不同体位对双上肢CTA图像质量的影响
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摘要
目的探讨CT血管造影(CTA)在观察透析患者动静脉内瘘中的作用,以及成像过程中双上肢上举或自然下垂于腹部两种不同体位对图像质量的影响。方法回顾性分析20例上肢动静脉内瘘患者的CTA图像,10例在检查时双上肢上举,10例自然下垂置于腹部。在内瘘的动脉流入、动静脉吻合口、前臂和上臂静脉流出以及中心静脉分别设置感兴趣区(ROI),测量ROI的信噪比(SNR)和对比噪声比(CNR),评价图像质量。结果在流入动脉及动静脉瘘口处,不同体位下两组的SNR及CNR存在显著性差异。结论不同体位下两组图像均可用于临床诊断。如在患者可耐受范围内,推荐采用双上肢上举体位进行CTA检查,对流入动脉及动静脉瘘口显示更好。
Objective The purpose of our study was to discuss the utilization of CTA to evaluation hemodialysis arteriovenousfistulas(AVFs), and compare the effect of arm position on image quality. Methods Our study retrospectively analyzed the data of 20 patients with hemodialysis fistula who underwent MDCT angiography with arms raised above the shoulder region(n=10) or both arms were down(n=10).The regions of interests(ROIs) were set on distal arterial inflow, arteriovenous anastomosis, forearm, distal half of upper arm, proximal half of upper arm, and central veins. Subjective image quality was assessed with two parameters: signal-to-noise ratio and contrast to noise ratio. Results The arm raised group displayed better image quality on distal arterial inflow,arteriovenous anastomosis regions than both arms down group(P<0.05). Conclusion We recommended arms raised up as the first choice position when a patient with hemodialysis fistula underwent a upper extremity CTA examination.
Objective The purpose of our study was to discuss the utilization of CTA to evaluation hemodialysis arteriovenousfistulas(AVFs), and compare the effect of arm position on image quality. Methods Our study retrospectively analyzed the data of 20 patients with hemodialysis fistula who underwent MDCT angiography with arms raised above the shoulder region(n=10) or both arms were down(n=10).The regions of interests(ROIs) were set on distal arterial inflow, arteriovenous anastomosis, forearm, distal half of upper arm, proximal half of upper arm, and central veins. Subjective image quality was assessed with two parameters: signal-to-noise ratio and contrast to noise ratio. Results The arm raised group displayed better image quality on distal arterial inflow,arteriovenous anastomosis regions than both arms down group(P<0.05). Conclusion We recommended arms raised up as the first choice position when a patient with hemodialysis fistula underwent a upper extremity CTA examination.
引文
1 Heye S, Maleux G, Claes K, et al.Stenosis Detection in Native Hemodialysis Fistulas with MDCT Angiography[J].American Journal of Roentgenology,2009 ,192:1079-1084.
2 Ahmed S,Raman SP,Fishman EK. Three-dimensional MDCT angiography for the assessment of arteriovenous grafts and fistulas in hemodialysis access[J]. Diagnostic and Interventional Imaging,2016,97,296-306.
3 Cansu A,Soyturk M,Ozturk MH,et al. Diagnostic value of color Doppler ultrasonography and MDCT angiography in complications of hemodialysis fistulas and grafts[J]. European Journal of Radiology,2013,82:1436-1443.
4 廖华强,张沉石,董伟华.256层与64层螺旋CT在透析患者上肢CT血管成像中的对比研究[J].中国医学影像学杂志,2012,20:573-576.
5 Dimopoulou A,Raland H,Wikstrom B,et al. MDCT angiography with 3D image reconstructions in the evaluation of failing arteriovenous fistulas and grafts in hemodialysis patients[J]. Acta Radiologica,2011,52: 935-942.
6 Froger CL, Duijm LE, Liem YS,et al.Stenosis detection with MR angiography and digital substraction angiography in dysfunctional hemodialysis access fistulas and grafts[J]. Radiology,2005,234:284-291.
