双源CT前瞻性心电门控技术在小儿主动脉缩窄诊断中的应用

目的 探讨双源CT(DSCT)前瞻性心电门控技术在小儿主动脉缩窄诊断中的价值.方法 对16例临床怀疑为主动脉缩窄的患儿行DSCT前瞻性心电门控心胸联合血管成像及心脏彩色多普勒血流显像(CDFI)检查.以手术或DSA结果为标准,采用x2检验比较DSCT和CDFI的诊断准确率.结果 DSCT诊断主动脉缩窄16例,其中伴房间隔缺损(ASD)4例、室间隔缺损(VSD)9例、大动脉转位1例、主动脉弓发育不良3例、动脉导管未闭( PDA)7例、冠状动脉起源异常1例、支气管动脉扩张l例.CDFI诊断主动脉缩窄15例,主动脉弓离断1例,伴ASD 4例、VSD 9例、二叶型主动脉瓣(BAV)2例、大动脉转位1例、主动脉弓发育不良2例、PDA 7例、支气管动脉扩张1例,未发现冠状动脉起源异常.与手术或DSA结果对照:DSCT和CDFI诊断准确率分别为97.2％(140/144)、97.9％ (141/144),两者差异无统计学意义(x2=0.00,P＞0.05),DSCT和CDFI诊断敏感度均为93.2％ (41/44),特异度分别为99.0％ (99/100)和100.0％ (100/100).DSCT前门控平均有效辐射剂量为0.42 mSv.结论 DSCT前瞻性心电门控技术是诊断小儿主动脉缩窄的首选检查方法.     

心电编辑技术在128层CT回顾性心电门控冠状动脉血管成像图像后处理中的应用

目的 :探讨心电编辑技术在128层CT回顾性心电门控冠状动脉血管成像图像后处理中的作用。方法 :选取行128层CT冠状动脉血管成像时心电门控记录的心电信号出现异常的50例患者使用心电编辑技术前后的后处理图像,并进行对照。结果:右冠状动脉、左主干、左前降支使用心电编辑技术后图像质量Ⅰ级和Ⅱ级所占比高于编辑前,Ⅲ级所占比低于编辑前,χ2分别为6.36、6.73、6.14,P值分别为0.042、0.034、0.046,差异均有统计学意义;而左回旋支编辑前后差异无统计学意义(χ2=4.93,P=0.085),并不具备可比性。结论:心电编辑技术能明显提高128层CT回顾性心电门控冠状动脉血管成像的后处理图像质量,提高检查成功率。     

前瞻性心电门控在64层CT冠状动脉成像的初步应用

目的 评价前瞻性心电门控64层CT冠状动脉成像的可行性和临床应用价值.方法 60例患者进行前瞻性心电门控64层CT冠状动脉成像检查,分析有效辐射剂量,并采用多平面重组(MPR)、最大密度投影(MIP)、曲面重组(CPR)及容积再现(VR)技术显示冠状动脉,评价其成像质量.结果 平均辐射剂量(2.7±0.2)mSv;符合诊断标准的冠状动脉节段为93.3%(720/772),44.2%(341/772)质量优秀,49.1%(379/772)质量中等,6.7%(52/772)质量较差.冠状动脉重度狭窄(＞75%)或闭塞5例(8.3%),中度狭窄(50%～75%)17例(28.4%),管腔不规则或轻度狭窄(＜50%)18例(30.0%),冠状动脉正常者20例(33.3%).结论 前瞻性心电门控64层CT冠状动脉成像的影像质量能达到诊断标准,大大降低了辐射剂量,具有很好的临床应用价值.     

