八层螺旋CT血管造影显示外周肺动脉的研究
摘要
目的：分析八层螺旋CT血管造影显示外周肺动脉的能力及其影响因素。
方法：选择40例无肺部器质性病变患者行八层螺旋CT肺动脉血管造影检查(准直8×1.25mm；螺距1.35；扫描时间0.6s)，对扫描后重建图像进行外周肺动脉分析。每一患者扫描后进行图像重建形成两组序列：1.25mm层厚、0.625mm层间距和2.5mm层厚、1.25mm层间距，称之为组1和组2。在每一组中共分析800支段肺动脉(每名患者20支动脉)1600支亚段肺动脉(每名患者40支动脉)，3200支五级分支肿动脉(每名患者80支动脉)，6400支六级分支肺动脉(每名患者160支动脉)。由两名具有丰富临床经验的放射医师阅读图像，记录显示清晰的各级外周肺动脉，评价其显示情况并作统计学分析。
结果：两组序列对段级肺动脉的显示率相同，均为99.38％(795／800)；亚段肺动脉的显示率组1为94.44％(1511／1600)，组2为83.06％(1329／1600)，两组相比差异有显著性(p＜0.01)；五级肺动脉显示率组1为70.59％(2259／3200)，组2为44.78％(1433／3200)，两组相比差异有显著性(p＜0.01)；六级肺动脉显示率组1为31.81％(2036／6400)，组2为14.29％(915／6400)，两组相比差异有显著性(p＜0.01)。
结论：(1)八层螺旋CT血管造影扫描后行1.25mm层厚重建可以精确的分析5级以内的外周肺动脉。(2)1.25mm层厚、0.625mm层间距重建图像较2.5mm层厚、1.25mm层间距重建图像显示外周肺动脉方面有更好的优势，表明图像重建层厚为影响外周肺动脉显示率的重要因素。
Purpose: To analyze the detection ability of peripheral pulmonary arteries with 8-sliceCTA and the influencial factor.
Methods: Peripheral pulmonary arteries were analyzed on contrast material-enhanced spiral CT angiograms in 40 patients devoid of pleuroparenchymal disease who underwent scanning with multi-slice row CT(collimation,8 X 1.25mm;pitch,1.35;scanning time,0.5secend). Two series of scans were systematically generated from each date set,1.25mm-thick sections 0.625mm-intervals(group 1) and 2.5mm-thick sections , 1.25mm-intervals(group 2),leading to the analysis of 800 segmental(20 arteries per patient), 1,600 subsegmental (40 arteries per patient), 3,200 fifth-order (80 arteries per patient), and 6,400 sixth-order (160 arteries per patient) pulmonary arteries in each group.Consensus interpretation of the CT images was performed by two radiologists who experienced in the reading of helical CT angiograms of the pulmonary circulation.The analyzable pulmonary arteries were recorded and the statistical analysis was pe
rformed.
Results: The percentage of analyzable segmental arteries was same identical both in group 1 and in group 2(99.38%[795/800]); For subsegmental pulmonary arteries, the resolution was 94.44%(1511/1600) in group 1 and 83.06%(1329/1600) in group 2, there was a significant difference between them( p<0.01); For fifth-order pulmonary arteries, the resolution was 70.59% (2259/3200) in group 1 and 44.78% (1433/3200) in group 2,there was a significant difference between them( p<0.01); For sixth-order pulmonary arteries, the resolution was 31.81% (2036/6400)in group 1 and 14.29%( 915/6400)in group 2,there was a significant difference between them( p<0.01).
Conclution : (1) Multi-detector row CT with reconstructed scans of 1.25-mm-thick sections enables accurate analysis of peripheral pulmonary arteries down to the fifth order on spiral CT angiograms. (2) The resolution of peripheral
pulmonary arteries was better in reconstructed images of 1.25-mm-thick sections than that of 2.5-mm-thick sections.The reconstructed slice-thick of images was an important factor that influences the resolution of peripheral pulmonary arteries.
