| Part Ⅰ:The application value of modified retrospective ECG-gating ang non ECG-gating scanning methods in bronchial arterial imaging with 128-slice dual source CT Objective:To evaluate the clinical value of 128-slice dual-source CT(DSCT)in bronchial artery display and image quality.The original BA image was obtained by applying the second generation DSCT and using two scanning methods,and the obtained original data was analyzed to further obtain the BA development effect and image quality data,etc.The development effect was discussed and the image quality was compared and analyzed.Methods:A retrospective analysis was performed on 200 patients who underwent BA examination in our unit from January 2017 to June 2018.100 patients received modified retrospective electrocardiogram sequence scanning and 100 patients received non-gated enhanced scanning.According to the scanning method,the two groups of patients were divided into two groups.The two groups of patients were respectively the electrocardiograph controlled group and the non-gated enhancement group.A total of 200 patients in the two groups were 110 males and 90 females,with an average age of 53.8 years.All subjects signed CT enhanced informed consent.Exclusion criteria: patients with allergies to iodinecontaining contrast agents,patients with severe renal disease and dysfunction,patients with severe heart disease and cardiac dysfunction,and patients with obvious arrhythmia were not eligible for CTA examination.This study observed the clear display rate of two groups of BA images,and measured the signal-to-noise ratio and contrast noise ratio of the two groups of BA images.Two experienced radiologists subjectively evaluated the image quality of the two groups of data using a double-blind method.Results:In order to facilitate observation and statistics,BA was roughly divided into two segments centered on the hilum of the lung in this study.The segment from the origin of BA to the hilum of the lung was named as the mediastinum segment,and the segment from the hilum of the lung to the end of the bronchus was named as the intrapulmonary segment.Images with subjective scores greater than or equal to 4 were regarded as clear display of BA.The total number of BA in the control group was 260,with an average of 2.6/ person.The general enhancement group showed a total of 214 BA,with an average of 2.1 per person.The number of BA in mediastinal segment of the ecg group was 260,and the clear display rate was 100%.The number of BA clearly displayed in the mediastinal segment of the general enhancement group was 200,with a clear display rate of 93.46%.The difference between the two groups was statistically significant(2=17.53,P<0.05).In the ecg control group,226 lung segments were clearly developed,with a clear display rate of86.92%.The clear display rate was 57.64%,and the difference between the two groups was statistically significant(2=51.03,P<0.05).The clear display rate of BA mediastinal segment and intrapulmonary segment in the ecg group was higher than that in the general enhancement group.CT values of the thoracic aorta in the electrocardioscope control group and the general enhancement group were about 403.66 78.85 and 398.99 74.56,respectively(P>0.05),and the subjective scores were 4.30 0.57 and 3.68 0.57,respectively(P<0.05).The consistency of subjective image quality of 2 senior radiologists was tested by Kappa.The Kappa value of >0.75 was consistent.Kappa value between 0.4 and 0.75 is generally consistent;Kappa value <0.40 indicates poor consistency.P<0.05 was considered statistically significant.In this study,the consistency of BA image quality score by two physicians was excellent(Kappa=0.80,P<0.05).The subjective scores,SNR and CNR of the two groups were all statistically significant(P<0.05).(all P values were <0.05),SNR,CNR and subjective scores of the electrocardioval-gated group were higher than those of the non-gated enhanced group.The subjective evaluation was performed by two radiologists with intermediate or above titles,and all the scores were double-blind and scored on a five-point scale.The scoring criteria were: 5 points: excellent image quality,clear vascular display,no obvious artifacts,good development;The score was 4 points: good image quality,clear vascular display,slight or no artifact,good development;The score was 3 points:acceptable image quality,general vascular display,visible artifacts,and diagnosable image;The score was 2 points: poor image quality,blurred blood vessels,heavy artifacts,image diagnosis was affected to some extent;Score 1: image quality cannot be assessed,blood vessels cannot be identified and cannot be assessed.The score agreed by two physicians was used as the scoring standard.Conclusion:The BA images obtained by the modified retrospective electrocardiograms sequence scan of 128-slice dual-source CT are superior to the general enhanced scanning group in terms of both display rate and image quality.Therefore,for the BA scans,we can use the improved retrospective electrocardiograms sequence scan to obtain better images.Effectively serve the clinic.Part Ⅱ: Dual-source CT and DSA were compared to evaluate the clinical value of the responsible vessels in patients with hemoptysisObjective:To evaluate the sensitivity and specificity of dual-source CT in the diagnosis of hemoptysis by DSA and to explore the anatomical characteristics of BA angiography(CTA).Methods:Firstly,retrospective analysis was performed on 40 cases of BAE patients who underwent BA dual-source CTA examination with hemoptysis as the etiology in our unit from June 2016 to December 2018.The maximum age was 82,the minimum 43,and the average age was 64.2.The original axial imaging data of all patients were further obtained.Then,the original image data were imported into the workstation for volume reconstruction(VR),maximum density projection(MIP)and multiplanar reconstruction(MPR),so as to obtain the reconstructed image of patient BA for observing the shape characteristics of BA and obtaining anatomical data such as the diameter,number and origin of BA.All patients were treated with dual source CT modified retrospective electrocardiograms.Results:Among the 40 patients with hemoptysis,24 patients with lung cancer,6 with bronchiectasis,5 with tuberculosis and 5 with pulmonary inflammation were treated with bronchial artery(BA)chemoembolization for the responsible vessels of lung cancer,and the rest were treated with BA embolization.The DSCT examination of 40 patients showed a total of 101 responsible vessels,including BA and NBSA.According to the DSA results and taking this as the standard,the true positive results were 83,the true negative results were 15,the false positive results were 1,and the false negative results were 2.Forty patients showed a total of 94 BA.The average diameter was 2.3 tubes/person,with 40 tubes on the left side and 54 tubes on the right side.The average diameter was 0.21 cm.Among them,18 BA were concomitant with the right costal artery.Eighty-three BA openings were located at t5-t6 level,two at T3 level,seven at T4 level,one at T7 level and one at T8 level.A total of 7 NBSA were found,6 of which originated from the subclavian artery,and 1 of which originated from the abdominal trunk.Conclusion:The application of DSCT can obtain the anatomical and morphological information of the responsible vessels of hemoptysis,including BA and NBSA,which can provide effective help for the follow-up embolization therapy,improve the work efficiency,and reduce the effective radiation dose of the patients and operators. |
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