CN111568459A - 一种ct肺动脉成像扫描延迟时间的确定方法 - Google Patents
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Abstract
本发明公开了一种CT肺动脉成像扫描延迟时间的确定方法,扫描采用对比剂测试法时,测试阶段在肺动脉主干及同层肺静脉内,同时设置相应大小的类圆形ROI,得到肺动‑静脉强化时间密度双曲线,将双曲线交叉点时间作为TCROSS,扫描持续时间作为TSD,通过TCROSS‑TSD的差值计算出扫描延迟时间TDELAY。采用本发明方法计算得出的扫描延迟时间,曝光扫描可以获得优质的肺动脉强化图像。
Description
技术领域
本发明属于CT血管成像技术领域,具体是一种CT肺动脉成像扫描延迟时间的确定方法。
背景技术
肺栓塞(PE)是以各种栓子阻塞肺动脉或其分支为其发病原因的一组疾病或临床综合征的总称,包括肺血栓栓塞(PTE)、脂肪栓塞综合征、羊水栓塞、空气栓塞等。PTE为PE的最常见类型,占PE中的绝大多数,而PTE的绝大多数为急性肺栓塞(APE)。临床特点以肺循环和呼吸功能障碍为其主要临床和病理生理学特征,是临床急性肺心病最常见的病因。APE是一种危及生命的疾病,是仅次于心肌梗死和中风的第三大常见急性心血管疾病。PTE的致死率和致残率都很高。新近国际注册登记研究显示,其7天全因病死率为1.9%-2.9%,30天全因病死率为4.9%-6.6%。PTE在我国一直被认为是少见病,近10年来有关临床流行病学调查发现国内PTE的诊断例数迅速增加,绝大多数医院所诊断的PE例数较10年前有10-30倍的增长。来自国内60家大型医院的统计资料显示,住院患者中PTE的比例从1997年的0.26‰上升到2008年的1.45‰。
CT血管成像是指从受检者的静脉快速注入碘对比剂,通过人体血液循环,当靶器官中对比剂浓度达到最高峰时,行螺旋CT容积扫描,经工作站的后处理重建出血管的三维立体影像。CT肺动脉成像(CTPA)可直观地显示肺动脉内血栓形态、部位及血管堵塞程度,对PTE诊断的敏感性和特异性均较高,且无创、便捷,目前已成为确诊PTE的首选检查方法。其直接征象为肺动脉内充盈缺损,部分或完全包围在不透光的血流之间(轨道征),或呈完全充盈缺损,远端血管不显影;间接征象包括肺野楔形、条带状密度增高影或盘状肺不张,中心肺动脉扩张及远端血管分支减少或消失等。CTPA可同时显示肺及肺外的其他胸部疾病,具有重要的诊断和鉴别诊断价值。
扫描时机是实现CT血管成像良好均匀强化的一个决定性变量。确定最优扫描延迟时间,产生足够的血管强化是一个挑战性的任务,现代CT的扫描速度越来越快,由于碘的k-边缘和患者特定参数的影响,低千伏扫描只需要少量的对比剂,因而得到了更广泛的应用。因此,在CT血管成像中错过动脉峰值强化的风险越来越大。对比剂跟踪技术(BT)与对比剂测试技术(TB)是临床中应用最广泛的两种CT血管成像技术。与TB技术相比,具有固定触发延迟时间的BT技术的主要优点是需要更少的对比剂、更少的辐射剂量和时间效率。尽管BT技术已经使用了几十年,但它仍然有缺点。它的一个主要缺点是,在达到阈值后的固定触发延迟时间,没有考虑患者特定的心血管参数,如心输出量或血液循环时间。例如,在高心排血量的患者中,一个固定的和预先设定的触发延迟时间可能会导致错过动脉增强峰值,因为扫描开始可能太晚了。相比之下,对于心输出量低的患者,扫描可能开始得太早,在达到动脉增强峰值之前就终止了图像采集。
优质的CTPA成像应做到肺动脉明显强化而肺静脉强化不明显,主动脉内无强化。并使用尽可能少的碘对比剂,理想情况下在上腔静脉中残留的碘对比剂尽量少(这可能导致射线硬化束伪影,影响肺动脉分支的观察)。同时,在保持可接受的图像噪声水平的同时,应尽量减少辐射剂量,并且扫描采集时间应尽可能短,以减轻运动伪影。
发明内容
针对目前CT肺动脉血管成像中图像质量层次不齐,静脉污染普遍存在,本发明旨在通过TB技术,得出最佳扫描延迟时间,减少肺静脉内碘对比剂污染,避免上腔静脉内碘对比剂浓聚,从而改善图像质量,降低患者碘对比剂的用量。
为了实现上述目的,本发明采取的技术方案如下:
一种CT肺动脉成像扫描延迟时间的确定方法,扫描采用对比剂测试法时,监测阶段在肺动脉主干及同层肺静脉内,同时设置相应大小的类圆形ROI,得到肺动-静脉强化时间密度双曲线,将双曲线交叉点时间作为TCROSS,扫描持续时间作为TSD,通过TCROSS-TSD的差值计算出最佳的扫描延迟时间TDELAY。
