多层螺旋CT胰腺增强扫描方案优化与胰周血管三维成像研究
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摘要
目的:
科学评估动脉期、胰腺实质期、门静脉期扫描在胰腺增强扫描中的地位和作用,探索胰腺最佳扫描方案,为临床应用提供参考,丰富循证放射学的内容。通过胰周血管三维成像科学评估动脉期、胰腺实质期、门静脉期胰周主要血管显示率及显示程度,为临床应用提供依据。
材料和方法:
选择20例胰腺平扫正常病人,经肘静脉团注对比剂后分别延迟25s、40s、60s行全胰腺三期扫描,层厚3.0mm,螺距6,获轴面图像,分别于动脉期、胰腺实质期和门静脉期测量肝脏、胰腺、脾脏、腹主动脉、下腔静脉、肠系膜上动脉、肠系膜上静脉和门静脉的CT值,并与平扫CT值取差值,用配对t检验比较其统计学差异,进而评估动脉期、胰腺实质期和门静脉期扫描在胰腺增强扫描中的地位和作用,并于三期分别行胰周血管三维成像,评估胰周主要血管的显示率及显示程度。
结果:
1.胰腺实质以胰腺实质期强化最佳,依次为动脉期、门脉期,三期均具有显著性差异,P<0.01。下腔静脉和脾脏强化亦以胰腺实质期为最佳,其次为动脉期和门静脉期,后两者之间无显著性差异,P>0.05,但均与胰腺实质期有显著性差异。肝脏、肠系膜上静脉、门静脉亦以胰腺实质期强化最佳,依次为门静脉期、动脉期。肠系膜上动脉、腹主动脉均于动脉期强化最佳,依次为胰腺实质期、门静脉期,三期均具有显著性差异,P<0.01。
2.MSCT胰周血管三维成像可较清晰的显示腹腔干、肠系膜上动脉、肾动脉、肝总动脉、肝固有动脉、脾动脉、胃十二指肠动脉及门静脉、脾
Objective: To evaluate the situation and effect of multi-slice spiral CTtriple-phase (arterial, pancreatic and portal venous phase) enhanced scanning of pancreas, to select the optimal scanning methods of pancreas, and to offer the reference for clinical application and rich the contents of the evidence-based radiology. To assess the opacification and degree of per-panereatic major vessels with the angiography of per-panereatic vessels.Materials and Methods: The triple-phase (arterial phase delay time 25second,pancreatic phase delay time 40 second,and portal venous phase delay time 60 second) enhanced scanning was performed in 20 patients without pancreatic disease. The scanning parameters were as follows: slice thickness of 3mm,a pitch of 6,obtaining axial imaging. CT values of liver, pancreas, spleen, abdominal aorta, inferior vena cava, superior mesenteric artery, superior mesenteric vein, and portal vein were measured, and were compared with the plain scanning. Then CT values, the displaying rate and degree of per-pancreatic vessels at the three phases were elevated. The results were statistically analyzed.Results : 1.The optimal temporal window for normal pancreatic parenchymais pancreatic phase. Significant difference in the increase of CT value existed between pancreatic and arterial phase, as well as pancreatic and portal venous phase (P<0.01). The optimal displaying rate of the major per-panereatic arteries is arterial phase, there is significant different among the triple-phase (P<0.01). The optimal displaying rate of larger per-panereatic veins is pancreatic phase. 2.The angiography of the per-panereatic major vessels with MSCT may clearly
display the location, shape and distribution of the pcr-pancrcatic major vessels. Conclusion: l.Whcn MSCT is used in the exam of pancreas, triple-phase enhanced scanning is one of the optimal selection, but the pancreatic phase scanning has the important clinical significance.2. The 3-dimension angiography on pancreas may clearly display the shape, location,and distribution of the major per-pancreatic vessels.3. VR and MIP may clearly display the larger per-pancreatic vessels, but VR shows more stereoscopic feeling, MIP is more sensitive to density, VR and MIP should be selected to apply..
