目的 探討多層螺旋CT在評價頸動脈斑塊特征中的價值。 方法 回顧性分析2011年7月－10月132例行CT頸部血管造影患者的影像資料。對頸動脈斑塊特征進行評價，重建方法包括多層面重建、容積再現技術、最大密度投影及曲面重建。 結果 132例患者中，80例檢出頸動脈斑塊，最常出現鈣化斑塊的部位為海綿竇段和床突上段，右側海綿竇段52例（65.0%）、左側海綿竇段49例（61.3%），右床突上段37例（46.3%）、左側床突上段30例（37.5%）。最常出現軟斑塊的部位為雙側頸總動脈，均為12例（15.0%）。最常出現混合斑塊的部位為頸總動脈，右側頸總動脈9例（11.3%）、左側頸總動脈12例（15.0%）。頸動脈最容易輕度狹窄294處（294/1 440，20.4%），中、重度狹窄少見，分別為8處（8/1 440，0.5%）和6處（6/1 440，0.4%）。頸部動脈血管斑塊最易出現鈣化，總計249處（249/1 440，17.3%），其次是軟斑塊和混合斑塊，均為39處（39/1 440，2.7%）。 結論 多層螺旋CT可準確評價頸動脈斑塊特征。
For refractory epilepsy requiring surgical treatment in clinic, precise preoperative positioning of the epileptogenic zone is the key to improving the success rate of clinical surgical treatment. Although the use of electrical stimulation to locate epileptogenic zone has been widely carried out in many medical centers, the preoperative implantation evaluation of stereoelectroencephalography (SEEG) and the interpretation of electrical stimulation induced EEG activity are still not perfect and rigorous. Especially, there are still technological limitations and unknown areas regarding electrode implantation mode, stimulation parameters design, and surgical prognosis correlation. In this paper, the clinical background, application status, technical progress and development trend of SEEG-based stereo-electric stimulation-induced cerebral electrical activity in the evaluation of refractory epilepsy are reviewed, and applications of this technology in clinical epileptogenic zone localization and cerebral cortical function evaluation are emphatically discussed. Additionally, the safety during both of high-frequency and low-frequency electrical stimulations which are commonly used in clinical evaluation of refractory epilepsy are also discussed.
ObjectivesTo investigate the influence of the abduction angle of the upper extremities on the image quality of non-enhanced CT scan and clinical value of the patients who cannot lift with double upper limbs by vehicle accident.Methods60 patients with double upper limbs that could not lift by vehicle accidents were required to receive liver non-enhanced CT scan, the patients were divided into 3 groups according to the abduction angle (group A, B, C), 20 cases in each group, another 20 cases with standard pose as the control group (group D). The CT value and standard deviation of the liver region of interest, the erector and the background air were measured, and the contrast to noise ratio of liver images, image noise value were calculated, together with the assessment of image quality and statistic analysis.ResultsThe liver non-enhanced CT scan were completed successfully. The image quality of group D was significantly better than A, B, C (Z=–10.753, P<0.05;Z=–11.645, P<0.05;Z=–12.281, P<0.05), respectively. Group C was better than A and B (Z=–8.502, P<0.05;Z=–4.068, P<0.05), respectively. Group B was better than A (Z=–5.885, P<0.05). The CNR of the four groups of images increased gradually, group A (0.09±0.77), group B (1.56±0.83), group C (2.51±0.87), group D (2.59±0.97), respectively. There were significant differences between four groups (F=36.323, P<0.05). The image noise decreased systematically, group A (14.84±2.94), group B (13.04±1.59), group C (11.60±1.72), group D (10.44±1.13), respectively. There were significant differences between four groups (H=426.755, P<0.05).ConclusionOn the premise of safety inspection, with the enlargement of angle of the upper limbs of patients who cannot lift with double upper limbs by vehicle accidents, the image noise decreased and image quality is improved with the increase of signal noise ratio.
【摘要】 目的 評價64層螺旋CT低劑量冠狀動脈血管成像的價值。 方法 2009年1-6月157例患者隨機分為3組，常規劑量組（A組）管電流量采用1 000 mAs，兩個低劑量組（B、C組）分別采用800、600 mAs。對3組的圖像質量、噪聲、CT劑量指數（CTDI）、劑量長度乘積（DLP）和有效劑量（ED）進行評估。 結果 A、B、C組圖像噪聲分別為20.50±3.23、23.02±3.05和26.28±2.58，組間差異均無統計學意義（Pgt;0.05）；A、B、C組的CTDI分別為（58.7±0.23）、（46.98±2.27）、（35.28±3.56） mGy，DLP分別為（1 050.88±89.63）、（846.21±57.86）、（641.13±32.15） mGy?cm，ED分別為（14.78±2.56）、（11.85±1.87）、（8.98±1.15） mSv，B、C組的CTDI、DLP、ED均明顯低于常規劑量A組（Plt;0.05），C組的CTDI、DLP、ED均為3組中最低值。 結論 64層螺旋CT冠狀動脈血管檢查，采用600 mAs管電流量獲得的冠脈圖像既可滿足診斷需要，又可使患者接受的輻射劑量降低。【Abstract】 Objective To evaluate the best tube current for low-dose radiation CT in coronary artery imaging by 64-slices multi-detector CT. Methods From January to June 2009, a total of 157 consecutive patients were randomly divided into 3 groups: group A (conventional group): 1 000 mAs; group B: 800 mAs; group C: 600 mAs. The image quality, noise, CT dose index (CTDI), dose length product (DLP) and effective dose (ED) in each group were measured and compared respectively. Results The image noise scores in group A, B, and C were (20.50±3.23), (23.02±3.05) and (26.28±2.58), respectively. There was no statistically significant difference among the three groups in the two indexes (Pgt;0.05). The CTDI in group A, B and C were (58.7±0.23), (46.98±2.27), and (35.28±3.56) mGy, respectively; the DLP in each were (1 050.88±89.63), (846.21±57.86), and (641.13±32.15) mGy?cm, respectively; the Ed were (14.78±2.56), (11.85±1.87), and (8.98±1.15) mSv, respectively. All of the differences among the three groups in CTDI, DLP and ED were statistically significant (Plt;0.05). Conclusion The image with 600 mAs as tube current in the coronary artery imaging of 64-slices multi-detector CT could fulfill the need of the diagnosis, and the radiation dose is apparently lower than the conventional scan.