方法：选择40例无肺部器质性病变患者行八层螺旋CT肺动脉血管造影检查(准直8×1.25mm；螺距1.35；扫描时间0.6s)，对扫描后重建图像进行外周肺动脉分析。每一患者扫描后进行图像重建形成两组序列：1.25mm层厚、0.625mm层间距和2.5mm层厚、1.25mm层间距，称之为组1和组2。在每一组中共分析800支段肺动脉(每名患者20支动脉)1600支亚段肺动脉(每名患者40支动脉)，3200支五级分支肿动脉(每名患者80支动脉)，6400支六级分支肺动脉(每名患者160支动脉)。由两名具有丰富临床经验的放射医师阅读图像，记录显示清晰的各级外周肺动脉，评价其显示情况并作统计学分析。
结果：两组序列对段级肺动脉的显示率相同，均为99.38％(795／800)；亚段肺动脉的显示率组1为94.44％(1511／1600)，组2为83.06％(1329／1600)，两组相比差异有显著性(p＜0.01)；五级肺动脉显示率组1为70.59％(2259／3200)，组2为44.78％(1433／3200)，两组相比差异有显著性(p＜0.01)；六级肺动脉显示率组1为31.81％(2036／6400)，组2为14.29％(915／6400)，两组相比差异有显著性(p＜0.01)。
结论：(1)八层螺旋CT血管造影扫描后行1.25mm层厚重建可以精确的分析5级以内的外周肺动脉。(2)1.25mm层厚、0.625mm层间距重建图像较2.5mm层厚、1.25mm层间距重建图像显示外周肺动脉方面有更好的优势，表明图像重建层厚为影响外周肺动脉显示率的重要因素。
Purpose: To analyze the detection ability of peripheral pulmonary arteries with 8-sliceCTA and the influencial factor.
Methods: Peripheral pulmonary arteries were analyzed on contrast material-enhanced spiral CT angiograms in 40 patients devoid of pleuroparenchymal disease who underwent scanning with multi-slice row CT(collimation,8 X 1.25mm;pitch,1.35;scanning time,0.5secend). Two series of scans were systematically generated from each date set,1.25mm-thick sections 0.625mm-intervals(group 1) and 2.5mm-thick sections , 1.25mm-intervals(group 2),leading to the analysis of 800 segmental(20 arteries per patient), 1,600 subsegmental (40 arteries per patient), 3,200 fifth-order (80 arteries per patient), and 6,400 sixth-order (160 arteries per patient) pulmonary arteries in each group.Consensus interpretation of the CT images was performed by two radiologists who experienced in the reading of helical CT angiograms of the pulmonary circulation.The analyzable pulmonary arteries were recorded and the statistical analysis was pe
rformed.
Results: The percentage of analyzable segmental arteries was same identical both in group 1 and in group 2(99.38%[795/800]); For subsegmental pulmonary arteries, the resolution was 94.44%(1511/1600) in group 1 and 83.06%(1329/1600) in group 2, there was a significant difference between them( p<0.01); For fifth-order pulmonary arteries, the resolution was 70.59% (2259/3200) in group 1 and 44.78% (1433/3200) in group 2,there was a significant difference between them( p<0.01); For sixth-order pulmonary arteries, the resolution was 31.81% (2036/6400)in group 1 and 14.29%( 915/6400)in group 2,there was a significant difference between them( p<0.01).
Conclution : (1) Multi-detector row CT with reconstructed scans of 1.25-mm-thick sections enables accurate analysis of peripheral pulmonary arteries down to the fifth order on spiral CT angiograms. (2) The resolution of peripheral
pulmonary arteries was better in reconstructed images of 1.25-mm-thick sections than that of 2.5-mm-thick sections.The reconstructed slice-thick of images was an important factor that influences the resolution of peripheral pulmonary arteries.
引文
1 Remy-Jardin M, Remy J, Wattinne I, Giraud F. Central pulmonary thromboem-bolism: diognosis with helical volumetric CT with the single breath hold technique-comparison with pulmonary angiography. Radiology 1992; 185:381-387
2 Goodman LR, Curtin JJ, Mewissen MW, et al. Detection of pulmonary embolism in patients with unresolved clinical and scintigraphic diognosis: helical CT versus angiography. A JR Am J Roentgenol 1995; 164:1369-1374
3 Senac JP, Verhnet H, Bousquet C, et al. Embolie pulmonaire: apport de la tomodensitometrie helicoidate, J Radiol 1995;74: 339-345
4 Van Rossum AB, Pattynama PMT, Ton ER, et al. Pulmonary embolism: validation of helical CT angiography in 149 patients. Radiology 1996; 201:467-470
5 Van Rossum AB, Treuniet FEE, Kieft GJ, Smith SJ, Schepers-Bok R. Role of helical volumetric computed tomographic scaning in the assessment of patients with clinical suspicion of pulmonary embolism and an abnormal ventilation-perfusion scan. Thorax 1996; 51:23-28
