低剂量螺旋CT胸部健康体检价值的探讨

目的:探讨低剂量螺旋CT对胸部健康体检的价值。方法:采用低剂量螺旋CT对1 953例参加健康体检者行胸部扫描,观察肺部、心血管、胸壁(软组织、骨骼)及上腹部的病变。结果:1953例被检者,304例检出肺内非钙化结节,其中21例诊断为肺癌,早期肺癌20例(95%);全部被检者冠状动脉钙化阳性者275例,阳性率为14.1%;胸主动脉钙化阳性者371例,阳性率为19.0%;胸椎骨质增生56例,胸椎压缩骨折8例;乳腺癌1例;脂肪肝23例,肝囊肿10例。结论:采用低剂量螺旋CT胸部体检,不仅可以检出早期肺癌,还可以检出冠状动脉和主动脉钙化斑块、胸壁病变及上腹部病变。一次胸部CT筛查可以检出多脏器具有临床价值的疾病。     

心外膜脂肪组织体积与零钙化积分冠状动脉斑块的关系

目的：探讨心外膜脂肪组织体积(EATV)与零钙化积分冠状动脉斑块的关系。方法回顾性分析临床疑诊为冠心病但冠状动脉钙化积分测定为零的183例患者,根据 CT 冠状动脉造影显示有无斑块分为斑块组及对照组。按照不同性别及年龄分层,采用独立样本 t 检验比较2组 EATV 。结果①斑块组 EATV 高于对照组(P <0.05)。②女性斑块组 EATV 高于对照组(P >0.05);男性斑块组 EATV 高于对照组(P <0.05)。③年龄<50岁人群斑块组 EATV 高于对照组(P <0.05);年龄≥50岁人群斑块组EATV 高于对照组(P <0.05)。结论EATV 增加与零钙化积分冠状动脉斑块形成在男性人群中有关,在女性人群中关系不大。不同年龄 EATV 增加均与零钙化积分冠状动脉斑块形成有关。     

糖尿病和非糖尿病患者冠状动脉粥样硬化病变的比较研究

目的:比较在冠状动脉CT检查中所显示的糖尿病和非糖尿病患者冠状动脉粥样硬化病变的情况.方法:96名糖尿病患者(平均年龄:64±10岁;男性:52例)和202名非糖尿病患者(年龄:61±13岁;男性:120例),应用冠状动脉CT检查有无冠状动脉病变及病变程度.同时利用钙化积分来评估冠状动脉钙化情况.结果:与非糖尿病患者相比,糖尿病患者冠状动脉有较多部位动脉粥样硬化病变(4.1±4.2 vs 2.1±3.0;P<0.000 1);冠状动脉钙化积分>400的比例较高(P<0.001);阻塞性冠状动脉病变比例较高(37% vs 18%;P<0.000 1),而正常的冠状动脉的比例较低(20% vs 42%;P<0.000 1).结论:糖尿病患者的冠状动脉粥样硬化负荷较高.     

多层螺旋CT对冠状动脉钙化的定量分析及临床意义

目的 :评价多层螺旋CT(MSCT)测定冠状动脉钙化积分的准确性及临床意义。方法 :搜集 12 5例在我院行MSCT检查临床怀疑或确诊为冠心病的病例资料。MSCT扫描采用心电门控触发成像 ,单次扫描时间为 0 .3 2s ,层厚为 2mm× 4。钙化灶定义为CT值≥ 13 0HU。其中 2 3例另行冠状动脉造影检查。结果 :12 5例受检者冠状动脉钙化有 92例 ( 73 .6% ) ,各部位发生率依次为左前降支 ( 3 4.9% )、回旋支 ( 3 1.7% )、右冠状动脉 ( 2 7.3 % )和左冠状动脉主干 ( 6.1% ) ;<5 0岁和 5 0～ 65岁冠心病组冠状动脉钙化率、钙化积分明显高于正常组 ,≥ 65岁冠心病组冠状动脉钙化率与正常组无显著差别 ,但钙化积分明显高于正常组。冠脉钙化检测冠心病在年轻组特异性高 ,敏感性低 ,随年龄增大敏感性增高而特异性降低。结论 :多层螺旋CT检出冠状动脉钙化简便易行 ,有较高的敏感性和特异性 ,可广泛用于临床预测及早期诊断冠心病。     

