动脉疾病多层螺旋CT血管成像.ppt

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1、Arterial Diseases:MSCTA,动脉疾病多层螺旋CT血管造影刘挨师,The Affiliated Hospital of Inner Mongolia Medical College,从1972年Hounsfield发明CT(Computed Tomography)以来，其扫描速度由最初每层扫描的270s发展到不足0.4s，Z轴分辨力由10mm发展至0.4mm以下，扫描范围由1cm/30s到180cm/10s。目前螺旋CT已实现1s器官成像，5s心脏成像和10s全身成像。,The Affiliated Hospital of Inner Mongolia Medical Col

2、lege,FEW,1972年头颅CT,1980年全身CT,1989年螺旋CT,1998年多层螺旋CT,2004年64排螺旋CT,The Affiliated Hospital of Inner Mongolia Medical College,扫描速度快，一次屏气完成连续扫描；提高了图像质量，Z轴分辨率明显提高多期动态增强扫描减少对比剂用量图像后处理功能强大-二维或三维重建技术降低了X线剂量（约40%）,MSCT的优点,将螺旋CT获得的薄层轴位图像在特定的工作站(workstation)上利用计算机重建处理软件完成图像的后处理，重建出直观的立体图像，称其为图像后处理技术。,The Affili

3、ated Hospital of Inner Mongolia Medical College,Post-Processing Techniques,最大密度投影法（maximum intensity projection,MIP）由每条射线上密度最大的像素重建而成，能反映组织的实际CT值，细节较精细，可显示狭窄的位置、范围、程度，易于区别钙化的动脉粥样硬化斑块和管腔内的对比剂。MIP的缺点是图像立体感不强，对重叠血管的空间关系显示不满意。,The Affiliated Hospital of Inner Mongolia Medical College,The Affiliated Hosp

4、ital of Inner Mongolia Medical College,多平面重建(multiplanar reconstruction,MPR)是利用原始二维的横断面图象重组为新的二维图象，可获得冠状面、矢状面和各种任意方向斜面图像。由于为容积扫描并经小间隔重建处理,重建图像与MRI的冠状面、矢状面相媲美。MPR能较好地显示组织器官内部复杂的解剖关系，有利于病变的定位。MPR重建结构在一个平面上，超出此平面的结构均不能显示。,The Affiliated Hospital of Inner Mongolia Medical College,The Affiliated Hospital

5、 of Inner Mongolia Medical College,曲面重建法（curved planar reconstruction，CPR）是指在容积数据的基础上，沿兴趣器官划一条曲线，计算指定曲面的所有像素的CT值，并以二维的图像形式显示出来。曲面重建将扭曲的重叠的血管伸展拉直显示在同一平面上，较好地显示其全貌，是MPR技术的延伸和发展。但在重建平面选择不当时，可能将病灶显示在观察野以外出现假阳性或假阴性。,The Affiliated Hospital of Inner Mongolia Medical College,The Affiliated Hospital of Inne

6、r Mongolia Medical College,表面遮盖显示(surface shaded display,SSD)是最简化的三维显示技术。首先确定兴趣结构的CT阈值，并产生一个虚光源，以描绘三维模型表面反射，并以灰阶或伪彩方式记录模型的表面影像。SSD的制作可用多个CT阈值并对不同CT值结构以彩色显示，以便切割有不同衰减值的结构。对阈值以上的象素进行遮盖显示，立体感强，多角度旋转，能很好显示血管间的复杂三维关系。目前主要用于骨骼、血管结构的三维成像。SSD法两个主要限制：CT阈值的选定明显影响血管狭窄的表现，阈值过小可导致正常的血管变窄，而阈值过大可导致狭窄段的钙化斑块落入显示范围，以