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

目的 探讨心率不低于91次/分(bpm)患者回顾性心电门控双源CT(DSCT)冠状动脉成像R-R间期的最佳重建时相,从扫描时相选择的角度分析前瞻性心电门控(简称前门控)应用的可行性.方法 分析232例行回顾性心电门控DSCT冠状动脉成像患者(体质量指数23～25 kg/m2,心率≥91 bpm)的图像,根据扫描过程中患者屏气时心电监控记录到的心率将其分为3组(A～C组),A组83例,心率91～95 bpm,B组68例,心率96～100 bpm,C组81例,心率≥101 bpm.每隔3%重建1个时相,分别由2名医师独立对横断面图像、薄层MIP、CPR、VRT图像质量采用5分法进行综合评估,按照15段分段法,选出每个节段的R-R间期的最佳重建时相及范围.采用Kappa检验,评价2名医师对冠状动脉图像评分的一致性.结果 232例患者中,可评价冠状动脉节段共3343个,其图像最佳重建时相范围集中在81%～61%和51%～31%.3组冠状动脉节段与之相对应的节段数百分比:A组(91～95 bpm,83例的1183个节段)分别为5.49%、94.51%;B组(96-100 bpm,68例986个节段)分别为0.20%、99.80%;C组(≥101 bpm,81例1174个节段)分别为0.17%、99.83%.232例患者的3343个冠状动脉节段中3274个节段(97.94%)最佳重建时相范围集中在以41%为中心的51%～31%R-R间期范围内.2名医师对232例患者的3343个冠状动脉节段图像质量的评分结果得到了较高的一致性(Kappa值=0.883,P<0.05).结论 具有稳定的窦性心律,且屏气时平均心率≥91 bpm患者,冠状动脉节段的最佳重建时相集中于以R-R间期41%为中心的51%～31%,从扫描时相选择的角度考虑,可以对稳定高心率(≥91 bpm)患者行前门控横断面扫描,并且预设41%为曝光时间窗,成功把握较大.     

双源CT前瞻性心电门控低剂量技术在小儿先天性心脏病中的应用

目的 探讨双源CT(DSCT)前瞻性心电门控(简称前门控)低剂量技术在小儿先天性心脏病(简称先心病)中的临床应用价值.方法 收集行DSCT前门控低剂量技术扫描的22例先心病患儿,记录其容积CT剂量指数(CTDIvol)和剂量长度乘积(DLP),计算出有效辐射剂量(ED).由2名放射科医师独立诊断并用5分法对图像进行质量评估,对图像质量的评价符合程度采用Kappa检验.以手术或DSA结果为标准,比较DSCT前门控与经胸超声心动图(TTE)结果的符合率,采用χ2检验,以P<0.05为差异有统计学意义.结果 22例患儿DSCT前门控低剂量技术扫描的平均有效辐射剂量是(0.37±0.10)mSv,最低0.195 mSv,最高0.594 mSv.图像质量评分为4.4±0.6,图像均符合诊断要求;2名放射科医师的图像质量评价一致性极强(Kw=0.838,P<0.05).DSCT前门控与TTE的诊断准确率分别为98.7%、98.2%,差异无统计学意义(χ2=0.338,P>0.05 ).结论 DSCT前门控低剂量技术在保证图像满足诊断要求的前提下,大大降低了受检患儿的辐射剂量,减少了辐射危害,具有重要的临床应用价值.     

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).     

回顾性心电门控结合心电编辑在64层螺旋CT冠状动脉成像中的应用

目的 探讨回顾性心电门控技术结合心电编辑在64层螺旋CT冠状动脉成像(MSCTA)中的应用价值.方法 因临床拟诊冠心病而行冠状动脉64层MSCTA检查的患者67例,其中37例扫描中出现期前收缩(房性17例,室性20例),16例心电信号出现错误触发点,14例部分R波上触发点缺失而导致R-R间期不等.对患者的心电信号进行编辑,结合回顾性心电门控技术和后处理工作站重组编辑后的图像.12例患者在MSCTA后4～30 d行冠状动脉导管造影(CAG)检查.结果 1例房性期前收缩患者未能实施心电编辑.66例763段冠状动脉中质量为优、良、中和差者分别为473(62.0%)、213(27.9%)、51(6.7%)和26段(3.4%);可用于诊断的血管为737段(96.6%).12例患者冠状动脉MSCTA检查结果 与CAG检查进行对照,MSCTA诊断血管狭窄程度1≥50%的敏感性为84.6%(22/26);诊断血管狭窄程度＜50%的敏感性为83.3%(10/12);诊断血管狭窄的特异性为96.3%(105/109),阴性预测值为97.2%(105/108).结论 回顾性心电门控配合心电编辑冠状动脉MSCTA能明显改善患者期前收缩和心电信号中触发点错误的图像质量,扩大了冠状动脉MSCTA检查的适应证范围.     