指甲下钙化

作者在1,000例由于各种关节痛原因而检查的成人X 线片中(大多40岁以上,73%为女性),发现13例女性3例男性患者有指甲下钙化。其中12例女性和1例男性兼有趾甲下钙化,但外表无异常改变,这16例平均年龄是67.6岁(50—83岁)。据文献记载50岁以上人群中仅1%可能发生原发性指甲下钙化,但随年龄增高发病率有所递增。指甲下钙化仅发生于甲床的浅表部位而不发生于甲床根区,似乎在甲床部位的结构更易导致钙化的发生。     

双能量胸部DR对筛查冠状动脉钙化的意义:与多排螺旋CT的比较性研究

目的探讨胸部双能量DR骨骼像在筛查冠脉钙化中的意义。方法35例患者分别行右前斜位胸部双能量DR检查及多排螺旋CT(MDCT)冠状动脉扫描并记录照射后射线的体表入射剂量ESD(mGy)。2位高年资放射科医师及2位低年资医师分析双能量胸片骨骼像,对LAD、LCX、RCA共105条血管的钙化情况进行评估。CT扫描图像进行钙化积分分析。以钙化积分>300为金标准,对双能量DR的结果进行ROC分析。结果DR胸片平均阳性率27.6%(29/105),其中LAD阳性率48.5%(17/35);LCX22.8%(8/35);RCA 11.4%(4/35)。4位医师的ROC结果显示曲线下面积分别为0.866、0.854、0.725、0.642。胸部DR照射平均体表入射剂量为(0.469±0.22)mGy;多排CT入射剂量为(12.29±1.40)mGy。两者经配对t检验有显著差异。结论DR骨骼片可以检出较明显的冠状动脉钙化,对冠心病的筛查和病情的检测有一定的临床意义。     

颅内动脉经颅彩色多普勒血流成像研究

目的探讨不同年龄正常人颅内动脉的显示率和内径变化。方法256例正常成人按年龄、性别分6组,采用经颅彩色多普勒血流成像(TCCDFI)、能量多普勒(CDE)及超声造影(ECE)技术,观察颅内动脉走行及血流方向,并测量其血管内径。结果①TCCDFI和CDE颅内动脉成功显示率在男女各组中均随年龄增长而下降。三组女性间差异有显著性意义,老年女性明显低于男性(P<0.05),Willis环完全未显示的老年组被检者行ECE仍有85%可清晰显示;②血管内径随年龄增加而变小且男女间差异有显著性意义(P<0.05)。结论TCCDFI、CDE及ECE能实时动态观测颅内动脉,可作为颅内动脉检查的有效方法。     

128层螺旋CT冠脉成像在诊断及分级评价冠心病的临床价值

目的探讨128层螺旋CT冠脉成像在临床诊断及分级评价冠心病中的应用价值。方法对120例进行128层螺旋CT检查诊断的疑似冠心病患者的临床检查结果分析,并与CAG对比评价冠脉狭窄程度分级诊断的准确性。结果120例患者经冠状动脉造影检查确诊冠状动脉狭窄阳性84例,阳性率为70.00%;阴性36例,阴性率为30%。另外,120例患者经冠状动脉造影检查发现冠状动脉内斑块出现钙化82例,钙化率为68.33%,非钙化38例,非钙化率为31.67%。120例患者经冠状动脉成像检查确诊冠状动脉狭窄阳性85例,阳性率为70.83%;阴性35例,阴性率为29.17%。另外,120例患者经冠状动脉成像检查发现冠状动脉内斑块出现钙化83例,钙化率为69.17%,非钙化37例,非钙化率为30.83%(37/120)。经统计学分析经冠状动脉成像检查与经冠状动脉造影检查两种方法对冠状动脉狭窄的阳性率和冠状动脉内斑块检查中钙化率检出情况比较无明显差异。120例患者检出1572段血管节段,在行冠脉狭窄程度检查时,其对狭窄程度分级过程中均清晰显现出较多的低估或高估情况。结论 128层螺旋CT冠状动脉成像技术可作为可疑冠心病患者筛查手段或低危冠心病患者的复查手段,具有可靠、简便、准确、快捷的优点。     