7、致狭窄被掩盖。在CT阈值的范围内，SSD法不能区分具有相同衰减值的结构，如钙化和管腔内的对比剂等,The Affiliated Hospital of Inner Mongolia Medical College,The Affiliated Hospital of Inner Mongolia Medical College,容积再现(volume render,VR)是利用全部容积数据，根据各种成分的比例进行像素的分类以不同的灰度和色彩显示，通过对不同结构的色彩编码和使用不同的透明度，可同时显示表浅或深在结构的影像。容积显示范围内的所有有效像素得以利用。图像精细逼真，解剖关系清晰，立体感强

8、，可以任意角度旋转，使用范围广，是目前MSCT图像后处理最常用的技术之一。,The Affiliated Hospital of Inner Mongolia Medical College,The Affiliated Hospital of Inner Mongolia Medical College,CT仿真内窥镜技术(CT virtual endoscopy,CTVE)是利用计算机软件将螺旋CT容积扫描获得的图像数据重建出空腔器官内部表面的立体图像，类似纤维内镜所见。临床主要应用于血管、喉腔、鼻窦、胃、大肠、气管及膀胱等病变的显示。优点如下：能从狭窄或阻塞的远端观察病灶；可观察纤维内径

9、无法观察的管腔，如血管。,The Affiliated Hospital of Inner Mongolia Medical College,The Affiliated Hospital of Inner Mongolia Medical College,CT血管成像(CT angiography,CTA)是经周围静脉快速注入水溶性有机碘对比剂，在靶血管对比剂高峰期，用螺旋CT对其进行快速容积扫描，由此获得的容积数据经计算机后处理，通常采用MIP、SSD、VR，重建成三维血管影像。CTA是一种微创性血管造影术，可清楚显示较大血管及其分支，清楚显示动脉瘤的形态、大小等。,The Affilia

10、ted Hospital of Inner Mongolia Medical College,Bolus Test,Delay Time,The scanning delay can also be accurately timed with a bolus tracking software program.,5ml/s 4sdelay 10sslice/s 2s interval20s,The Affiliated Hospital of Inner Mongolia Medical College,F 26yrs ICAA-SAH,Clinical Data:突发头痛、呕吐、意识欠清1小

11、时。行走时突然眼前发黑，继而跌倒，呕吐咖啡色胃液。,The Affiliated Hospital of Inner Mongolia Medical College,F 26yrs ICAA-SAH,The Affiliated Hospital of Inner Mongolia Medical College,The Affiliated Hospital of Inner Mongolia Medical College,The Affiliated Hospital of Inner Mongolia Medical College,M 40yrs AVM,突发头痛呕吐2周。头颅CT

12、脑室出血。MRI提示胼胝体占位性病变。DSA:左顶枕区AVM，供血动脉来自双侧大脑前动脉、左侧大脑后动脉，左侧横窦充盈差，闭塞。,The Affiliated Hospital of Inner Mongolia Medical College,The Affiliated Hospital of Inner Mongolia Medical College,VR,The Affiliated Hospital of Inner Mongolia Medical College,MIP,The Affiliated Hospital of Inner Mongolia Medical Coll

13、ege,M 57yrs,Clinical Data:头晕、恶心、呕吐，伴肢体无力，右侧面瘫，病理征阳性，有高血压史。MRI:大脑前动脉瘤，双侧大脑中动脉狭窄。BUS：双侧颈内动脉斑块，左侧颈总动脉斑块。CT:脑内多发腔梗,The Affiliated Hospital of Inner Mongolia Medical College,The Affiliated Hospital of Inner Mongolia Medical College,The Affiliated Hospital of Inner Mongolia Medical College,The Affiliated

14、Hospital of Inner Mongolia Medical College,M 62yrs L-ICA-S、R-ECA-S,The Affiliated Hospital of Inner Mongolia Medical College,The Affiliated Hospital of Inner Mongolia Medical College,The Affiliated Hospital of Inner Mongolia Medical College,The Affiliated Hospital of Inner Mongolia Medical College,M

