Fetal cardiac screening by three- and four-dimensional ultrasound

Objective. The objective of our paper is to show that the spatio-temporal image correlation (STIC) and tomographic ultrasound imaging (TUI) is very convenient and helpful for the fetal screening of complex congenital heart defects (CHD).

Methods. Ultrasound examinations were performed using a Voluson 730 EXPERT or PRO system (GE Medical system, Kretztechnik, Zipf, Austria), and the transabdominal probe (RAB 4-8 MHz or 1-5 MHz) was used to acquire the STIC volumes. Various complex CHD including heterotaxia, ventricular septal defect (VSD), atrio-ventricular septal defect (AVSD), tetralogy of fallot (TOF), transposition of great artery (TGA), hypoplastic left heart syndrome (HLHS) were examined between 20 weeks and 35 weeks. After routine cardiac screening and examination by two-dimensional ultrasound, three- and four-dimensional ultrasound were performed by gray-scaled and color flow mapping. After the examination detailed analysis of CHD were performed by STIC and TUI.

Results. In the case of heterotaxia, STIC and TUI was useful for the detection of stomach and cardiac apex in the different slices. In the case of VSD and AVSD, they were useful for the exact determination of septal defect location. In the cases of TOF, TGA and HLHS, they were helpful for observation of outflow tract and exact diagnosis.

Conclusion. In the screening of complex CHD including heterotaxia, VSD, AVSD, TOF, TGA and HLHS, STIC is very useful and powerful tool.     

Four-Dimensional Computerized Tomography （4D-CT） Reconstruction Based on the Similarity Measure of Spatial Adjacent Images

Objective：To investigate the feasibility of a 4D-CT reconstruction method based on the similarity principle of spatial adjacent images and mutual information measure. Methods：A motor driven sinusoidal motion platform made in house was used to create one-dimensional periodical motion that was along the longitudinal axis of the CT couch. The amplitude of sinusoidal motion was set to an amplitude of ±1 cm. The period of the motion was adjustable and set to 3.5 s. Phantom objects of two eggs were placed in a Styrofoam block, which in turn were placed on the motion platform. These objects were used to simulate volumes of interest Undergoing ideal periodic motion. CT data of static phantom were acquired using a multi-slice general electric （GE） LightSpeed 16-slice CT scanner in an axial mode. And the CT data of periodical motion phantom were acquired in an axial and cine-mode scan. A software program was developed by using VC ＋ ＋ and VTK software tools to resort the CT data and reconstruct the 4D-CT. Then all of the CT data with same phase were sorted by the program into the same series based on the similarity principle of spatial adjacent images and mutual information measure among them, and 3D reconstruction of different phase CT data were completed by using the software. Results：All of the CT data were sorted accurately into different series based on the similarity principle of spatial adjacent images and mutual information measures among them. Compared with the unsorted CT data, the motion artifacts in the 3 D reconstruction of sorted CT data were re- duced significantly, and all of the sorted CT series result in a 4D-CT that reflected the characteristic of the periodical motion phantom. Conclusion：Time-resolved 4D-CT reconstruction can be implemented with any general multi-slice CT scanners based on the similarity principle of spatial adjacent images and mutual information measure. The process of the 4D-CT data acquisition and reconstruction were not restricted to the hardware or software of the C     

四维斑点追踪显像技术在评价2型糖尿病患者早期左室收缩功能中的应用

目的应用四维斑点追踪显像技术（4D-STI）评价2型糖尿病（T2DM）患者早期的左室收缩功能。方法选取左室形态结构正常、左室射血分数（LVEF）≥55%的T2DM患者60例为糖尿病组,健康志愿者30例为对照组。采用4D-STI检测两组的左室整体纵向峰值应变（GPSL）、左室整体圆周峰值应变（GPSC）、左室整体面积峰值应变（GPSA）、左室整体径向峰值应变（GPSR）、左室整体扭转角度（GTA）及各分节段牛眼图。比较两组上述各参数的差异,以及糖尿病组的整体应变值与糖化血红蛋白（HbA1C）之间的相关性。结果糖尿病组的GPSL、GPSC、GPSA、GPSR均低于对照组,差异有统计学意义（P＜0.05）,两组的GTA差异无统计学意义（P＞0.05）。4个方向的应变中,大部分节段糖尿病组均低于对照组,差异有统计学意义（P＜0.05）,除以下节段外：纵向应变中的前壁基底段、前间隔基底段,圆周应变中的侧壁基底段、后间隔基底段、侧壁中间段、前壁心尖段、心尖部,面积应变中的侧壁基底段、后间隔基底段、心尖部,径向应变中的侧壁基底段、心尖部。相关性分析显示HbA1C与GPSL的绝对值（R＝-0.79）、GPSA的绝对值（R＝-0.45）、GPSR（R＝-0.50）呈负相关（P均＜0.01）。结论左室心肌损伤在糖尿病早期即已出现,心肌损伤的程度与血糖控制的情况有关,4D-STI可方便、快捷且客观、准确地评价左室整体及局部收缩功能,具有重要的临床应用价值。     

