64排螺旋CT门静脉系统成像技术的优化及对门静脉系统栓塞诊断的应用价值
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摘要
第一部分
目的:使用两种不同的注射方式对肝硬化伴门脉高压患者进行门脉系统血管成像,探讨门静脉系统血管成像技术的优化。
方法:对40例患者(男26例,女14例)随机采用单相注射方式(A组)及双相注射方式(B组)进行门脉系统血管成像,比较并分析两种注射方式的成像质量及技术优势。
结果:
1.两组注射方式门静脉成像图像质量无明显差异(P>0.05),B组造影剂用量(90mL)少于A组(100mL)。
2. B组患者的门静脉主干、肝实质及P-L差峰值的CT值均稍低于A组患者,但无统计学差异(P>0.05)。而在45s之后B组的P-L差大于A组;B组患者的门静脉主干、肝实质及P-L差的达峰值时间均长于A组患者,存在统计学差异(P<0.05)。
3. P-L差曲线图显示:B组P-L差的阈值间期长于A组。
结论:
1.双相注射方式对于肝硬化门脉高压患者的门静脉系统成像质量可靠,且造影剂使用总剂量较少。
2.双相注射方式在门静脉系统成像技术方面较单相注射方式有显著优势,可作为肝硬化门脉高压患者门脉血管成像的一种优化的技术选择。
第二部分
目的:以DSA门静脉直接造影为金标准,评估MSCTP对门静脉系统栓塞诊断的临床应用价值。
方法:对34例临床疑有门静脉系统栓塞的肝硬化门脉高压患者,分别行MSCTP及DSA检查,比较MSCTP与DSA对门静脉及其分支的显示效果,评估MSCTP对门静脉系统栓塞的诊断价值,并总结门静脉系统栓塞患者的临床资料及CT表现特征。
结果:
1.两种检查方法在门静脉肝内3级以上分支的显示程度方面无统计学差异(P>0.05)。
2.以DSA为金标准,MSCTP对于34例疑有门静脉系统栓塞患者的诊断灵敏度为87.0%(20/23),特异度为90.9%(10/11),准确率为88.2%(30/34)。MSCTP与DSA对34例疑有门静脉系统栓塞患者的诊断结果一致(χ2=0.25,P>0.05)。
3. 23例门静脉系统栓塞患者中有21例患者表现为不同程度的门脉系统管径增宽,血管内血栓形成,另有两例栓塞患者的MSCTP图像未出现门脉栓塞的CT征象;20例患者可见肠壁水肿增厚;15例出现肠管扩张积气、肠腔积液;18例患者表现为肠系膜密度弥漫性增高、模糊;有19例患者出现腹腔积液影。
结论:MSCTP对肝硬化门脉高压患者的门静脉系统血管成像的质量可靠,敏感性与特异性较高,完全有能力取代传统的DSA门脉直接造影检查而成为门静脉系统栓塞的首选检查方法。
The first part
Object: Use two different injection methods on patients with liver cirrhosis and portal hypertension for portal systemic vascular imaging , and explore the optimization of portal vein systemic vascular imaging.
Method: Use single-phase injection (group A) or biphasic injection (group B) on 40 patients(Male 26 cases, female 14 cases) by random for portal systemic vascular imaging. Compare and analyze the imaging quality and technical superiority between them.
Results:
1. There was no significant difference in image quality between two kinds of injections(P>0.05).Group B contrast agent dosage (90mL) is less than group A(100mL).
2. Group B patients with portal vein, liver parenchyma and the P-L discrepancy between CT values are slightly lower than group A,but had no significant statistically difference (P>0.05).After 45 second group B was larger than group A on the P-L discrepancy. The peak times of group B were longer than group A on portal vein, liver parenchyma and the P-L discrepancy.And had significant statistically difference (P<0.05).
3. The graph of P-L discrepancy showed: group B was longer than group A on the threshold interval of P-L discrepancy.
Conclusion:
1. On imaging of portal venous system, biphasic injection had reliable imaging quality for cirrhotic patients with portal hypertension. And the total dose of contrast agent was less.