科学评估动脉期、胰腺实质期、门静脉期扫描在胰腺增强扫描中的地位和作用,探索胰腺最佳扫描方案,为临床应用提供参考,丰富循证放射学的内容。通过胰周血管三维成像科学评估动脉期、胰腺实质期、门静脉期胰周主要血管显示率及显示程度,为临床应用提供依据。
材料和方法:
选择20例胰腺平扫正常病人,经肘静脉团注对比剂后分别延迟25s、40s、60s行全胰腺三期扫描,层厚3.0mm,螺距6,获轴面图像,分别于动脉期、胰腺实质期和门静脉期测量肝脏、胰腺、脾脏、腹主动脉、下腔静脉、肠系膜上动脉、肠系膜上静脉和门静脉的CT值,并与平扫CT值取差值,用配对t检验比较其统计学差异,进而评估动脉期、胰腺实质期和门静脉期扫描在胰腺增强扫描中的地位和作用,并于三期分别行胰周血管三维成像,评估胰周主要血管的显示率及显示程度。
结果:
1.胰腺实质以胰腺实质期强化最佳,依次为动脉期、门脉期,三期均具有显著性差异,P<0.01。下腔静脉和脾脏强化亦以胰腺实质期为最佳,其次为动脉期和门静脉期,后两者之间无显著性差异,P>0.05,但均与胰腺实质期有显著性差异。肝脏、肠系膜上静脉、门静脉亦以胰腺实质期强化最佳,依次为门静脉期、动脉期。肠系膜上动脉、腹主动脉均于动脉期强化最佳,依次为胰腺实质期、门静脉期,三期均具有显著性差异,P<0.01。
2.MSCT胰周血管三维成像可较清晰的显示腹腔干、肠系膜上动脉、肾动脉、肝总动脉、肝固有动脉、脾动脉、胃十二指肠动脉及门静脉、脾
Objective: To evaluate the situation and effect of multi-slice spiral CTtriple-phase (arterial, pancreatic and portal venous phase) enhanced scanning of pancreas, to select the optimal scanning methods of pancreas, and to offer the reference for clinical application and rich the contents of the evidence-based radiology. To assess the opacification and degree of per-panereatic major vessels with the angiography of per-panereatic vessels.Materials and Methods: The triple-phase (arterial phase delay time 25second,pancreatic phase delay time 40 second,and portal venous phase delay time 60 second) enhanced scanning was performed in 20 patients without pancreatic disease. The scanning parameters were as follows: slice thickness of 3mm,a pitch of 6,obtaining axial imaging. CT values of liver, pancreas, spleen, abdominal aorta, inferior vena cava, superior mesenteric artery, superior mesenteric vein, and portal vein were measured, and were compared with the plain scanning. Then CT values, the displaying rate and degree of per-pancreatic vessels at the three phases were elevated. The results were statistically analyzed.Results : 1.The optimal temporal window for normal pancreatic parenchymais pancreatic phase. Significant difference in the increase of CT value existed between pancreatic and arterial phase, as well as pancreatic and portal venous phase (P<0.01). The optimal displaying rate of the major per-panereatic arteries is arterial phase, there is significant different among the triple-phase (P<0.01). The optimal displaying rate of larger per-panereatic veins is pancreatic phase. 2.The angiography of the per-panereatic major vessels with MSCT may clearly
display the location, shape and distribution of the pcr-pancrcatic major vessels. Conclusion: l.Whcn MSCT is used in the exam of pancreas, triple-phase enhanced scanning is one of the optimal selection, but the pancreatic phase scanning has the important clinical significance.2. The 3-dimension angiography on pancreas may clearly display the shape, location,and distribution of the major per-pancreatic vessels.3. VR and MIP may clearly display the larger per-pancreatic vessels, but VR shows more stereoscopic feeling, MIP is more sensitive to density, VR and MIP should be selected to apply..