电子束CT对冠状动脉钙化的定量分析及临床意义

目的：探讨电子束CT在冠心病早期诊断中的作用。方法：应用Imatron C-150型电子束CT,检查1267例患者冠脉钙化情况并进行定量分析。结果：冠脉钙化发生率依次为LAD（40.5%）、RCA（24.8%）、CX（21.4%）和LM（13.3%）;＜50岁和50-59岁冠心病组冠状动脉钙化率、钙化积分明显高于正常组,≥60岁冠心病组冠状动脉钙化率与正常组无显著差别,但钙化积分明显高于正常组。冠脉钙化检测冠心病在年轻组特异性高,敏感性低,随年龄增大敏感性增高而特性降低。结论：电子束CT冠脉钙化检查及定量分析,对冠心病早期诊断有重要临床价值。     

中低风险度无典型冠心病症状男性和女性256层螺旋CT冠状动脉成像分析

目的初步探讨国人缺血性心脏病(ICVD)综合危险度记分中低风险度无典型冠心病症状男女人群冠状动脉CT血管成像临床应用价值。方法回顾分析495例无典型冠心病症状、国人ICVD记分中低风险度者256层冠状动脉成像影像图像,采用SPSS 19.0统计软件计算全体研究者斑块及≥50%狭窄检出率,并对比男女间斑块及≥50%狭窄检出率,分析全体及男女间各斑块类型。结果全体495例中有304例检出斑块627个,斑块检出率为61.4%,其中≥50%狭窄检出率为23.0%。非钙化、钙化及混合斑块检出率分别为18.6%、39.0%、12.1%。男性与女性各类型斑块及≥50%狭窄检出率分别为70.2%、29.4%与53.4%、17.3%,男性与女性非钙化、钙化及混合斑块的检出率分别为22.6%、44.7%及15.3%与15.0%、33.8%及9.2%,差异均具有统计学意义(P0.05)。结论对于中低风险度无典型冠心病症状人群,冠脉CTA检查能够为临床提供客观影像学依据,可以作为冠心病一种有效的筛查手段。     

Frequency of coronary artery calcification on low-dose computed tomography screening for lung cancer

PURPOSE: The purpose of this study was to determine the frequency of coronary artery calcification (CAC) in high-risk people undergoing computed tomography (CT) screening for lung cancer. METHODS: Between 1999 and 2004, we performed CT screening for lung cancer on 4250 participants, all without documented prior cardiovascular disease, using multidetector-row (MD) CT. Of the patients, 1102 underwent imaging with a four-detector-row CT at 120 kVp and 40 mA, with pitch 1.5 and collimation of 2.5 mm in a single breath hold of 15-20 seconds, and 3148 did with an eight-detector-row CT at the same kVp, mA, and pitch settings but with collimation of 1.25 mm. Visualized CACs in each coronary artery (main, left anterior descending, circumflex, and right) were scored separately as 0 (absent), 1 (mild), 2 (moderate), or 3 (severe), yielding a possible score of 0-12 for each person. Frequency distributions by gender, age, and pack-years of smoking were determined. Odds ratios (ORs) were calculated using logistic regression analysis of the prevalence of CAC as a joint function of gender, age, pack-years of smoking, and presence of diabetes. RESULTS: Among the subjects younger than 50 years, positive CAC scores were three times more frequent for men than for women (22% vs. 7%); among those older than 50 years, the frequency increased for both men and women but the increase for women was greater than that for men. The frequency of positive CAC scores increased with increasing pack-years of smoking; it was always higher for men than for women. The ORs were 2.6 for male gender (P<.0001), 3.7 and 9.6 for ages 60-69 years and 70 years or older, respectively, for increasing age (P<.0001 for both), 1.6 and 2.3 for 30-59 pack-years and 60 pack-years or longer, respectively, for increasing pack-years of smoking (P<.0001 for both), and 1.6 for having diabetes (P=.016). CONCLUSION: The CAC score can be derived from ungated low-dose MDCT images. This information can contribute to risk stratification and management of coronary artery disease.     

