CN111568459B - Method for determining CT pulmonary artery imaging scanning delay time - Google Patents
Method for determining CT pulmonary artery imaging scanning delay time Download PDFInfo
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- CN111568459B CN111568459B CN202010494382.3A CN202010494382A CN111568459B CN 111568459 B CN111568459 B CN 111568459B CN 202010494382 A CN202010494382 A CN 202010494382A CN 111568459 B CN111568459 B CN 111568459B
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- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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- A61B6/00—Apparatus for radiation diagnosis, e.g. combined with radiation therapy equipment
- A61B6/02—Devices for diagnosis sequentially in different planes; Stereoscopic radiation diagnosis
- A61B6/03—Computerised tomographs
- A61B6/032—Transmission computed tomography [CT]
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B6/00—Apparatus for radiation diagnosis, e.g. combined with radiation therapy equipment
- A61B6/48—Diagnostic techniques
- A61B6/481—Diagnostic techniques involving the use of contrast agents
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B6/00—Apparatus for radiation diagnosis, e.g. combined with radiation therapy equipment
- A61B6/50—Clinical applications
- A61B6/504—Clinical applications involving diagnosis of blood vessels, e.g. by angiography
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- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B6/00—Apparatus for radiation diagnosis, e.g. combined with radiation therapy equipment
- A61B6/52—Devices using data or image processing specially adapted for radiation diagnosis
- A61B6/5258—Devices using data or image processing specially adapted for radiation diagnosis involving detection or reduction of artifacts or noise
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- G06T11/00—2D [Two Dimensional] image generation
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- G06T11/005—Specific pre-processing for tomographic reconstruction, e.g. calibration, source positioning, rebinning, scatter correction, retrospective gating
Abstract
The invention discloses a CT pulmonary arteryA method for determining the delay time of pulse imaging scan features that when the contrast agent test method is used in scan, the quasi-circular ROI with relative size is simultaneously arranged in the trunk of pulmonary artery and the pulmonary vein in same layer to obtain the hyperbola of intensified time density of pulmonary artery-vein, and the time of the cross point of hyperbola is used as TCROSSWith scan duration as TSDThrough TCROSS‑TSDCalculating the scan delay time T from the differenceDELAY. The scanning delay time calculated by the method of the invention is adopted, and the exposure scanning can obtain a high-quality pulmonary artery strengthening image.
Description
Technical Field
The invention belongs to the technical field of CT blood vessel imaging, and particularly relates to a method for determining CT pulmonary artery imaging scanning delay time.
Background
Pulmonary Embolism (PE) is a generic term for a group of diseases or clinical syndromes in which various emboli block a pulmonary artery or its branches as their pathogenesis, including Pulmonary Thromboembolism (PTE), fatty embolism syndrome, amniotic fluid embolism, air embolism, and the like. PTE is the most common type of PE, accounting for the vast majority of PE, while the vast majority of PTE is Acute Pulmonary Embolism (APE). The clinical characteristics of the traditional Chinese medicine are that the pulmonary circulation and the respiratory dysfunction are taken as main clinical and pathophysiological characteristics, and the traditional Chinese medicine is the most common cause of clinical acute pulmonary heart disease. APE is a life-threatening disease, the third most common acute cardiovascular disease after myocardial infarction and stroke. The lethality and disability rate of PTE are high. Recent international registration studies have shown that 7-day all-cause mortality is 1.9% -2.9%, and 30-day all-cause mortality is 4.9% -6.6%. PTE is considered to be a rare disease in China, the number of diagnosis cases of PTE in China is rapidly increased in recent 10 years through related clinical epidemiological investigation, and the number of PE cases diagnosed by most hospitals is increased by 10-30 times compared with 10 years ago. Statistics from 60 domestic major hospitals showed that the proportion of PTE in hospitalised patients rose from 0.26% o in 1997 to 1.45% o in 2008.
CT blood vessel imaging means that iodine contrast agent is injected rapidly from veins of a detected person, when the concentration of the contrast agent in a target organ reaches the highest peak through blood circulation of a human body, spiral CT volume scanning is performed, and a three-dimensional image of a blood vessel is reconstructed through post-processing of a workstation. CT pulmonary artery imaging (CTPA) can visually display thrombus form, position and vascular blockage degree in pulmonary artery, has higher sensitivity and specificity to PTE diagnosis, is noninvasive and convenient, and is the first choice inspection method for confirmed PTE at present. It is directly characterized by a filling defect in the pulmonary artery, partially or completely enclosed between opaque blood flows (orbital features), or a completely filled defect, with no visualization of the distal blood vessels; indirect signs include a wedge-shaped lung field, a strip-like increased density of shadows or discoid atelectasis, an expanded central pulmonary artery and a reduction or disappearance of distal vessel branches. CTPA can simultaneously display lung and other chest diseases outside the lung, and has important diagnosis and differential diagnosis values.