四维CT技术在放疗中的应用

介绍了四维CT技术在国内肿瘤放疗中的应用现状,阐述了四维cT图像采集的软件参数设置方法和具体操作步骤,以及使用四维CT图像勾画肿瘤靶区的应用方法,以期提高诊断的准确率,更好地为临床服务。     

四维彩超输卵管造影流程的规范与优化

四维彩超输卵管造影检查术是将微气泡超声造影剂——声诺维注入到宫腔,使原本闭合的宫腔和输卵管扩张,然后进行四维成像,主要用于评价输卵管通畅性和诊断子宫宫腔病变,用以诊断女性不孕的原因,具有准确、安全、无创伤、快捷及治疗作用。该文详细叙述了四维彩超输卵管造影的规范流程。     

经阴道四维子宫输卵管超声造影对不孕症患者的舒适度及准确度的临床观察

目的:评估经阴道四维子宫输卵管超声造影技术(4D-SonoVue-HyCoSy)对不孕症患者的舒适程度及诊断输卵管通畅性的准确度。方法:对655名不孕女性患者行4D-S-HyCoSy,观察患者术中疼痛程度、副反应及术后并发症;以腹腔镜下美兰通液检查的22例为对照,比较其诊断输卵管通畅性的准确度。结果:68.55%患者无明显术中疼痛,19.54%轻度疼痛,9.92%中等疼痛,1.53%重度疼痛。1.98%有轻微迷走神经反应。4D-SHyCoSy诊断输卵管通畅的准确率为90.9%,敏感度90.9%,特异度90.9%,阳性预测值76.9%,阴性预测值96.8%,与腹腔镜检查无明显差异(P=0.625)。结论:采用4D-S-HyCoSy评估输卵管通畅性安全、有效、快捷、准确。     

Comparison of radiotherapy treatment plans for left-sided breast cancer patients based on three- and four-dimensional computed tomography imaging

Aims

The target volume for breast radiotherapy after conservative surgery for breast cancer may be affected by breathing motion. We investigated differences between conventional and four-dimensional computed tomography-based treatment planning and whether gating could improve dose volume parameters.

Materials and methods

Ten patients with left-sided breast cancer and surgical clips at the excision site had conventional treatment planning computed tomography and four-dimensional computed tomography. Treatment plans using two tangential beams (6 MV X-rays) were optimised for target coverage and homogeneity using a field in field technique for the three-dimensional scan. This plan was applied directly to four-dimensional datasets representing individual phases of the breathing cycle and combinations thereof (average and maximum intensity projection). Optimised plans were generated for the maximum inhalation scan to study what could potentially be achieved in gated radiotherapy.

Results

Four-dimensional computed tomography with effective doses of around 10 mSv proved to be adequate for treatment planning in all patients. The average motion of the surgical clips was 3.7 mm (range 1.7–6.5 mm), which was similar to the movement of the chest wall. With a margin of 7 mm for the whole breast to planning target volume, conventional three-dimensional computed tomography-based planning was found to adequately cover the target as seen on four-dimensional computed tomography without significant differences in normal tissue sparing. Improved sparing of the heart and lung could only be achieved by reducing the posterior margin of the target volume, which may be justified if four-dimensional computed tomography is used to determine the target and its motion.

Conclusion

No significant benefit has been shown for the use of four-dimensional computed tomography-based planning if motion management is not implemented concurrently with a reduced posterior margin between clinical and planning target volumes.     

基于四维CT和ABC辅助下三维CT确定肝癌内靶区对照研究

目的 比较四维CT (4DCT)和ABC辅助下三维CT (3DCT)两种模拟定位技术,探讨3DCT进行原发性肝癌(HCC)个体化内靶区制定的可行性.方法 选取经导管肝动脉化疗栓塞术后HCC患者15例,依次完成4DCT和自由呼吸(FB)、主动呼吸控制(ABC)辅助下平静吸气末屏气(EIH)、平静呼气末屏气(EEH) 3D...     

