothing except the window of data acquisition is considered, the prospective ECC,-gated DSCT coronary angingraphy can be used in patients with stable HR(≥91 bpm).     

双源CT冠脉血管造影的临床价值

目的 探讨双源CT在冠状动脉造影中的临床应用价值.方法 对450例患者行双源CT冠状动脉血管造影(DSCTCA)检查,对其中76例患者同时行双源CT冠状动脉血管造影及选择性冠状动脉血管造影(CAG) 检查,分析比较DSCTCA的敏感性、特异性及准确率.结果 450例患者均成功完成了DSCTCA检查,并可清晰显示冠脉主干及部分分支,228例患者的747支冠脉伴有不同程度狭窄,其中76例患者的122支冠状动脉伴有重度狭窄或闭塞,以CAG为金标准,得出DSCTA的敏感性、特异性及准确率分别为100%、90.00%及94.84%,尤其对于重度狭窄及闭塞的诊断准确性达98.92%.结论 双源CT对冠状动脉疾病的诊断准确率接近选择性冠状动脉造影,是一种准确可靠的检查方法 .     

前瞻性心电门控扫描在冠脉支架随访中的应用

目的探讨前瞻性心电门控扫描在冠状动脉支架随访中的可行性。方法 77例冠状动脉支架植入术后患者行冠状动脉CT血管成像检查,按照心率不同分为两组,分别采用回顾性心电门控及前瞻性心电门控扫描。比较两组图像支架内及支架近端的CT值、噪声、信噪比(SNR)、支架内CT值净增比(SAIR)、图像质量主观评分及辐射剂量。定量数据表示为平均数±标准差。结果回顾性心电门控组的心率快于前瞻性心电门控组(P 0. 05)。两组图像支架内及支架近端的CT值、噪声、信噪比(SNR)、支架内CT值净增比(SAIR)以及图像质量主观评分差异均无统计学意义(P0. 05)。前瞻性心电门控组辐射剂量显著降低,平均有效辐射剂量为(2. 40±0. 99) m Sv,组间差异具有统计学意义(P 0. 05)。结论对于冠脉支架植入术后的患者,前瞻性心电门控扫描方案在降低辐射剂量的同时,可获得满意的图像质量。     

双源CT在主动脉弓断离诊断中的价值

目的 探讨双源CT(DSCT)门控下低剂量扫描在主动脉弓断离诊断中的价值.方法 对9例主动脉弓断离患儿行DSCT门控下低剂量心胸联合血管成像扫描并进行胸部动脉血管重建,进行诊断.所有患儿同时行心脏彩色多普勒(CDFI)检查,2种检查方法 在3 d内完成.所有患儿均行手术治疗.结果 9例行DSCT门控下低剂量心胸联合血管成像均成功完成,DSCT均诊断为主动脉弓断离,其中伴有室间隔缺损(VSD)9例、动脉导管未闭(PDA)8例、冠状动脉起源异常3例、支气管动脉扩张2例.断离后降主动脉的血液来源于肺动脉8例、肋间动脉和头臂动脉1例.CDFI诊断主动脉弓断离7例、动脉单干1例、主动脉缩窄1例,其中伴有VSD 9例、PDA 8例.5例断离后主动脉弓血液来源于肺动脉,1例断离后降主动脉的血液来源于肋间动脉及头臂动脉未能显示,1例显示支气管动脉扩张.与手术结果 对照:DSCT诊断准确率为94.12%(32/34处),CDFI诊断准确率为82.35%(28/34 处).结论 DSCT是诊断主动脉弓断离的有效方法 .