6 Remy-Jardin M, Remy J, Deschildre F, et al. Diagnosis of acute pulmonary embolism witn helical CT: comparison with pulmonary angiography and scintigraphy. Radiology 1996; 200:699-706
7 Ferretti GR, Bosson JL, Buffaz PD, et al. Acute pulmonary embolism: role of helical CT in 164 patients with intermedioate probability at ventilation-perfusion scintigraphy and normal results at duplex US of the legs, Radiology 1997; 205:453-458
8 Van Rossum AB, Pattynama PM, Mallens WM, Hermans J, Heijerman HG. Can helical CT replace scintigraphy in the diognostic process in suspected pulmonary embolism ? A retrolective-prolective cohort study focusing on total diagnostic yield. Eur Radiol 1998; 8:90-96
Drucker EA, Rivitz SM, Shepard JAP, et al. Acute pulmonary embolism: assessment of helical CT for diagnosis. Radiology 1998; 209:235-241
10 Blachere H, Latrabe V, Montaudon M, et al. Pulmonary embolism revealed on helical CT angiography: comparison with ventilation perfusion radionuclide lung scanning. AJR,2000,174(4): 10412-10416
11 李永忠，李坤成．亚秒级螺旋CT肺动脉造影检测段与亚段肺动脉．中国医学影像技术，2001，17(12)：1167-1169
12 Ghaye B, Szapiro D, et al. Peripheral Pulmonary Arteries: How Far in the Lung Does Multi-Detector Row Spiral CT Allow Analysis? Radiology 2001,219:629-636
13 Remy-Jardin M, Remy J, Artaud D, Deschildre F, Duhamel A. Peripheral pulmonary arteries: optimization of the acquisition protocol. Radiology 1997; 204:157-163
14 Jackson CL, Huber JF. Correlated applied anatomy of the bronchial tree and lungs with a system of nomenclature. Dis Chest 1943; 9:319-326
15 Boyden EA. Segmental anatomy of the lungs. New York, NY: McGraw-Hill, 1955-1958
16 GE Medical Systems. Light Speed Q×I General Service Manual. 2001:534-538
17 付强，张玉志．多层螺旋CT技术新进展．中国医学影像技术，2001，17(5)：481-482
18 Taguchi k, Aradate H. Algorithm for image reconstruction in multi-slice helical CT[J]. J Med phys, 1998, 25(4): 550-561
19 Ohnesorge BM, Flohr T, Kopp AF, et al. High resolution imaging with multi-slice spiral CT [J]. Radiology, 1999,213:318-321
20 Rubin GD, Shiau MC, Leung AN, er al. Aorta and iliac artheries: single versus mutiple detector row helical CT angiography[J]. Radiology, 2000,215(3):670-676
21 Hopper KD, Lyriboz TA, Mahraj RP, et al. CT bronchoscdpy: oplimizalion of imaging paramelers [J]. Radiology, 1909, 209:
872-877
22 Summers RM, Shaw DJ, Shelhamer JH. CT virlual bronchoscopy of simulaled endobronchial lesions: effect of scanning, reconstruction, and display sellings and polenlial pilfalls [J]. A JR Am J Roenlgenol, 1998, 170:947-950
23 Rodenwald. J, Kopka L, Roedel R, et al. 3D virlual endoscopy of the upper airway: oplimization of the scan paramelers assessment [J]. J Comput Assist Tomogr, 1997, 21:405-411
24 Rydberg J, Buckwalter KA,Caldemeyer KS, et al. Multisection CT:scanning techniques and clinical applications. Radiographies, 2000, 20(6):1787-1806
25 Remy-Jardin M, Baghaie F, Masson P, Duhamel A, Remy J. Thoracic helical CT: influence of subsecond scan time and thin collimation on evaluation of peripheral pulmonary arteries. Eur Radiol 2000; 10:1297-1303
26 Schoepf UJ, Helmberger T, Holzknecht, et al. Segmental and subsegmental pulmonary arteries: evaluation with electronbeam versus spiral CT. Radiology 2000; 214:433-439
27 Baile EM, King GG, Muller NL, et al. Spiral computed tomography is comparabke to angiography for the diagnasos of pulmonary embolism. Am J Respir Crit Care Med 2000; 161:1010-1015
2 Goodman LR, Curtin JJ, Mewissen MW, et al. Detection of pulmonary embolism in patients with unresolved clinical and scintigraphic diognosis: helical CT versus angiography. A JR Am J Roentgenol 1995; 164:1369-1374
3 Senac JP, Verhnet H, Bousquet C, et al. Embolie pulmonaire: apport de la tomodensitometrie helicoidate, J Radiol 1995;74: 339-345