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).     

64层螺旋CT肺动脉成像低管电压设置结合个体化对比剂应用的对照研究

目的 探讨低kV设置及个体化对比剂应用在64层MSCT肺动脉成像(MSCTPA)中应用的可行性.方法 连续选取具有发生肺动脉栓塞可能的高危患者90例,按完全随机设计分为3组:(1)常规组30例,管电压120 kV,对比剂总量70ml;(2)120 kV组30例,管电压120 kV,对比剂总量根据患者体质量进行个体化设置(1.0 ml/kg);(3)100 kV组30例,管电压100 kV,对比剂总量根据患者体质量进行个体化设置(1.0 ml/kg).3组患者的对比剂均在20 s注射完毕,并以相同流率追加生理盐水20ml.对120 kV组和100 kV组CT图像的客观指标、主观图像质量评价、GT容积剂量指数(CTDIvol)和有效吸收剂量(ERD)进行比较;对100 kV组和常规组的对比剂用量、对比剂注射流率、CT图像的客观指标和主观图像质量评价进行比较,以评价64层MSCT低kV设置联合个体化对比剂应用在MSCTPA中应用的可行性.使用方差分析及post hoc检验对3组数据进行统计学分析.结果 图像噪声水平:100 kV组(5.2±1.8)与120 kV组(3.4±0.7)比较增加了52.9%,纵隔窗图像主观图像质量评价差异无统计学意义(q=0.272,P=0.063);CTDIvol:100 kV组[(9.5±0,0)mGy]与120 kV组[(14,6±0,0)mGy]比较下降34,9%;ERD:100 kV组[(2,4±0.4)mSv]与120 kV组[(3.8±0.6)mSv]比较下降36.8%;肺动脉平均CT值:100 kV组[(269.2±54.7)HU]相对于120 kV组[(237.4±62.9)HU]平均增加了13.4%,与常规组比较差异无统计学意义(q=0.172,P=0.260).结论 64层MSCTPA应用低kV设置(100 kV)降低辐射剂量是可行和有效的,个体化对比剂注射方案对特殊人群有一定临床价值.     

低剂量冠状动脉CTA:前瞻性与回顾性心电门控扫描的对比分析

目的：对比分析前瞻和回顾性心电门控双源CT冠状动脉成像时辐射剂量及图像质量的差异,为临床低剂量冠状动脉CT成像扫描方案的制定提供参考依据。方法：回顾性分析105例双源CT冠脉成像资料,前瞻性门控扫描组55例,应用自动管电流调制技术(ATCM)40例,未应用ATCM技术15例。回顾性扫描组50例均采用ATCM技术、ECG...     

CT肺血管成像对急性大面积肺栓塞患者的动态分析价值

目的 探讨CT肺血管成像(CTPA)对大面积肺栓塞患者的动脉栓塞程度及右心功能的动态分析价值.方法 回顾性分析23例大面积肺栓塞患者的CTPA资料,分析治疗前、治疗后24 h及14 d时的CTPA肺动脉栓塞指数及右心功能参数,采用单因素方差分析、LSD检验和X2检验分析治疗前后的变化,并采用Pearson法分析肺动脉栓寨指数与右心功能参数之间的相关性.结果 CTPA肺动脉栓塞指数在溶栓治疗后逐渐减小,Qanadli和Mastora评分在治疗前(分别为50.0、46.5分)与治疗后24 h(分别为42.5、12.1分)比较差异有统计学意义(t值分别为2.830、6.493,P值均<0.01);治疗后24 h与治疗后14 d(分别为25.0、8.4分)比较差异有统计学意义(t值分别为4.640、4.299,P值均<0.01).治疗后24 h,右心室最大短轴直径(4.58 cm)及横截面积(23.10 cm2)明显减小,左心室最大短轴直径(4.41 cm)及横截面积(26.37 cm2)明显增大,双侧心室最大直径比(1.07)和面积比(0.94)明显减小,与上述各指标治疗前相比(分别为5.07 cm、25.42 cm2、3.57 cm、20.17 cm2、1.59,1.38)差异有统计学意义(t=2.081～4.959,P值均<0.05);治疗后24 h,肺动脉收缩压(40.92 mm Hg)明显变小,与治疗前(58.61 mm Hg)相比差异有统计学意义(t=2.824,P<0.01);治疗前与治疗后24 h,CTPA肺动脉栓塞指数与右心功能参数间均有不同程度的相关性(r=0.034～0.598,P值均<0.01).结论 CTPA可以动态观察急性肺栓塞的肺动脉阻塞程度及右心功能的变化,为临床治疗提供重要的信息.     