The scanning time is a decisive variable for realizing good uniform strengthening of CT blood vessel imaging. Determining the optimal scan delay time to produce adequate vessel enhancement is a challenging task, and modern CT scans are faster and faster, and due to the influence of the iodine k-edge and patient specific parameters, low kilovoltage scans require only small amounts of contrast agent and are therefore more widely used. Therefore, there is an increasing risk of missing arterial peak intensification in CT vessel imaging. The contrast agent tracking technique (BT) and the contrast agent testing Technique (TB) are two of the most widely used CT angiography techniques in the clinic. The main advantages of BT technology with fixed trigger delay time compared to TB technology are the need for less contrast agent, less radiation dose and time efficiency. Although BT technology has been used for decades, it still has drawbacks. One of its main disadvantages is that the fixed trigger delay time after reaching the threshold value does not take into account patient specific cardiovascular parameters, such as cardiac output or blood circulation time. For example, in patients with high cardiac output, a fixed and pre-set trigger delay time may result in missing arterial enhancement peaks, as the scan start may be too late. In contrast, for patients with low cardiac output, the scan may start too early, terminating the image acquisition before the arterial enhancement peak is reached.
The high-quality CTPA imaging should achieve obvious pulmonary artery strengthening, unobvious pulmonary vein strengthening and no strengthening in the aorta. And use as little iodine contrast as possible, ideally with as little iodine contrast remaining in the superior vena cava (which may lead to radiation hardening beam artifacts, affecting the viewing of pulmonary artery branches). At the same time, the radiation dose should be minimized and the scan acquisition time should be as short as possible to mitigate motion artifacts while maintaining an acceptable image noise level.
Disclosure of Invention
Aiming at the problems of uneven image quality level and common vein pollution in the current CT pulmonary artery blood vessel imaging, the invention aims to obtain the optimal scanning delay time by the TB technology, reduce the pollution of iodine contrast agent in pulmonary veins and avoid the concentration of the iodine contrast agent in superior vena cava, thereby improving the image quality and reducing the dosage of the iodine contrast agent of a patient.
In order to achieve the purpose, the technical scheme adopted by the invention is as follows:
a method for determining the delay time of CT pulmonary artery imaging scan features that when the contrast agent test method is used in scan, the quasi-circular ROIs with relative sizes are simultaneously arranged in the trunk of pulmonary artery and pulmonary vein in same layer at the monitoring stage to obtain the hyperbola of intensified time density of pulmonary artery and vein, and the time of cross point of hyperbola is used as TCROSSWith scan duration as TSDThrough TCROSS-TSDCalculates the optimal scan delay time TDELAY。
Specifically, the method for determining the CT pulmonary artery imaging scan delay time includes the following steps:
(1) and (3) finishing the positioning image by scanning: the patient lies on the scanning bed, the upper limbs are placed on the two sides of the head, the patient is subjected to breathing training, breath is easily held under quiet breathing, and the scanning range comprises the lung apex to the costal diaphragm angle;
(2) obtaining pulmonary artery-vein reinforcement time density hyperbola: placing the monitoring layer at a position 1cm below the bifurcation of the trachea according to the positioning image obtained in the step (1), easily holding breath under quiet breathing, injecting an iodine contrast agent, synchronously performing monitoring scanning, and stopping scanning after the ascending aorta is strengthened to obtain a group of circular strengthened images of the iodine contrast agent;
selecting one of the circulation strengthening images with obvious strengthening of the pulmonary veins, and simultaneously setting similar circular ROIs with corresponding sizes in the pulmonary artery trunk and the pulmonary veins at the same layer to obtain a pulmonary artery-vein strengthening time density hyperbola;
(3) calculating the delay time of pulmonary artery blood vessel imaging scanning: obtaining the hyperbolic curve intersection point time T according to the pulmonary artery-vein strengthening time density hyperbolic curve in the step (2)CROSS(ii) a Meanwhile, according to the positioning image obtained in the step (1), the scanning duration T is obtained after the scanning direction and the scanning range of the pulmonary artery imaging are determinedSD(ii) a Finally, pass TCROSS-TSDCalculates the optimal scan delay time TDELAY。
Preferably, in step (1), the scanning conditions are tube voltage 80-120kVp, tube current 20mA, and window width/level set at 500/50 HU.
In the step (2), a double-tube high-pressure injector is used for injecting the iodine contrast agent, one side of the tube is filled with the iodine contrast agent, the other side of the tube is filled with the normal saline, the iodine contrast agent is injected firstly, and then the normal saline is injected at the same flow rate. The dosage of the iodine contrast agent is 5-10ml, the dosage of the physiological saline is 40-45ml, and the injection flow rate is 4.0-5.0 ml/s.