引文
[1] Abuch T. Itoh K. Ohshio G. et al. Tumor Staging of pancreatic adenocarcinoma using carly and late-phase helical CT. AJR, 1999. 173:375-380
[2] Mcnulty NJ. Francis IR. Platt JF. et al. Multi-detector row helical CT of the pancreas: effect of contrast-enhanced multi-phasic imaging on cnhancement of the pancreas, peripancreatic vasculature, and pancreatic adenocarcinoma. Radiology, 2001,220(1): 97-102
[3] Fishman EK, Herton KM, Urban BA, et al. Multi-detector CT angiography in the evaluation of pancreatic carcinoma: preliminary observations. J Comput Assist Tomogr, 2000, 24(6):849-853
[4] Prokesch RW. Chow LC, Beaulicu CF. et al. Iso-attenuating pancreatic adenocarcinoma at multi-detector row CT: secondary signs. Radiology, 2002, 224: 764-768
[5] Hollett MD, Jorgensen MJ, Jeffrey RB. Quantitative evaluation of pancreatic enhancement during dual-phase helical CT. Radiology, 1995. 195(2): 359-361
[6] Zeman RK, Cooper C, Zeiberg AS, et al. TNM staging of pancreatic carcinoma using helical CT. AJR, 1997,169:459
[7] Keogan MT, McDermott VG, Paulson EK, et al. Pancreatic malignancy: eftect of dual-phase helical CT in tumor dctection and vascular opacification. Radiology, 1997, 205:513
[8] Hui HU. Multi-slice helical CT: scan and reconstruction. Med phys, 1999, 26:5-18
[9] 张方方,周翔平,陈宪,等. 螺旋CT动态扫描胰腺实质强化时相优化的探讨.临床放射学杂志,2001,8:600-603
[10] Lu DS, Vedantham S, Krasny RM, et al. Two-phase helical CT for pancreatic tumors: pancreatic versus hepatic phase enhancement of tumor, pancreas, and vascular structures. Radiology, 1996,199(3):697-701
[11] Boland GW,O Malley ME, Saez M. et al. Pancreatic-phase versus portal vein-phase helical CT of the pancreas: optimal temporal window for evaluation of pancreatic adenocarcinoma. AJR, 1999,172(3):605-608
[12] 周存升,孙丛,柳澄,等.螺旋CT双期扫描技术及其在胰腺癌诊断中的价值.中华放射学杂志,2001,35(2):90-95
[13] 李传福,张晓明,刘松涛,等.螺旋CT双期增强扫描在小胰腺癌诊断中的应用.中华放射学杂志,2001,24:153
[14] 左红,祁吉.循证放射学—一种放射学实践的新途径(上).国外医学临床放射册,2002,25(3):135-138
[15] 左红,祁吉.循证放射学—一种放射学实践的新途径(下).国外医学临床放射学分册,2002,25(4):201-204
[16] Taguchi K, Aradate H. Algorithm for reconstruction in multi-slice helical CT. Med Phys, 1998,25(4):550-561
[17] Smith PA. Klein AS .Heath DG. et al. Dual-phase spiral CT angiography with volumetric 3D rendering for preoperative liver transplant evaluation: preliminary observations.J Comput Assist Tomogr. 1998.22(6):868-874
[18] Soyer P, Heath D. Bluemke DA. et al Three-dimensional helical CT of intra-heparic venous structures: comparison of three rendering technique.J Computed Assist Tomogr, 1996.20(1): 122-127
[19] Kopka L. Rodenwa J, Fischer U, et al. Dual-phase helical CT of the liver: effect of bolus tracking and different volumes of contrast material. Radiology, 1996 201:321-326
[20] Han JK. Kim AY, Lee KY. et al. Factors influencing vascular and hepatic cnhancement at CT: experimental study on injection protocol using a canine model. J Comput Assist Tomogr,2000,24:400-406
[21] Kim T, Murakami T. Takahashi S, et al. Pancreatic CT imaging: Effects of different injection rates and doses of contrast material. Radiology, 1999.212(1): 219-225
