CN111789627B - Head and neck angiography method - Google Patents
Head and neck angiography method Download PDFInfo
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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
- A61B6/02—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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- 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
- A61B6/54—Control of apparatus or devices for radiation diagnosis
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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
- A61B6/54—Control of apparatus or devices for radiation diagnosis
- A61B6/542—Control of apparatus or devices for radiation diagnosis involving control of exposure
Abstract
The application relates to the field of medical imaging, in particular to a head and neck angiography method, which comprises the following steps: 1) Obtaining basic data of a subject, including gender, age, heart rate, systolic pressure and diastolic pressure; 2) Substituting the obtained basic data of the checked person into a PT time calculation formula; 3) Determining a scanning/exposure time T through a defined scanning range; 4) Obtaining total injection time according to PT time and exposure time T; selecting the injection rate of the contrast agent to be 3.0-5.0ml/s, and calculating the total injection amount and the total contrast agent amount; 5) Setting the delay time as PT time on the CT scanner, starting an exposure key of the CT scanner and a contrast agent injector simultaneously, injecting the total amount of contrast agent, then continuously injecting normal saline and injecting the total amount, and completing the exposure of the CT scanner to obtain an inspection image. The application is used for improving the imaging effect of blood vessels, and the dosage of the contrast agent is personalized to reduce the radiation dosage and reduce the radiation injury of contrast to patients and the probability of anaphylactic reaction.
Description
Technical Field
The application relates to the field of angiography methods of medical imaging technology, in particular to a angiography method applied to a head and neck vascular examination process.
Background
Cerebrovascular diseases are clinical common nervous system diseases, the incidence rate is gradually increased in recent years, and the death rate is higher, and 50% -70% of patients in the survivors of the cerebrovascular diseases have sequelae, so that social and family burdens are increased. In the prior art, head and neck combined CT angiography (Computed Tomography Angiography, CTA) can clearly display the blood vessel images of the common carotid artery, the internal carotid artery, the external carotid artery, the vertebral artery, the basilar artery and the Willis ring, and can judge the relevant responsible blood vessel conditions in the event, so the CTA has been widely applied to diagnosis of head and neck vascular lesions. In the CTA imaging process, in order to make the head and neck blood vessel image reach the diagnostic requirement, the contrast agent (contrast agent) must be required to start scanning when the concentration of the contrast agent in the head and neck blood vessel (target blood vessel or target blood vessel) reaches the peak value, so as to complete imaging. Therefore, in order to determine the peak time of the contrast agent in the head and neck blood vessel (target blood vessel or target blood vessel) is particularly important, and is also a key point and difficulty of head and neck CTA examination, the method for determining the peak time/delay time of the head and neck CTA contrast agent in the medical field currently includes: the empirical value method, CTP-CTA combination method, test-Bolus method and intelligent tracking method are 4, but all the four methods have some defects.
Empirical value method: the method determines the peak reaching/delay time of the contrast agent in the blood vessel of the head and neck, which is mainly based on the delay time (18-25 s) disclosed by the existing medical data, but the delay time cannot be accurately determined because of the large difference of the peak reaching time of the contrast agent in individuals due to the differences of age, height, heart rate and the like of the individuals. Therefore, if the method is adopted in the process of head and neck radiography, the contrast agent is easy to scan when not in peak value, so that the scanning fails, and the image quality can not meet the clinical diagnosis requirement; the method also cannot accurately determine the amount of contrast agent, and cannot control the patient to be allergic to excessive contrast agent, so that the safety of the examination is unstable.
CTP-CTA binding method: this method requires that the peak/delay time of the contrast agent within the target vessel be determined by one perfusion scan prior to angiography. Although the method can accurately scan at the time point when the contrast agent reaches the peak value, the method needs to increase one more scanning and one more injection of the contrast agent, and the injection scanning needs to be performed with extremely short interval for multiple exposure, thereby greatly increasing the radiation risk of angiography and the anaphylactic risk of the contrast agent.
The Test-Bolus method is to take small dosage of Bolus contrast agent first and then determine the delay time of the contrast agent reaching peak value in blood vessel. In addition, this method requires an additional monitoring scan and an additional amount of contrast agent, resulting in an increased radiation dose and an increased contrast agent dose for the examination, increasing the incidence of radiation hazards and adverse contrast agent allergic reactions.
Tracking method (intelligent tracking contrast method): the method sets a threshold value at the position of the target blood vessel, starts scanning when the monitoring threshold value of the target blood vessel exceeds the set threshold value, and scans when the concentration of the contrast agent is not the highest. Disadvantages: in this inspection method, although the final image can meet the diagnostic requirement, the radiation dose is greatly increased, and the dosage of the contrast agent cannot be accurately controlled and personalized to the contrast agent.
In combination with the four existing delay time determining methods, the empirical value method is easy to cause that the contrast image cannot meet the clinical diagnosis requirement, and other three methods are required to increase the scanning times in order to ensure that the contrast image meets the diagnosis standard, so that the radiation dose for realizing the examination is increased, and potential harm is easily caused to the health of a detected person; in addition, the amount of contrast agent used in the four methods cannot realize personalized administration, and as the contrast agent used in head-neck radiography is generally water-soluble organic iodine contrast agent, the risk of anaphylactic reaction exists, and once anaphylactic reaction occurs, serious people can endanger the life of the tested person. In the current clinical examination, a large-dose and high-concentration contrast agent is generally used to ensure that the image reaches the diagnostic standard; at the same time, reducing the dosage of contrast agent and reducing the radiation dose of the subject is also a hot spot in clinical research. Therefore, the use of large doses and high concentrations of contrast agent can lead to a significant increase in contrast agent allergic response rate, as well as increased cost of imaging, and increased cost of hospitalization.