2. Biphasic injection had a significant advantage in the imaging technology of portal venous system compared with single-phase injection. Biphasic injection could be used as an optimal choice of technology for patients with liver cirrhosis and portal hypertension for portal systemic vascular imaging.
The second part Object: Using DSA as the gold standard to assess the clinical application of portal venous system thrombosis diagnosis by MSCTP.
Methods: Use MSCTP and DSA respectively in 34 patients with liver cirrhosis and portal hypertension who were suspected of portal vein thrombosis.Compare the display consequence of portal vein and its branches between MSCTP and DSA. Assess the diagnosis of portal venous system thrombosis by MSCTP. And summarized the clinical data and characteristic CT performance of the patients with portal venous system thrombosis.
Results:
1. There was no significant difference in the show extent of the three or more intrahepatic portal vein branches between MSCTP and DSA(P>0.05).
2. For the 34 patients who were suspected of portal vein thrombosis, the sensitivity of MSCTP was 87.0% (20/23), the specificity was 90.9% (10/11), the accuracy was 88.2% (30/34). The diagnosis results between MSCTP and DSA in 34 patients who were suspected of portal vein thrombosis are consistent(χ2=0.25,P>0.05).
3. There were 21 patients showed varying degrees of portal system widened diameter and intravascular thrombosis in the 23 patients who had portal vein thrombosis. Another two patients with thrombosis did not appear the CT signs of portal vein embolizationin in MSCTP. 20 patients could be seen edema and thicken bowel wall. 15 patients appeared intestinal expansion and gas accumulation and intestinal fluid. 18 patients showed diffuse increased density of mesenteric and fuzzy mesenteric density; 19 patients had ascites.
Conclusion: MSCTP had reliable quality on patients with liver cirrhosis and portal hypertension. MSCTP had high sensitivity and specificity,and is fully capable of replacing the traditional DSA as the first choice of portal vein thrombosis inspection method.
目的:使用两种不同的注射方式对肝硬化伴门脉高压患者进行门脉系统血管成像,探讨门静脉系统血管成像技术的优化。
方法:对40例患者(男26例,女14例)随机采用单相注射方式(A组)及双相注射方式(B组)进行门脉系统血管成像,比较并分析两种注射方式的成像质量及技术优势。
结果:
1.两组注射方式门静脉成像图像质量无明显差异(P>0.05),B组造影剂用量(90mL)少于A组(100mL)。
2. B组患者的门静脉主干、肝实质及P-L差峰值的CT值均稍低于A组患者,但无统计学差异(P>0.05)。而在45s之后B组的P-L差大于A组;B组患者的门静脉主干、肝实质及P-L差的达峰值时间均长于A组患者,存在统计学差异(P<0.05)。
3. P-L差曲线图显示:B组P-L差的阈值间期长于A组。
结论:
1.双相注射方式对于肝硬化门脉高压患者的门静脉系统成像质量可靠,且造影剂使用总剂量较少。
2.双相注射方式在门静脉系统成像技术方面较单相注射方式有显著优势,可作为肝硬化门脉高压患者门脉血管成像的一种优化的技术选择。
第二部分
目的:以DSA门静脉直接造影为金标准,评估MSCTP对门静脉系统栓塞诊断的临床应用价值。
方法:对34例临床疑有门静脉系统栓塞的肝硬化门脉高压患者,分别行MSCTP及DSA检查,比较MSCTP与DSA对门静脉及其分支的显示效果,评估MSCTP对门静脉系统栓塞的诊断价值,并总结门静脉系统栓塞患者的临床资料及CT表现特征。
结果:
1.两种检查方法在门静脉肝内3级以上分支的显示程度方面无统计学差异(P>0.05)。
2.以DSA为金标准,MSCTP对于34例疑有门静脉系统栓塞患者的诊断灵敏度为87.0%(20/23),特异度为90.9%(10/11),准确率为88.2%(30/34)。MSCTP与DSA对34例疑有门静脉系统栓塞患者的诊断结果一致(χ2=0.25,P>0.05)。
3. 23例门静脉系统栓塞患者中有21例患者表现为不同程度的门脉系统管径增宽,血管内血栓形成,另有两例栓塞患者的MSCTP图像未出现门脉栓塞的CT征象;20例患者可见肠壁水肿增厚;15例出现肠管扩张积气、肠腔积液;18例患者表现为肠系膜密度弥漫性增高、模糊;有19例患者出现腹腔积液影。
结论:MSCTP对肝硬化门脉高压患者的门静脉系统血管成像的质量可靠,敏感性与特异性较高,完全有能力取代传统的DSA门脉直接造影检查而成为门静脉系统栓塞的首选检查方法。
The first part
Object: Use two different injection methods on patients with liver cirrhosis and portal hypertension for portal systemic vascular imaging , and explore the optimization of portal vein systemic vascular imaging.