应用四维CT评价肺癌大体肿瘤体积随呼吸运动的位移及影响因素

目的 应用四维CT(4DCT)测量肺癌大体肿瘤体积(GTV)在三维方向上随呼吸运动的位移并分析其影响因素.方法 选择21例肺癌患者共22个肺部病灶行4DCT扫描,勾画10个呼吸时相中的GTV0%～GTV90%.测量GTV变化及GTV质心、边界在三维方向上随呼吸运动的位移,计算出三维空间位移向量→(II)v并分析其影响因素.结果 GTV变化的平均值为+14.3%或-8.4%,GTV 中心点和GTV各边界在左右、前后、头脚方向上随呼吸运动的位移分别为(0.20±0.16)、(0.18±0.12)、(0.53±0.59)cm和(0.42±0.23)、(0.41±0.22)、(0.57±0.70)cm,其中GTV中心点在头脚方向上的位移大于左右(Z=-2.12,P=0.034)、前后方向(Z=-2.10,P=0.035),GTV各边界在头脚方向上的位移与左右、前后方向差异无统计学意义(Z=-0.81,P=0.417;Z=-0.86,P=0.391).GTV中心点随呼吸的位移大小只与所在肺叶有关,GTV位于下叶者在头脚方向的位移大于位于上叶者[(0.87±O.64)和(0.35±0.49)em,(t=-2.12,P=0.047)],在前后、左右方向上的位移无差异[(0.23±0.10)和(0.19±0.18)cm(t=-0.49,P=0.629)、(0.21±0.13)和(0.17±0.11)cm(t=-0.76,P=0.460)].GTV体积大小与GTV中心点在头脚、前后、左右方向位移以及三维空间位移向量→(II)v间无明显相关性(r=0.306、-0.062、-0.279、-0.300,P=0.189、0.796、0.234、0.199).结论 肺癌患者GTV随呼吸运动的位移个体化差异明显,头脚方向位移尤为显著,应用4DCT可进行较好评价;下叶病灶位移大,GTV大小与位移间无明显相关性.

Abstract：

Objective This study was to assess the three-dimensional gross tumor volume(GTV)motion of lung cancer caused by respiration using four-dimensional computed tomography(4DCT),and to analyze the influenee factors.Methotis Four-DCT scans of 22 lung focuses in 21 patients with lung cancer were analyzed.The gross tumor volume was contoured in all 10 respiration phases of 4DCT scans.The changes in volume of GTV,the 3D motion of the centroid,boundary of GTV and the 3D spatial motion vectors were calculated and the irdluenee factors were analyzed.Results The average change in volume of GTV was+14.3%(0.2%.42.5%)/-8.4%(0.4%-38.6%),the average movement amplitude of GTV centroid and GTV boundary were(0.18±0.12)cm,(0.20±0.16)cm,(0.53±0.59)cm and(0.42±0.23)cm,(0.41±0.22)cm,(0.57±0.70)cm in medio-lateral,vertro-dorsal,cranio-caudal(CC) direction,respectively.The CC movement was larger than other directions(Z=-2.12,P=0.034;Z:-2.10,P=0.035),and no significant difference was observed in 3D motion of GTV boundary(Z=-0.81.P=0.417;Z=-0.86,0.391).The CC motion of GTV eentroid in lower lobe was larger than that in upper lobe[(0.87±0.64)and(0.35±0.49)cm,(t=-2.12,P=0.047)],and no significant difference was found in other directions[(0.23±0.10)and(0.19±0.18)em(t=-0.49,P=0.629),(0.21±0.13)and(0.17±0.11)cm(t=0.76,P=0.460)].There was no correlation of the 3D movement and 3D spatial motion vector of GTV to the volume of GTV(r=-0.306,-0.062,-0.279,-0.300;P=0.189,0.796.0.234,0.199).Conclusions GTV motion of patients with lung cancer is individual,the CC movement is the moat obvious,using 4DCT to assess is comparatively accurate.The motion amplitude of lower lobe focuses is larger.No significant correlation of the GTV motion to the volume was observed.Larger sample study is needed to analyze the influence of adjacency to the GTV motion.