In the step (2), the monitoring scanning mode is axial scanning, the rotating speed of the frame is 1.0s/r, the tube voltage is 80-120kVp, the tube current is 40mA, the layer thickness is 5mm, the reconstruction type is a standard mode, the window width/window level is set to be 350/50HU, and the reconstruction algorithm is iterative reconstruction.
In the step (2), the test scanning is set to be 15-30 times, and the scanning is performed once every 1-2 seconds.
Specifically, in the step (2), the pulmonary artery-vein strengthening time density hyperbola is obtained by simultaneously placing the ROI in the pulmonary artery and the pulmonary vein at the monitoring level.
In the step (3), the scanning direction and range of pulmonary artery imaging are from 2cm below the top of the diaphragm to 2cm above the aortic arch.
Has the advantages that:
the scanning delay time calculated by the method of the invention can be used for obtaining a high-quality pulmonary artery strengthening image by exposure scanning, so that the strengthened pulmonary artery can be accurately collected, the development accompanying the pulmonary vein is reduced, the using amount of an iodine contrast agent can be reduced, the iodine load of a patient is reduced, and the ray hardening beam artifact caused by the concentration of the iodine contrast agent in the subclavian vein and the superior vena cava on the injection side is avoided.
Drawings
The foregoing and/or other advantages of the invention will become further apparent from the following detailed description of the invention when taken in conjunction with the accompanying drawings.
Fig. 1 is a preparation before TB technique test scan, a is a scout image of the subject, B is the set test slice and scan range.
FIG. 2 is a process of obtaining a hyperbola of pulmonary artery-vein reinforcement time density, where A is a frame of the selected test chart set showing pulmonary vein reinforcement, and B is a similar circle ROI with a corresponding size set in the pulmonary artery trunk and the pulmonary vein of the same layer.
FIG. 3 is a hyperbola of time density of pulmonary artery-vein augmentation obtained.
FIG. 4 is a graph of hyperbolic intersection time T derived with reference to coordinatesCROSS。
FIG. 5 is a diagram of a CT pulmonary artery vessel image of good quality obtained using a resulting scan delay time exposure scan.
Detailed Description
The invention will be better understood from the following examples.
The structures, proportions, and dimensions shown in the drawings and described in the specification are for understanding and reading the present disclosure, and are not intended to limit the scope of the present disclosure, which is defined in the claims, and are not essential to the skilled in the art. In addition, the terms "upper", "lower", "front", "rear" and "middle" used in the present specification are for clarity of description, and are not intended to limit the scope of the present invention, and the relative relationship between the terms and the relative positions may be changed or adjusted without substantial technical changes.
The following is a specific example of determining the CT pulmonary artery imaging scan delay time.
(1) And (3) finishing the positioning image by scanning: the patient lies on the scanning bed, the feet are advanced, the upper limbs are placed on the two sides of the head, the following examination procedures are introduced to the patient, effective communication is achieved, the patient is prevented from being tensed, the patient is subjected to breathing training, breath is easily held under quiet breathing, the scanning range comprises the lung tip to the rib diaphragm angle (shown in figure 1), the scanning condition is tube voltage of 80kVp, tube current of 20mA, and the window width/window position is set to be 500/50 HU.
(2) Obtaining pulmonary artery-vein reinforcement time density hyperbola: according to the positioning image obtained in the step (1), a monitoring layer is placed at a position 1cm below a tracheal bifurcation (a pulmonary artery trunk layer), breath is easily suppressed under quiet breathing, 5ml of iodine contrast agent +45ml of normal saline is injected, the flow rate is 5.0ml/s, the monitoring scanning mode is axial scanning, the rotating speed of a frame is 1.0s/r, the tube voltage is 80kVp, the tube current is 40mA, the layer thickness is 5mm, the reconstruction type is a standard mode, the window width/window position is set to be 350/50HU, the reconstruction algorithm is iterative reconstruction, the injection of the iodine contrast agent and the monitoring scanning are synchronously performed, the monitoring scanning is preset for 15 times, the scanning is performed once every 2 seconds, the scanning is stopped after the ascending aorta is strengthened, and a group of circular strengthened images of the iodine contrast agent is obtained. Selecting one of the circulation strengthening images with obvious pulmonary vein strengthening, and simultaneously setting a similar-circle ROI (shown in figure 2) with corresponding size in the pulmonary artery trunk and the pulmonary vein at the same layer to obtain a pulmonary artery-vein strengthening time density hyperbola (shown in figure 3).
(3) Calculating the delay time of pulmonary artery blood vessel imaging scanning: obtaining the hyperbolic curve intersection point time T according to the pulmonary artery-vein strengthening time density hyperbolic curve in the step (2)CROSS9 seconds; meanwhile, according to the positioning image obtained in the step (1), determining that the scanning direction and range of the pulmonary artery imaging are from 2cm below the top of the diaphragm to 2cm above the aortic arch, and obtaining the scanning duration TSD1.9 seconds; finally, pass TCROSS-TSDCalculates the optimal scan delay time TDELAYIt was 7.1 seconds.