7 Karadeli E,Tarhan NC,Ulu EM,et al. Evaluation of failing hemodialysis fistulas with multidetector CT angiography: Comparison of different 3D planes[J]. European Journal of Radiology,2009,69: 184-192.
8 张婷婷,白玫,赵丽琴,等.能谱 CT 对婴幼儿肝移植供体血管成像的评估[J].CT 理论与应用研究,2014,23:895-903.
9 刘彬,柳扬,沈俊林,等.GSI质量控制图像及单能图像与常规CT图像质量物理参数比较研究[J].中国医学装备,2013,10:1-3.
10 杨正汉,冯逢,王霄英. 磁共振成像技术指南:检查规范、临床策略及新技术应用[M].第2版.北京:人民军医出版社,2010:424-426.
11 Barrett JF, Keat N.Artifacts in CT: Recognition and Avoidance[J]. Radiographics,2004,24:1679-1691.
12 袁知东,刘远健,江国银,等.双上肢均不能上举患者胸腹部CT扫描技术改进[J].中华放射学杂志,2010,44:198-201.
13 Brink M,de Lange F,Oostveen LJ,et al. Arm Raising at Exposurecontrolled Multidetector Trauma CT of Thoracoabdominal Region:Higher Image Quality,Lower Radiation Dose[J]. Radiology,2008,249:661-670.
2 Ahmed S,Raman SP,Fishman EK. Three-dimensional MDCT angiography for the assessment of arteriovenous grafts and fistulas in hemodialysis access[J]. Diagnostic and Interventional Imaging,2016,97,296-306.
3 Cansu A,Soyturk M,Ozturk MH,et al. Diagnostic value of color Doppler ultrasonography and MDCT angiography in complications of hemodialysis fistulas and grafts[J]. European Journal of Radiology,2013,82:1436-1443.
4 廖华强,张沉石,董伟华.256层与64层螺旋CT在透析患者上肢CT血管成像中的对比研究[J].中国医学影像学杂志,2012,20:573-576.
5 Dimopoulou A,Raland H,Wikstrom B,et al. MDCT angiography with 3D image reconstructions in the evaluation of failing arteriovenous fistulas and grafts in hemodialysis patients[J]. Acta Radiologica,2011,52: 935-942.
6 Froger CL, Duijm LE, Liem YS,et al.Stenosis detection with MR angiography and digital substraction angiography in dysfunctional hemodialysis access fistulas and grafts[J]. Radiology,2005,234:284-291.
7 Karadeli E,Tarhan NC,Ulu EM,et al. Evaluation of failing hemodialysis fistulas with multidetector CT angiography: Comparison of different 3D planes[J]. European Journal of Radiology,2009,69: 184-192.
8 张婷婷,白玫,赵丽琴,等.能谱 CT 对婴幼儿肝移植供体血管成像的评估[J].CT 理论与应用研究,2014,23:895-903.
9 刘彬,柳扬,沈俊林,等.GSI质量控制图像及单能图像与常规CT图像质量物理参数比较研究[J].中国医学装备,2013,10:1-3.
10 杨正汉,冯逢,王霄英. 磁共振成像技术指南:检查规范、临床策略及新技术应用[M].第2版.北京:人民军医出版社,2010:424-426.
11 Barrett JF, Keat N.Artifacts in CT: Recognition and Avoidance[J]. Radiographics,2004,24:1679-1691.
12 袁知东,刘远健,江国银,等.双上肢均不能上举患者胸腹部CT扫描技术改进[J].中华放射学杂志,2010,44:198-201.
13 Brink M,de Lange F,Oostveen LJ,et al. Arm Raising at Exposurecontrolled Multidetector Trauma CT of Thoracoabdominal Region:Higher Image Quality,Lower Radiation Dose[J]. Radiology,2008,249:661-670.