Threshold-dependent variability of coronary artery calcification measurements -- implications for contrast-enhanced multi-detector row-computed tomography

INTRODUCTION: The present study investigated the threshold-dependent variability of coronary artery calcification (CAC) measurements and the potential to quantify CAC in contrast-enhanced multi-detector row-computed tomography (MDCT). METHODS: We compared the mean CT attenuation of CAC to luminal contrast enhancement of the coronary arteries in 30 patients (n = 30) undergoing standard coronary contrast-enhanced spiral MDCT. The modified Agatston score [AS], calcified plaque volume [CV], and mineral mass [MM]) at four different thresholds (130, 200, 300, and 400 HU) were measured in 50 patients who underwent non-contrast-enhanced MDCT. RESULTS: Mean CT attenuation of CAC was similar to the attenuation of the contrast-enhanced coronary lumen (CAC 297.1 +/- 68.7 HU versus 295 +/- 65 HU (p < 0.0001), respectively). Above a threshold of 300 HU CAC measurements significantly varied to standard measurements obtained at a threshold of 130 HU (p < 0.0001). The threshold-dependent variation of MM measurements was significantly smaller than for AS and CV (130 HU versus 400 HU: 63, 75, and 81, respectively; p < 0.001). These differences resulted in a change of age and gender based percentile category for AS in 78% of subjects. DISCUSSION: We demonstrated that CAC measurements are threshold dependent with MM measurements having significantly less variation than AS or CV. Due to the similarity of mean CT attenuation of CAC and the contrast-enhanced coronary lumen accurate quantification of CAC may be difficult in standard coronary contrast-enhanced spiral MDCT.     

Effect of CT digital image compression on detection of coronary artery calcification

Purpose: To test the effect of digital compression of CT images on the detection of small linear or spotted high attenuation lesions such as coronary artery calcification (CAC).Material and Methods: Fifty cases with and 50 without CAC were randomly selected from a population that had undergone spiral CT of the thorax for screening lung cancer. CT image data were compressed using JPEG (Joint Photographic Experts Group) or wavelet algorithms at ratios of 10:1, 20:1 or 40:1. Five radiologists reviewed the uncompressed and compressed images on a cathode-ray-tube. Observer performance was evaluated with receiver operating characteristic analysis.Results: CT images compressed at a ratio as high as 20:1 were acceptable for primary diagnosis of CAC. There was no significant difference in the detection accuracy for CAC between JPEG and wavelet algorithms at the compression ratios up to 20:1. CT images were more vulnerable to image blurring on the wavelet compression at relatively lower ratios, and "blocking" artifacts occurred on the JPEG compression at relatively higher ratios.Conclusion: JPEG and wavelet algorithms allow compression of CT images without compromising their diagnostic value at ratios up to 20:1 in detecting small linear or spotted high attenuation lesions such as CAC, and there was no difference between the two algorithms in diagnostic accuracy.     