16层螺旋CT肺动脉造影对肺栓塞诊断的临床价值

目的:探讨16层螺旋CT肺血管造影术(MSCTPA)诊断肺动脉栓塞的临床价值。方法:对临床拟诊肺栓塞的46例患者行MSCTPA检查及后重建技术,后重建方法包括容积再现(VR)、多平面重建(MPR)、最大密度投影(MIP)。结果:46例共发现栓子698个,其中肺动脉主干4个,左右肺动脉41个,叶动脉114个,段及亚段动脉539个。直接征象:①)血管截断征,表现为肺动脉管腔完全闭塞;②轨道征,表现为腔内充盈缺损位于血管中央,周围有对比剂环绕;③偏心性充盈缺损,表现为管腔内不规则充盈缺损偏向管壁一侧,边缘欠光整;④附壁性充盈缺损。间接征象:①肺窗观察见局限性的血管纹理稀疏,呈"马赛克征";②肺梗死,表现为肺外围以胸膜为基底的楔形或条状实变影;③胸腔积液、肺动脉高压、右心室肥大以及心包积液等。结论:MSCTPA能对肺动脉栓塞作出准确诊断,是无创、快速、安全、敏感的检查方法,并可追踪复查,评估治疗效果。     

预注射双点监测法行肺动静脉CT血管成像的可行性研究

目的:评价预注射双点监测法行多层螺旋CT肺动脉成像(CTPA)和肺静脉成像(CTPV)的成像技术及图片质量。方法:应用MSCT对30例疑似肺动脉栓塞患者行CTPA及CTPV检查。对比剂剂量为20ml(370mg I/ml),所有患者均采用预实验时间-密度曲线法,监测平面定于支气管隆突水平。CTPA及CTPV的兴趣区(ROI)分别选在肺动脉主干及相应层面肺静脉内,分别获得肺动脉及肺静脉时间-密度曲线,以对比剂注射开始到增强峰值的时间为延迟时间。采用盲法对CTPA及CTPV图像中同级别肺动静脉CT值进行测量并进行统计学分析。结果:30例患者均同时获得肺动脉及肺静脉的时间-密度曲线。肺动脉对比剂达峰值时间为(10.2±1.8)s,肺静脉对比剂达峰值时间为(14.7±2.3)s。所有图像均能清晰显示肺动静脉1～4级血管。CTPA及CTPV图像中1～4级动静脉血管CT值差异均具有统计学意义(P<0.05)。结论:预注射双点监测法可同时完成CTPA及CTPV肺动静脉各级分支成像,并且达到临床诊断要求。     

64层CT肺动脉造影对肺栓塞诊断及治疗后复查的应用研究

目的:探讨64层CT肺动脉造影(CTPA)对肺栓塞的诊断效果及治疗后复查的价值。方法:对32例肺动脉栓塞的患者采用64层CT行CTPA检查,并进行多平面重建(MPR)、最大密度投影及容积重建处理。患者复查采用相同CT检查及后处理重建。结果:32例患者中15例有下肢静脉栓塞、4例有恶性肿瘤、3例有近期手术病史,2例有近期外伤史。CTPA对肺动脉主干、左右肺动脉及叶、段、亚段动脉显示良好,32例患者中显示受累肺动脉221支,其直接征象为肺动脉血管内充盈缺损,间接征象包括肺梗死实变、肺野少血征、胸腔积液等。肺栓塞治疗后复查有24例患者1月内肺动脉栓子消失或明显吸收缩小(占75%);6例患者吸收不明显(占18.7%);2例死亡。结论:64层CT能清楚地显示肺栓塞的形态、部位及其它间接征象,并能有效监测治疗效果,为临床提供有益帮助。     