ObjectiveTo investigate the influence of 70 kV low-dose CT perfusion technique on brain CT perfusion parameter maps and image quality. MethodsRetrospective analysis of all patients who underwent CT perfusion of brain between October 2013 and February 2014 was carried out. The patients were randomly divided into two groups according to diTherent CT examination dose: group A (80 kV, 200 mAs) and group B (70 kV, 200 mAs). All patients were scanned on a dual-source-CT (Siemens Definition Flash). Fifteen normal subjects without brain diseases in each group were selected to be studied. Region of interest (ROI) with an area of 80 mm2 was placed in the nucleus, putamen, thalamus, periventricular white matter of the frontal lobe and temporo-occipital area, and the parameters in the ROI including cerebral blood flow, cerebral blood volume, mean transit time and time to peak were detected. The carrierto-noise ratio and signal-to-noise ratio of thalamus and periventricular white matter of the frontal lobe were contrasted. The image quality of perfusion was assessed by two senior radiologists using 5 point system for blind assessment (5=best, 1=worst). The measurement of radiation dose was studied through effective dose, volume CT dose index (CTDIVOL) and dose length product (DLP). Statistical analysis was performed by independent sample t test. ResultsThere was no significant difference between group A and group B in brain CT perfusion parameters (P>0.05). There was no significant diTherence in image quality between the two groups in the objective and subjective assessment (P>0.05). In comparison with group A, the measured effective dose, CTDIVOL and DLP for group B decreased by 35%. ConclusionThere was no significant influence on the brain CT perfusion parameters and image quality using 70 kV tube voltage, and radiation dose is decreased obviously.
This study aims to explore the inferior adhesion of the renal fascia (RF), and the inferior connectivity of the perirenal spaces (PS) with multidetector computed tomography (MDCT), and to investigate the diagnostic value of CT for showing this anatomy. From May to July 2012, eighty-two patients with acute pancreatitis presented in our hospital were enrolled into this study and underwent contrast-enhanced CT scans. All the image data were used to perform three dimensional reconstruction to show the inferior attachment of RF and the inferior connectivity of PS. The fusion of anterior renal fascia (ARF) and posterior renal fascia (PRF) next to the plane of iliac fossa were found on the left in 71.95% (59/82) cases, and on the right in 75.61% (62/82). In these cases, bilateral perirenal spaces, and anterior and posterior pararenal spaces were not found to be connected with each other. No fusion of ARF and PRF below the level of bilateral kidneys occurred on the left side in 28.05% (23/82) cases and on the right side in 24.39% (20/82). In these patients, the PS extended to the extraperitoneal space of the pelvic cavity and further to the inguinal region, and bilateral anterior and posterior pararenal spaces were not found to be connected with each other. Three-dimensional reconstruction on contrast-enhanced MDCT could be a valuable procedure for depicting inferior attachment of RF, and the inferior connectivity of PS.
ObjectiveTo evaluate the value of 70 kV and sonogram-affirmed iterative reconstruction technique in CT examination for children with congenital heart disease. MethodsThirty children with congenital heart disease who underwent CT scan between January and September 2014 were included in this study. According to the different tube voltage, they were randomly divided into group A (80 kV) and group B (70 kV), with fifteen in each. All the children were scanned on a dual-source-CT (Siemens Definition Flash). Group A used filtered back projection reconstruction. Group B used sonogram-affirmed iterative reconstruction. We measured and calculated the pulmonary artery signal-to-noise ratio at the level of main pulmonary artery window, the signal-to-noise ratio of the ascending aorta, noise ratio contrast between the pulmonary artery and erector spinae and between the ascending aorta and erector spinae. The image quality for congenital heart disease was assessed by two senior radiologists. The measurement of radiation dose included effective dose (ED), volume CT dose index (CTDIvol) and dose length product (DLP). ResultsThere were no significant differences between group A and B in terms of pulmonary artery signal-to-noise ratio (14.54±3.77, 11.23±2.52), the signal-to-noise ratio of the ascending aorta (14.76±3.41, 12.31±3.47), the noise ratio contrast between pulmonary artery and erector spinae (12.04±3.96, 9.18±3.76) and between the ascending aorta and erector spinae (12.47±4.59, 9.77±4.41) (P > 0.05). There was significant difference between group A and group B in CTDIvol[(0.53±0.09), (0.38±0.03) mGy], DLP[(12.93±1.79), (6.67±0.72) mGy·cm], and ED[(0.34±0.05), (0.17±0.02) mSv] (P < 0.05). ConclusionThe application of 70 kV and sonogram-affirmed iterative reconstruction technique in CT examination for children with congenital heart disease can significantly reduce the radiation dose without any influence on image quality.