Systemic arterial calcium burden in patients with chronic limb-threatening ischemia

Introduction5-year mortality of chronic limb-threatening ischemia (CLTI) is 50–60% and coronary artery disease (CAD) is the main cause of death of CLTI patients, followed by stroke. The aim of this study is to quantify and qualify the calcium load in different arterial territories in patients with CLTI.MethodsProspectively, 60 patients with CLTI were included and received a full-body CT scan. 6 patients were excluded. Different arterial territories (the peripheral lower extremity arteries, coronary arteries, extracranial and intracranial carotid arteries, thoracic and abdominal aorta) were analyzed. Analysis and interrelations of both quantitative and semi-quantitative CT measurements was performed.ResultsMean age was 72 years (range 47–95; SD 11.4). Almost all CLTI patients had calcified arterial beds (femoropopliteal 100%, crural 98.1%, coronary 100%, carotid bifurcation 96.2%, internal carotid artery 98.1%, thoracic aorta 96.2%, abdominal aorta 92.3%). Nearly all arterial territories had severe calcifications. 57% had a very high coronary Agatston score (>1000), and 35% extremely high (>2000). Calcifications in the lower extremity were significantly correlated to CAC score, carotid artery bifurcation calcification score, and to a lesser extent correlated to annular calcifications in the aorta. Very high and extremely high total CAC scores were strongly correlated with severe lower extremity arterial calcifications and severe carotid and intracranial internal carotid artery, thoracic and abdominal aorta calcifications in patients with CLTI patients.ConclusionsIn CLTI patients nearly all arterial territories are severely calcified, suggesting that systemic calcification plays an important role in the poor outcome of this disease.     

双层螺旋CT冠状动脉钙化积分评估

目的 :对冠状动脉钙化进行定性判断 ,并对其钙化程度进行积分评估和相关技术探讨。方法 :采用GELightspeed 2 .0螺旋CT ,结合心电门控技术 ,对临床怀疑冠心病及要求体检者共 16例行心脏平扫。结果 :CT成像 ,应用SmartScore软件行冠状动脉钙化积分评估。 9例可见双侧冠状动脉多发钙化 ,3例高积分病例随后行DSA检查 ,进一步判断冠脉狭窄程度 ;3例单支冠状动脉钙化 ;4例未见明显钙化 ,其中 1例右侧冠状动脉密度增高 ,有粥样硬化斑块。结论 :螺旋CT冠状动脉钙化积分评估 ,可作为临床诊断重要辅助参考依据 ,是一种值得推广的技术。     

Risk stratification of non-contrast CT beyond the coronary calcium scan

Coronary artery calcification (CAC) is a well-known marker for coronary artery disease and has important prognostic implications. CAC is able to provide clinicians with a reliable source of information related to cardiovascular atherosclerosis, which carries incremental information beyond Framingham risk. However, non-contrast scans of the heart provide additional information beyond the Agatston score. These studies are also able to measure various sources of fat, including intrathoracic (eg, pericardial or epicardial) and hepatic, both of which are thought to be metabolically active and linked to increased incidence of subclinical atherosclerosis as well as increased prevalence of type 2  diabetes. Testing for CAC is also useful in identifying extracoronary sources of calcification. Specifically, aortic valve calcification, mitral annular calcification, and thoracic aortic calcium (TAC) provide additional risk stratification information for cardiovascular events. Finally, scanning for CAC is able to evaluate myocardial scaring due to myocardial infarcts, which may also add incremental prognostic information. To ensure the benefits outweigh the risks of a scanning for CAC for an appropriately selected asymptomatic patient, the full utility of the scan should be realized. This review describes the current state of the art interpretation of non-contrast cardiac CT, which clinically should go well beyond coronary artery Agatston scoring alone.     