[22] Bonald VM. Bret PM, Atri M, et al. A comparision of two injection protocol using helical and dynamic acquisition in CT examinations of the pancreas. AJR. 1996, 167: 49
[23] Tublin ME, Tessler FN, Cheng SI, et al. Effect of injection rate of contrast medium on pancreatic and hepatic helical CT. Radiology, 1999.210(1): 97-101
[24] 李卉,曾蒙苏,周康荣,等.多层螺旋CT胰腺检查:多期增强扫描的最佳延迟时间 研究.中华放射学杂志,2004,38:287-290
[25] 李卉,周康荣,曾蒙苏,等.多层螺旋CT胰腺三期增强扫描的临床价值.临床放射学杂志,2004,23:593-596
[26] Horton KM. Fishman EK. Multi-detector CT angiography of pancreatic carcinoma: part Ⅰ. evaluation of arterial involvement. AJR, 2002, 178(4): 827-831
[27] Vails C, Andia E, Sanchez A. et al. Dual-phase helical CT of pancreatic adenocarcinoma: assessment of respectability before surgery. AJR, 2002, 178:821
[28] 曾蒙苏,严福华,周康荣.螺旋CT双期增强扫描在胰头癌检查中的临床应用和价值.中华放射学杂志,1997,31:848-850
[29] 龚静山,周康荣.螺旋CT双期扫描对胰腺癌分期的评价。国外医学.临床放射学分册,2001,24:153
[30] Nion-Murcia M. Olcott EW, Jeffrey RB Jr, et al. Focal liver lesions: pattern-based classification scheme for enhancement at arterial phase CT. Radiology, 2000, 215: 746-751
[31] Scatarige JC, Horton KM, Rather LE, et al. Left adrenal vein localization by 3D real-time volume-rendering CTA before laparoscopic nephrectomy in living renal donors. Abdom Imaging,2001,26(5):553-556
[32] Cbou CK.CT manifestations of bowel ischemia. AJR,2002,178(1):87-91
[33] Horton KM, Fishman EK.3D CT angiograpby of the celiac and superior mesentcric arteries with multi-detector CT data sets: preliminary observations. Abdom Imaging,2000,25(4):523-525
[2] Mcnulty NJ. Francis IR. Platt JF. et al. Multi-detector row helical CT of the pancreas: effect of contrast-enhanced multi-phasic imaging on cnhancement of the pancreas, peripancreatic vasculature, and pancreatic adenocarcinoma. Radiology, 2001,220(1): 97-102
[3] Fishman EK, Herton KM, Urban BA, et al. Multi-detector CT angiography in the evaluation of pancreatic carcinoma: preliminary observations. J Comput Assist Tomogr, 2000, 24(6):849-853
[4] Prokesch RW. Chow LC, Beaulicu CF. et al. Iso-attenuating pancreatic adenocarcinoma at multi-detector row CT: secondary signs. Radiology, 2002, 224: 764-768
[5] Hollett MD, Jorgensen MJ, Jeffrey RB. Quantitative evaluation of pancreatic enhancement during dual-phase helical CT. Radiology, 1995. 195(2): 359-361
[6] Zeman RK, Cooper C, Zeiberg AS, et al. TNM staging of pancreatic carcinoma using helical CT. AJR, 1997,169:459
[7] Keogan MT, McDermott VG, Paulson EK, et al. Pancreatic malignancy: eftect of dual-phase helical CT in tumor dctection and vascular opacification. Radiology, 1997, 205:513
[8] Hui HU. Multi-slice helical CT: scan and reconstruction. Med phys, 1999, 26:5-18
[9] 张方方,周翔平,陈宪,等. 螺旋CT动态扫描胰腺实质强化时相优化的探讨.临床放射学杂志,2001,8:600-603
[10] Lu DS, Vedantham S, Krasny RM, et al. Two-phase helical CT for pancreatic tumors: pancreatic versus hepatic phase enhancement of tumor, pancreas, and vascular structures. Radiology, 1996,199(3):697-701