Method: Use single-phase injection (group A) or biphasic injection (group B) on 40 patients(Male 26 cases, female 14 cases) by random for portal systemic vascular imaging. Compare and analyze the imaging quality and technical superiority between them.
Results:
1. There was no significant difference in image quality between two kinds of injections(P>0.05).Group B contrast agent dosage (90mL) is less than group A(100mL).
2. Group B patients with portal vein, liver parenchyma and the P-L discrepancy between CT values are slightly lower than group A,but had no significant statistically difference (P>0.05).After 45 second group B was larger than group A on the P-L discrepancy. The peak times of group B were longer than group A on portal vein, liver parenchyma and the P-L discrepancy.And had significant statistically difference (P<0.05).
3. The graph of P-L discrepancy showed: group B was longer than group A on the threshold interval of P-L discrepancy.
Conclusion:
1. On imaging of portal venous system, biphasic injection had reliable imaging quality for cirrhotic patients with portal hypertension. And the total dose of contrast agent was less.
2. Biphasic injection had a significant advantage in the imaging technology of portal venous system compared with single-phase injection. Biphasic injection could be used as an optimal choice of technology for patients with liver cirrhosis and portal hypertension for portal systemic vascular imaging.
The second part Object: Using DSA as the gold standard to assess the clinical application of portal venous system thrombosis diagnosis by MSCTP.
Methods: Use MSCTP and DSA respectively in 34 patients with liver cirrhosis and portal hypertension who were suspected of portal vein thrombosis.Compare the display consequence of portal vein and its branches between MSCTP and DSA. Assess the diagnosis of portal venous system thrombosis by MSCTP. And summarized the clinical data and characteristic CT performance of the patients with portal venous system thrombosis.
Results:
1. There was no significant difference in the show extent of the three or more intrahepatic portal vein branches between MSCTP and DSA(P>0.05).
2. For the 34 patients who were suspected of portal vein thrombosis, the sensitivity of MSCTP was 87.0% (20/23), the specificity was 90.9% (10/11), the accuracy was 88.2% (30/34). The diagnosis results between MSCTP and DSA in 34 patients who were suspected of portal vein thrombosis are consistent(χ2=0.25,P>0.05).
3. There were 21 patients showed varying degrees of portal system widened diameter and intravascular thrombosis in the 23 patients who had portal vein thrombosis. Another two patients with thrombosis did not appear the CT signs of portal vein embolizationin in MSCTP. 20 patients could be seen edema and thicken bowel wall. 15 patients appeared intestinal expansion and gas accumulation and intestinal fluid. 18 patients showed diffuse increased density of mesenteric and fuzzy mesenteric density; 19 patients had ascites.
Conclusion: MSCTP had reliable quality on patients with liver cirrhosis and portal hypertension. MSCTP had high sensitivity and specificity,and is fully capable of replacing the traditional DSA as the first choice of portal vein thrombosis inspection method.
引文
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