(4) The scanning delay time calculated by the method is 7.1 seconds, and the excellent pulmonary artery blood vessel imaging can be obtained by exposure scanning, as shown in fig. 5.
The dosage of the iodine contrast agent in the conventional pulmonary artery blood vessel imaging technology is more than 25ml, and the BMI of a patient is less than 28kg/m by the method of the invention2When the body weight is less than 80kg, only 15ml is needed to complete the examination. 5ml of iodine contrast +45ml of saline was used during the monitoring phase, and 10ml of iodine contrast +40ml of saline was used for the final CTPA scan.
The present invention provides a method and a system for determining a CT pulmonary artery imaging scan delay time, and a method and a system for implementing the method and the system are many, and the above description is only a preferred embodiment of the present invention, and it should be noted that, for those skilled in the art, a plurality of modifications and embellishments can be made without departing from the principle of the present invention, and these modifications and embellishments should also be regarded as the protection scope of the present invention. All the components not specified in the present embodiment can be realized by the prior art.
Claims (7)
1. A method for determining the delay time of CT pulmonary artery imaging scan is characterized in that when a contrast agent test method is adopted in the scan, circular-like ROIs with corresponding sizes are simultaneously set in the pulmonary artery trunk and the pulmonary vein at the same layer in the test stage to obtain a pulmonary artery-vein intensified time density hyperbola, and the time of the intersection of the hyperbola is taken as TCROSSWith scan duration as TSDThrough TCROSS-TSDCalculating the scan delay time T from the differenceDELAY；
The method comprises the following specific steps:
(1) and (3) finishing the positioning image by scanning: the patient lies on the scanning bed, the upper limbs are placed on the two sides of the head, the patient is subjected to breathing training, breath is easily held under quiet breathing, and the scanning range comprises the lung apex to the costal diaphragm angle;
(2) obtaining pulmonary artery-vein reinforcement time density hyperbola: placing the monitoring layer at a position 1cm below the bifurcation of the trachea according to the positioning image obtained in the step (1), easily holding breath under quiet breathing, injecting an iodine contrast agent, synchronously performing monitoring scanning, and stopping scanning after the ascending aorta is strengthened to obtain a group of circular strengthened images of the iodine contrast agent;
selecting one of the circulation strengthening images with obvious strengthening of the pulmonary veins, and simultaneously setting similar circular ROIs with corresponding sizes in the pulmonary artery trunk and the pulmonary veins at the same layer to obtain a pulmonary artery-vein strengthening time density hyperbola;
(3) calculating the delay time of pulmonary artery blood vessel imaging scanning: obtaining the hyperbolic curve intersection point time T according to the pulmonary artery-vein strengthening time density hyperbolic curve in the step (2)CROSS(ii) a Meanwhile, according to the positioning image obtained in the step (1), the scanning duration T is obtained after the scanning direction and the scanning range of the pulmonary artery imaging are determinedSD(ii) a Finally, pass TCROSS-TSDCalculates the optimal scan delay time TDELAY。
2. The method for determining the delay time in CT pulmonary artery imaging scan according to claim 1, wherein in step (1), the scan conditions are 80-120kVp tube voltage, 20mA tube current, 500 HU window width and 50HU window level.
3. The method for determining the delay time in CT pulmonary artery imaging scan according to claim 1, wherein in step (2), the iodine contrast agent is injected by using a double-tube high-pressure syringe, the dosage of the iodine contrast agent is 5-10ml, the physiological saline is 40-45ml, and the injection flow rate is 4.0-5.0 ml/s.
4. The method for determining the delay time of CT pulmonary artery imaging scan according to claim 1, wherein in step (2), the monitoring scan mode is axial scan, the gantry rotation speed is 1.0s/r, the tube voltage is 80-120kVp, the tube current is 40mA, the layer thickness is 5mm, the reconstruction type is standard mode, the window width is set to 350 HU, the window level is set to 50HU, and the reconstruction algorithm is iterative reconstruction.
5. The method for determining the delay time of CT pulmonary artery imaging scan according to claim 1, wherein in step (2), the monitoring scan is set to 15-30 times, and is scanned every 1-2 seconds.
6. The method for determining the delay time of CT pulmonary artery imaging scan according to claim 1, wherein in step (2), the pulmonary artery-vein intensification time density hyperbola is obtained by simultaneously placing the ROI in the pulmonary artery and the pulmonary vein at the monitoring level.
7. The method for determining the delay time of the CT pulmonary artery imaging scan according to claim 1, wherein in the step (3), the scanning direction and range of the pulmonary artery imaging scan are from 2cm below the top of the diaphragm to 2cm above the aortic arch.
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