电子束CT检测冠状动脉钙化的方法及初步结果报告

目的：报告电子束ＣＴ检测冠状动脉钙化（ＣＡＣ）的方法和初步研究结果。材料和方法：将经ＩｍａｔｒｏｎＣ－１５０电子束ＣＴ机检查冠状动脉的９０例分为三组：（１）非冠心组；（２）可疑组；（３）冠心组。对各例冠状动脉的走行进行观察；对比分析各组ＣＡＣ的发生率和钙化定量积分。结果：电子束ＣＴ能清晰地显示冠状动脉主干及主要分支。ＣＡＣ发生率冠心组为９５．０％（１９／２０例），可疑组为４８．６％（１７／３５例），非冠心组为２２．９％（８／３５例），差别具有显著性（ｐ＜０．００１）。发生ＣＡＣ的４４例中，冠心组的定量总分显著高于可疑组和非冠心组（Ｐ值分别＜０．０５和＜０．０１）。结论：电子束ＣＴ检测ＣＡＣ可为早期冠心病的诊断、预测和防治提供依据。     

Relationship between Incidental Abnormalities on Screening Thoracic Computed Tomography and Mortality: A Long-Term Follow-Up Analysis

ObjectiveThe present study aimed to assess the relationship between incidental abnormalities on thoracic computed tomography (CT) and mortality in a general screening population using a long-term follow-up analysis.Materials and MethodsWe retrospectively collected the medical records and CT images of 840 participants (mean age ± standard deviation [SD], 58.5 ± 6.7 years; 564 male) who underwent thoracic CT at a single health promotion center between 2007 and 2010. Two thoracic radiologists independently reviewed all CT images and evaluated any incidental abnormalities (interstitial lung abnormality [ILA], emphysema, coronary artery calcification [CAC], aortic valve [AV] calcification, and pulmonary nodules). Kaplan–Meier analysis with log-rank and z-tests was performed to assess the relationship between incidental CT abnormalities and all-cause mortality in the subsequent follow-up. Cox proportional hazards regression was performed to further identify risk factors of all-cause mortality among the incidental CT abnormalities and clinical factors.ResultsAmong the 840 participants, 55 (6%), 171 (20%), 288 (34%), 396 (47%), and 97 (11%) had findings of ILA, emphysema, CAC, pulmonary nodule, and AV calcification, respectively, on initial CT. The participants were followed up for a mean period ± SD of 10.9 ± 1.4 years. All incidental CT abnormalities were associated with all-cause mortality in univariable analysis (p < 0.05). However, multivariable analysis further revealed fibrotic ILA as an independent risk factor for all-cause mortality (hazard ratio, 2.52 [95% confidence interval, 1.02–6.22], p = 0.046). ILA were also identified as an independent risk factor for lung cancer or respiratory disease-related deaths.ConclusionIncidental abnormalities on screening thoracic CT were associated with increased mortality during the long-term follow-up. Among incidental CT abnormalities, fibrotic ILA were independently associated with increased mortality. Appropriate management and surveillance may be required for patients with fibrotic ILA on thoracic CT obtained for general screening purposes.     

低剂量64层螺旋CT测定冠状动脉钙化积分的准确性评价

目的 探讨低剂量64层螺旋CT测定冠状动脉钙化积分的准确性。方法 2006年8月至2009年9月间对43名冠状动脉钙化的患者连续进行2次64层螺旋CT扫描,管电流时间积分别为常规剂量(100 mAs)和低剂量(55 mAs),其余参数不变,由2名放射科副主任医师测定钙化积分并测量升主动脉CT值的均数及标准差。结果 低剂量与常规剂量钙化总积分和独立血管钙化积分取平方根转换后均直线相关(r =0.998、0.997)。低剂量管电流时间积所测升主动脉根部的CT值的均数与2倍标准差之和小于130 HU,可满足所要求的信噪比,与常规剂量扫描辐射剂量(1.32±0.08)mSv相比较,低剂量扫描有效剂量降低0.6 mSv(P <0.05)。结论 低剂量前瞻性心电门控64层MDCT钙化积分扫描图像能满足测量需要,测量结果具有较高的准确性。