具体地,所述的CT肺动脉成像扫描延迟时间的确定方法包括如下步骤:
(1)扫描完成定位像:病人平卧于扫描床,上肢放置于头两侧,对病人进行呼吸训练,平静呼吸下轻松憋气,扫描范围包括肺尖至肋膈角;
(2)获得肺动-静脉强化时间密度双曲线:根据步骤(1)得到的定位像,将监测层面放置于气管分叉下1cm处,平静呼吸下轻松憋气,注射碘对比剂,并同步进行监测扫描,待升主动脉强化后停止扫描,得到一组碘对比剂的循环强化图像;
选取循环强化图像中肺静脉强化明显的一幅,在肺动脉主干及同层肺静脉内,同时设置相应大小的类圆形ROI,得到肺动-静脉强化时间密度双曲线;
(3)计算得出肺动脉血管成像扫描延迟时间:根据步骤(2)肺动-静脉强化时间密度双曲线得到双曲线交叉点时间TCROSS;同时,根据步骤(1)得到的定位像,确定肺动脉成像扫描方向及范围后得到扫描持续时间TSD;最后,通过TCROSS-TSD的差值计算出最佳的扫描延迟时间TDELAY。
优选地,步骤(1)中,扫描条件为管电压80-120kVp,管电流20mA,窗宽/窗位设定为500/50HU。
步骤(2)中,使用双管高压注射器注射碘对比剂,一侧管里是碘对比剂,另一侧管里是生理盐水,先注射碘对比剂,后面同流速跟注生理盐水。碘对比剂用量为5-10ml,生理盐水为40-45ml,注射流速为4.0-5.0ml/s。
步骤(2)中,所述的监测扫描模式为轴扫,机架旋转速度1.0s/r,管电压80-120kVp,管电流40mA,层厚5mm,重建类型为标准模式,窗宽/窗位设定为350/50HU,重建算法为迭代重建。
步骤(2)中,所述测试扫描设定为15-30次,每隔1-2秒扫描一次。
具体地,步骤(2)中,所述肺动-静脉强化时间密度双曲线为在监测层面肺动脉和肺静脉内,同时放置ROI得到。
步骤(3)中,肺动脉成像扫描方向及范围为膈肌顶部下2cm至主动脉弓上2cm。
有益效果:
采用本发明方法计算得出的扫描延迟时间,曝光扫描可以获得优质的肺动脉强化图像,既可以准确采集强化的肺动脉,减少伴行肺静脉的显影,同时又可以减少碘对比剂的使用量,降低病人的碘负荷,避免注射侧锁骨下静脉及上腔静脉内,碘对比剂浓聚造成的射线硬化束伪影。
附图说明
下面结合附图和具体实施方式对本发明做更进一步的具体说明,本发明的上述和/或其他方面的优点将会变得更加清楚。
图1是TB技术测试扫描前的准备,A为受检者的定位像,B为设定的测试层面和扫描范围。
图2是获得肺动-静脉强化时间密度双曲线的过程,A为选择测试图组中肺静脉强化明显的一幅,B为在肺动脉主干及同层肺静脉内,同时设置相应大小的类圆形ROI。
图3是获得的肺动-静脉强化时间密度双曲线。
图4是参照坐标得出双曲线交叉点时间TCROSS。
图5是采用得出的扫描延迟时间曝光扫描获得优质的CT肺动脉血管成像。
具体实施方式
根据下述实施例,可以更好地理解本发明。
说明书附图所绘示的结构、比例、大小等,均仅用以配合说明书所揭示的内容,以供熟悉此技术的人士了解与阅读,并非用以限定本发明可实施的限定条件,故不具技术上的实质意义,任何结构的修饰、比例关系的改变或大小的调整,在不影响本发明所能产生的功效及所能达成的目的下,均应仍落在本发明所揭示的技术内容所能涵盖的范围内。同时,本说明书中所引用的如“上”、“下”、“前”、“后”、“中间”等用语,亦仅为便于叙述的明了,而非用以限定本发明可实施的范围,其相对关系的改变或调整,在无实质变更技术内容下,当亦视为本发明可实施的范畴。
以下为确定CT肺动脉成像扫描延迟时间的具体实例。
(1)扫描完成定位像:病人平卧于扫描床,足先进,上肢放置于头两侧,向病人介绍接下来的检查程序,取得有效沟通,使病人避免紧张,对病人进行呼吸训练,平静呼吸下轻松憋气,扫描范围包括肺尖至肋膈角(如图1所示),扫描条件为管电压80kVp,管电流20mA,窗宽/窗位设定为500/50HU。
(2)获得肺动-静脉强化时间密度双曲线:根据步骤(1)得到的定位像,将监测层面放置于气管分叉下1cm处(肺动脉主干层面),平静呼吸下轻松憋气,注射5ml碘对比剂+45ml生理盐水,流速5.0ml/s,监测扫描模式为轴扫,机架旋转速度1.0s/r,管电压80kVp,管电流40mA,层厚5mm,重建类型为标准模式,窗宽/窗位设定为350/50HU,重建算法为迭代重建,碘对比剂注射与监测扫描同步进行,预设定监测扫描15次,每隔2秒钟扫描一次,待升主动脉强化后停止扫描,得到一组碘对比剂的循环强化图像。选取循环强化图像中肺静脉强化明显的一幅,在肺动脉主干及同层肺静脉内,同时设置相应大小的类圆形ROI(如图2所示),获得肺动-静脉强化时间密度双曲线(如图3所示)。