螺旋CT血管成像诊断肺动静脉畸形的价值

目的:探讨多层螺旋CT肺血管成像在肺动静脉畸形(PAVM)中的诊断价值。方法:回顾性分析7例PAVM的多层螺旋CT三维肺血管成像的影像表现,1例为多发,6例单发。2例经手术证实,5例经其他影像学检查方法及随访证实。结果:7例PAVM均清晰显示瘤体形态、大小、位置,以及供血动脉、引流静脉数目、走行、直径。单纯型4例,复杂型2例,弥漫型1例。结论:多层螺旋CT肺血管成像可以明确PAVM的瘤体、供血动脉、引流静脉的空间关系和解剖细节,可作为PAVM的首选检查和随访方法。     

多层螺旋CT肺动脉成像的图像后处理技术及应用

目的：探讨多层螺旋CT肺动脉成像的各种图像后处理技术对显示肺动脉的优缺点及临床应用价值。方法：采用Philips Brillance 16排螺旋CT,美国MADRAD双筒高压注射器。图像后处理分析软件包括MIP、VR、VE、VIP。分析58例行胸部CTA检查的血管重建图像,比较各种图像后处理技术对肺动脉的显示效果。结果：58例患者都能清晰显示肺动脉走形、分支及管径。各种常用图像后处理技术中,MIP既能清晰显示肺动脉的解剖学形态,又能显示其与周围组织关系;在完整显示肺动脉的解剖学形态方面,VR优于MIP,但不能显示血管腔内情况;VIP优势在于单条血管的跟踪观察;在显示肺动脉分支,尤其是细小分支时,VE能跟踪血管发现血管的分支及其走形,并了解管壁是否光滑,在这一方面优于其他后处理技术。结论：多层螺旋CT的肺动脉成像可直观地、准确地显示肺动脉及其分支、走形、形态、管径。肺动脉成像的各种后处理技术中,MIP和VR两者联合应用对解剖学形态及其与周围组织关系显示很好;VIP及VE亦有很好的辅助作用。     

64层螺旋CT肺动脉造影在肺动脉栓塞诊断中的应用

目的 探讨64层螺旋CT肺动脉造影(CT pulmonary angiography,CTPA)对肺动脉栓塞(pulmonary embolism,PE)的诊断价值.方法 回顾分析24例肺动脉栓塞患者的64层螺旋CT增强图像,将原始图像复制到EBW4.0工作站,对肺动脉主干及分支进行多平面重建(MPR),最大密度投影(MIP)及容积重建(VR)分析.结果 24例患者中,共检出了76处肺动脉及其分支的栓子.其中,左、右肺动脉主干14处(右主干10处、左主干4处),肺叶动脉24处,肺段动脉26处,亚肺段动脉12处.CT表现为肺动脉主干或分支内混合性、附壁性、中心性充盈缺损,可分为完全性或部分性.结论 64层CTPA具有准确、高效、无创等优点,可直观、立体地观察到肺动脉血栓的大小、分布、范围及类型,是临床诊断及观察疗效的首选方法,有望成为肺动脉栓塞检查的“金标准”.     

64层螺旋CT在冠状动脉造影中的应用

目的 探讨64层螺旋CT（MSCT）冠状动脉（简称冠脉）造影的临床应用价值。方法 对26例患者行64层MSCT冠脉造影检查，利用其先进的后处理功能对冠脉进行重组，以显示冠脉各主支及分支，并对冠脉病变进行诊断。对诊断冠脉不同程度狭窄的16例患者中15例行选择性血管造影检查。结果 26例行64层MSCT冠脉造影均成功地显示冠脉各主支（左冠脉主支、左冠脉回旋支、左冠脉前降支及右冠脉主支）及其分支（包括右冠脉的后降支、左室后支、圆锥支、窦房结动脉及左冠脉的对角支、钝缘支等），18例患者的56支冠脉有不同程度的硬斑块和软斑块，其中16例的38支冠脉伴有不同程度的狭窄，15例行选择性血管造影的患者显示32支冠脉有不同程度的狭窄。结论 64层MSCT是1种安全可靠的检查方法，其对冠脉疾病的诊断准确率较4～16层MSCT有明显提高。