[11] Boland GW,O Malley ME, Saez M. et al. Pancreatic-phase versus portal vein-phase helical CT of the pancreas: optimal temporal window for evaluation of pancreatic adenocarcinoma. AJR, 1999,172(3):605-608
[12] 周存升,孙丛,柳澄,等.螺旋CT双期扫描技术及其在胰腺癌诊断中的价值.中华放射学杂志,2001,35(2):90-95
[13] 李传福,张晓明,刘松涛,等.螺旋CT双期增强扫描在小胰腺癌诊断中的应用.中华放射学杂志,2001,24:153
[14] 左红,祁吉.循证放射学—一种放射学实践的新途径(上).国外医学临床放射册,2002,25(3):135-138
[15] 左红,祁吉.循证放射学—一种放射学实践的新途径(下).国外医学临床放射学分册,2002,25(4):201-204
[16] Taguchi K, Aradate H. Algorithm for reconstruction in multi-slice helical CT. Med Phys, 1998,25(4):550-561
[17] Smith PA. Klein AS .Heath DG. et al. Dual-phase spiral CT angiography with volumetric 3D rendering for preoperative liver transplant evaluation: preliminary observations.J Comput Assist Tomogr. 1998.22(6):868-874
[18] Soyer P, Heath D. Bluemke DA. et al Three-dimensional helical CT of intra-heparic venous structures: comparison of three rendering technique.J Computed Assist Tomogr, 1996.20(1): 122-127
[19] Kopka L. Rodenwa J, Fischer U, et al. Dual-phase helical CT of the liver: effect of bolus tracking and different volumes of contrast material. Radiology, 1996 201:321-326
[20] Han JK. Kim AY, Lee KY. et al. Factors influencing vascular and hepatic cnhancement at CT: experimental study on injection protocol using a canine model. J Comput Assist Tomogr,2000,24:400-406
[21] Kim T, Murakami T. Takahashi S, et al. Pancreatic CT imaging: Effects of different injection rates and doses of contrast material. Radiology, 1999.212(1): 219-225
[22] Bonald VM. Bret PM, Atri M, et al. A comparision of two injection protocol using helical and dynamic acquisition in CT examinations of the pancreas. AJR. 1996, 167: 49
[23] Tublin ME, Tessler FN, Cheng SI, et al. Effect of injection rate of contrast medium on pancreatic and hepatic helical CT. Radiology, 1999.210(1): 97-101
[24] 李卉,曾蒙苏,周康荣,等.多层螺旋CT胰腺检查:多期增强扫描的最佳延迟时间 研究.中华放射学杂志,2004,38:287-290
[25] 李卉,周康荣,曾蒙苏,等.多层螺旋CT胰腺三期增强扫描的临床价值.临床放射学杂志,2004,23:593-596
[26] Horton KM. Fishman EK. Multi-detector CT angiography of pancreatic carcinoma: part Ⅰ. evaluation of arterial involvement. AJR, 2002, 178(4): 827-831
[27] Vails C, Andia E, Sanchez A. et al. Dual-phase helical CT of pancreatic adenocarcinoma: assessment of respectability before surgery. AJR, 2002, 178:821
[28] 曾蒙苏,严福华,周康荣.螺旋CT双期增强扫描在胰头癌检查中的临床应用和价值.中华放射学杂志,1997,31:848-850
[29] 龚静山,周康荣.螺旋CT双期扫描对胰腺癌分期的评价。国外医学.临床放射学分册,2001,24:153
[30] Nion-Murcia M. Olcott EW, Jeffrey RB Jr, et al. Focal liver lesions: pattern-based classification scheme for enhancement at arterial phase CT. Radiology, 2000, 215: 746-751
[31] Scatarige JC, Horton KM, Rather LE, et al. Left adrenal vein localization by 3D real-time volume-rendering CTA before laparoscopic nephrectomy in living renal donors. Abdom Imaging,2001,26(5):553-556
[32] Cbou CK.CT manifestations of bowel ischemia. AJR,2002,178(1):87-91
[33] Horton KM, Fishman EK.3D CT angiograpby of the celiac and superior mesentcric arteries with multi-detector CT data sets: preliminary observations. Abdom Imaging,2000,25(4):523-525