(3)计算得出肺动脉血管成像扫描延迟时间:根据步骤(2)肺动-静脉强化时间密度双曲线得到双曲线交叉点时间TCROSS为9秒;同时,根据步骤(1)得到的定位像,确定肺动脉成像扫描方向及范围为膈肌顶部下2cm至主动脉弓上2cm,得到扫描持续时间TSD为1.9秒;最后,通过TCROSS-TSD的差值计算出最佳的扫描延迟时间TDELAY为7.1秒。
(4)采用上述方法计算得出的扫描延迟时间7.1秒,曝光扫描即可得到优质的肺动脉血管成像,如图5所示。
常规肺动脉血管成像技术碘对比剂的使用量在25ml以上,本发明方法在病人BMI<28kg/m2,体重<80kg时,仅需15ml就可以完成检查。在监测阶段采用5ml碘对比剂+45ml生理盐水,最终CTPA扫描时采用10ml碘对比剂+40ml生理盐水。
本发明提供了一种CT肺动脉成像扫描延迟时间的确定方法的思路及方法,具体实现该技术方案的方法和途径很多,以上所述仅是本发明的优选实施方式,应当指出,对于本技术领域的普通技术人员来说,在不脱离本发明原理的前提下,还可以做出若干改进和润饰,这些改进和润饰也应视为本发明的保护范围。本实施例中未明确的各组成部分均可用现有技术加以实现。
Claims (8)
1.一种CT肺动脉成像扫描延迟时间的确定方法,其特征在于,扫描采用对比剂测试法时,测试阶段在肺动脉主干及同层肺静脉内,同时设置相应大小的类圆形ROI,得到肺动-静脉强化时间密度双曲线,将双曲线交叉点时间作为TCROSS,扫描持续时间作为TSD,通过TCROSS-TSD的差值计算出扫描延迟时间TDELAY。
2.根据权利要求1所述的CT肺动脉成像扫描延迟时间的确定方法,其特征在于,包括如下步骤:
(1)扫描完成定位像:病人平卧于扫描床,上肢放置于头两侧,对病人进行呼吸训练,平静呼吸下轻松憋气,扫描范围包括肺尖至肋膈角;
(2)获得肺动-静脉强化时间密度双曲线:根据步骤(1)得到的定位像,将监测层面放置于气管分叉下1cm处,平静呼吸下轻松憋气,注射碘对比剂,同步进行监测扫描,待升主动脉强化后停止扫描,得到一组碘对比剂的循环强化图像;
选取循环强化图像中肺静脉强化明显的一幅,在肺动脉主干及同层肺静脉内,同时设置相应大小的类圆形ROI,得到肺动-静脉强化时间密度双曲线;
(3)计算得出肺动脉血管成像扫描延迟时间:根据步骤(2)肺动-静脉强化时间密度双曲线得到双曲线交叉点时间TCROSS;同时,根据步骤(1)得到的定位像,确定肺动脉成像扫描方向及范围后得到扫描持续时间TSD;最后,通过TCROSS-TSD的差值计算出最佳的扫描延迟时间TDELAY。
3.根据权利要求2所述的CT肺动脉成像扫描延迟时间的确定方法,其特征在于,步骤(1)中,扫描条件为管电压80-120kVp,管电流20mA,窗宽/窗位设定为500/50HU。
4.根据权利要求2所述的CT肺动脉成像扫描延迟时间的确定方法,其特征在于,步骤(2)中,使用双管高压注射器注射碘对比剂,碘对比剂用量为5-10ml,生理盐水为40-45ml,注射流速为4.0-5.0ml/s。
5.根据权利要求2所述的CT肺动脉成像扫描延迟时间的确定方法,其特征在于,步骤(2)中,所述的监测扫描模式为轴扫,机架旋转速度1.0s/r,管电压80-120kVp,管电流40mA,层厚5mm,重建类型为标准模式,窗宽/窗位设定为350/50HU,重建算法为迭代重建。
6.根据权利要求2所述的CT肺动脉成像扫描延迟时间的确定方法,其特征在于,步骤(2)中,所述监测扫描设定为15-30次,每隔1-2秒扫描一次。
7.根据权利要求2所述的CT肺动脉成像扫描延迟时间的确定方法,其特征在于,步骤(2)中,所述肺动-静脉强化时间密度双曲线为在监测层面肺动脉和肺静脉内,同时放置ROI得到。
8.根据权利要求2所述的CT肺动脉成像扫描延迟时间的确定方法,其特征在于,步骤(3)中,肺动脉成像扫描方向及范围为膈肌顶部下2cm至主动脉弓上2cm。
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