15、 63yrs PE+DVT,Clinical Data:左下肢肿胀半月，胸疼、咳嗽10天。彩超：左股总至股浅静脉上段见中等回声物填充，其内见少量血流信号。曾2006年12月9日住院，最终手术切除左腹股沟淋巴结（转移性低分化粘液表皮样癌）。,The Affiliated Hospital of Inner Mongolia Medical College,M 63yrs PE+DVT,优维显（300mgI/ml）80ml（速率4ml/s）自动触发,The Affiliated Hospital of Inner Mongolia Medical College,The Affiliated Ho

16、spital of Inner Mongolia Medical College,The Affiliated Hospital of Inner Mongolia Medical College,The Affiliated Hospital of Inner Mongolia Medical College,M 64yrs AA+T,Clinical Data:中腹部搏动性包块2月。无明显诱因中腹部偏右侧可触及包块，有搏动。无高血压、糖尿病史。人工血管置换术。,The Affiliated Hospital of Inner Mongolia Medical College,M 64yrs

17、 AA+T,The Affiliated Hospital of Inner Mongolia Medical College,The Affiliated Hospital of Inner Mongolia Medical College,VR,The Affiliated Hospital of Inner Mongolia Medical College,MIP,The Affiliated Hospital of Inner Mongolia Medical College,F 69yrs AD-Type I,Clinical Data:间断性头晕20年，发作性胸痛2年，加重3小时。

18、血压：160/100mmHg。,The Affiliated Hospital of Inner Mongolia Medical College,F 69yrs AD-Type I,The Affiliated Hospital of Inner Mongolia Medical College,The Affiliated Hospital of Inner Mongolia Medical College,The Affiliated Hospital of Inner Mongolia Medical College,The Affiliated Hospital of Inner M

19、ongolia Medical College,The Affiliated Hospital of Inner Mongolia Medical College,VR,The Affiliated Hospital of Inner Mongolia Medical College,CTVE,The Affiliated Hospital of Inner Mongolia Medical College,CTVE,The Affiliated Hospital of Inner Mongolia Medical College,CTVE,The Affiliated Hospital of

20、 Inner Mongolia Medical College,Clinical Data:反复头痛3年。血压210/120mmHg，上腹部闻及3/8级收缩期杂音。双下肢水肿。,M 37yrs RAS,The Affiliated Hospital of Inner Mongolia Medical College,M 37yrs RAS,The Affiliated Hospital of Inner Mongolia Medical College,RAS,The Affiliated Hospital of Inner Mongolia Medical College,F 70yrs L

21、E-A,The Affiliated Hospital of Inner Mongolia Medical College,M 79yrs LEA-O,Clinical Data:2月前无明显诱因出现左下肢行走乏力，发困，休息时略好转。近2月患者上述症状频发，并渐加重，半月前患者左下肢远端麻木，肢体发凉。彩超：动脉粥样硬化闭塞。查体：双侧足背动脉无搏动，左足发凉，皮温低。,The Affiliated Hospital of Inner Mongolia Medical College,M 79yrs LEA-O,The Affiliated Hospital of Inner Mongoli

22、a Medical College,The Affiliated Hospital of Inner Mongolia Medical College,The Affiliated Hospital of Inner Mongolia Medical College,M 60yrs Takayasus arteritis:history 2-year、,Clinical Data:4年前无明显诱因出现左侧肢体活动不灵。双下肢肿胀疼痛1周。双下肢麻木。1周前因长时间行走出现右足红肿胀痛，渐加重，伴行走困难（感染）。足背动脉搏动消失。血压180/110mmHg。BUS:左上肢及双下肢深动脉血流充盈

23、减少，双下肢动脉与腹主动脉壁增厚。腹主动脉MRI示未见异常。DSA（2948）：右髂总动脉狭窄，球囊扩张后支架植入，左股动脉人工血管搭桥术。,The Affiliated Hospital of Inner Mongolia Medical College,M 60yrs Takayasus arteritis:history 2-year、,The Affiliated Hospital of Inner Mongolia Medical College,The Affiliated Hospital of Inner Mongolia Medical College,祝本次大会圆满成功！,THANKS,The Affiliated Hospital of Inner Mongolia Medical College,CTVE,