4 Van Rossum AB, Pattynama PMT, Ton ER, et al. Pulmonary embolism: validation of helical CT angiography in 149 patients. Radiology 1996; 201:467-470
5 Van Rossum AB, Treuniet FEE, Kieft GJ, Smith SJ, Schepers-Bok R. Role of helical volumetric computed tomographic scaning in the assessment of patients with clinical suspicion of pulmonary embolism and an abnormal ventilation-perfusion scan. Thorax 1996; 51:23-28
6 Remy-Jardin M, Remy J, Deschildre F, et al. Diagnosis of acute pulmonary embolism witn helical CT: comparison with pulmonary angiography and scintigraphy. Radiology 1996; 200:699-706
7 Ferretti GR, Bosson JL, Buffaz PD, et al. Acute pulmonary embolism: role of helical CT in 164 patients with intermedioate probability at ventilation-perfusion scintigraphy and normal results at duplex US of the legs, Radiology 1997; 205:453-458
8 Van Rossum AB, Pattynama PM, Mallens WM, Hermans J, Heijerman HG. Can helical CT replace scintigraphy in the diognostic process in suspected pulmonary embolism ? A retrolective-prolective cohort study focusing on total diagnostic yield. Eur Radiol 1998; 8:90-96
Drucker EA, Rivitz SM, Shepard JAP, et al. Acute pulmonary embolism: assessment of helical CT for diagnosis. Radiology 1998; 209:235-241
10 Blachere H, Latrabe V, Montaudon M, et al. Pulmonary embolism revealed on helical CT angiography: comparison with ventilation perfusion radionuclide lung scanning. AJR,2000,174(4): 10412-10416
11 李永忠，李坤成．亚秒级螺旋CT肺动脉造影检测段与亚段肺动脉．中国医学影像技术，2001，17(12)：1167-1169
12 Ghaye B, Szapiro D, et al. Peripheral Pulmonary Arteries: How Far in the Lung Does Multi-Detector Row Spiral CT Allow Analysis? Radiology 2001,219:629-636
13 Remy-Jardin M, Remy J, Artaud D, Deschildre F, Duhamel A. Peripheral pulmonary arteries: optimization of the acquisition protocol. Radiology 1997; 204:157-163
14 Jackson CL, Huber JF. Correlated applied anatomy of the bronchial tree and lungs with a system of nomenclature. Dis Chest 1943; 9:319-326
15 Boyden EA. Segmental anatomy of the lungs. New York, NY: McGraw-Hill, 1955-1958
16 GE Medical Systems. Light Speed Q×I General Service Manual. 2001:534-538
17 付强，张玉志．多层螺旋CT技术新进展．中国医学影像技术，2001，17(5)：481-482
18 Taguchi k, Aradate H. Algorithm for image reconstruction in multi-slice helical CT[J]. J Med phys, 1998, 25(4): 550-561
19 Ohnesorge BM, Flohr T, Kopp AF, et al. High resolution imaging with multi-slice spiral CT [J]. Radiology, 1999,213:318-321
20 Rubin GD, Shiau MC, Leung AN, er al. Aorta and iliac artheries: single versus mutiple detector row helical CT angiography[J]. Radiology, 2000,215(3):670-676
21 Hopper KD, Lyriboz TA, Mahraj RP, et al. CT bronchoscdpy: oplimizalion of imaging paramelers [J]. Radiology, 1909, 209:
872-877
22 Summers RM, Shaw DJ, Shelhamer JH. CT virlual bronchoscopy of simulaled endobronchial lesions: effect of scanning, reconstruction, and display sellings and polenlial pilfalls [J]. A JR Am J Roenlgenol, 1998, 170:947-950
23 Rodenwald. J, Kopka L, Roedel R, et al. 3D virlual endoscopy of the upper airway: oplimization of the scan paramelers assessment [J]. J Comput Assist Tomogr, 1997, 21:405-411
24 Rydberg J, Buckwalter KA,Caldemeyer KS, et al. Multisection CT:scanning techniques and clinical applications. Radiographies, 2000, 20(6):1787-1806
25 Remy-Jardin M, Baghaie F, Masson P, Duhamel A, Remy J. Thoracic helical CT: influence of subsecond scan time and thin collimation on evaluation of peripheral pulmonary arteries. Eur Radiol 2000; 10:1297-1303
26 Schoepf UJ, Helmberger T, Holzknecht, et al. Segmental and subsegmental pulmonary arteries: evaluation with electronbeam versus spiral CT. Radiology 2000; 214:433-439
27 Baile EM, King GG, Muller NL, et al. Spiral computed tomography is comparabke to angiography for the diagnasos of pulmonary embolism. Am J Respir Crit Care Med 2000; 161:1010-1015