Disclosure of Invention
Aiming at the defects in the prior art, the application provides a head and neck angiography method, which simplifies the steps of head and neck angiography, is used for improving the imaging effect of blood vessels, reducing the dosage of contrast agent, realizing personalized use of the contrast agent, reducing the radiation dosage, reducing the harm of angiography to the body of a detected person and reducing the probability of anaphylactic reaction of the detected person in the angiography process.
In order to achieve the above object, the present application provides a head and neck angiography method comprising the steps of:
1) Basic data are acquired: obtaining basic data of a subject, the basic data comprising: gender, age, heart rate, systolic and diastolic pressure; wherein male=1, female=0, and the unit of heart rate is: the units of systolic and diastolic blood pressure are: mmHg;
2) Calculating the peak time PT: and (3) superposing the basic data acquired in the step (1) into a PT time calculation formula: pt=22.860+0.055 x age+1.591 x gender-0.080 x hr-0.029 x sbp+0.04dbp; PT time units are: second, wherein the second is;
3) Determining a scan/exposure time T: defining a scanning range according to the examination purpose of the examinee, and determining a scanning/exposure time T through the defined scanning range;
4) Calculating the total amount of the contrast agent: calculating the delay peak time PT according to the step 2), and determining the scanning/exposure time T according to the step 3); the injection rate of the contrast agent is 3.0-5.0ml/s, the total injection time is obtained according to the peak reaching time PT plus the scanning/exposure time T, the total injection amount is calculated according to the injection rate and the total injection time, and the total contrast agent amount = total injection amount-normal saline and total injection amount are calculated to obtain the total contrast agent amount;
5) Angiography is completed: setting the scanning delay time to be the value of the peak reaching time PT calculated in the step 2) on a CT scanner, starting an exposure key of the CT scanner and a contrast agent injector simultaneously, injecting the total amount of the contrast agent obtained in the step 4), then continuously injecting normal saline at the same flow rate with the total amount of injection, and completing the exposure of the CT scanner to obtain an inspection image.
According to the application, the agreement of the previous head and neck vascular testees is firstly characterized, head and neck radiography information of a plurality of patients is collected according to different age groups and different height ranges, wherein, the male and female half of the patients collecting the information find out the influence factors of the peak time of the contrast agent in the target blood vessel through a multiple regression method, and a PT time calculation formula is obtained through modeling and multiple correction. The application can calculate the time PT of the contrast agent reaching the peak value in the target blood vessel according to the obtained PT time calculation formula and based on the sex, age, heart rate, systolic pressure, diastolic pressure and other basic data of the detected person, then determine the scanning time T according to the scanning range, and then determine the total injection time, thus the dosage of the contrast agent and the time for starting scanning can be calculated individually for each detected person, then the delay time of the CT scanner is set according to the calculated dosage of the contrast agent, and the patient is scanned and injected once only under the condition of contrast agent, so that the operation flow of head and neck angiography is more efficient and simple, the contrast agent in the target blood vessel is ensured to be scanned at the peak value, the condition of no contrast failure is ensured, the strengthening effect of the image is ensured to be better, the radiation dosage and the dosage of the contrast agent are strictly controlled, and the anaphylactic reaction rate and the radiation injury of the detected person can be reduced.
The application preferably provides for the injection rate of the contrast agent in step 4) to be 3.5-4.5ml/s. The contrast agent injection rate selected in the application can ensure that the contrast agent can reach the peak value in the target blood vessel quickly while not causing great burden to the heart of a person to be detected during the contrast agent injection, can ensure that the peak value of the contrast agent is maintained for a long time, and ensures that the content of the contrast agent in the target blood vessel is in the peak value state in the whole scanning time, so that the contrast image obtained by the application has better strengthening effect than the image obtained by the existing contrast technology, thereby improving the accuracy of diagnosing the vascular diseases of the head and neck.
Preferably, the total amount of the physiological saline is 30-50ml. According to the characteristics of the blood vessel through which the contrast agent needs to flow and the blood vessel of the head and neck, the total injection amount obtained by calculation is selected, 30-50ml of physiological saline is continuously injected after the contrast agent is injected, the distribution of the contrast agent in the blood vessel can be reduced, the geometric curve of the bolus is improved, the harness hardening artifact caused by the contrast agent in the brachiocephalic vein and the superior vena cava is reduced, the interference factor of contrast is reduced, and the strengthening effect of the contrast image is better. And under the condition that the contrast agent in a target blood vessel reaches the requirement of continuously reaching a peak value in contrast, the dosage of the contrast agent is greatly reduced, the probability of anaphylactic reaction after the contrast is reduced, in addition, the physiological saline can play a role in hydration, reduce the nephrotoxicity of the contrast agent, and prevent the high-viscosity contrast agent from blocking a contrast passage.
Preferably, the contrast agent injector is a high pressure injector. The high-pressure injector is selected to ensure that the contrast agent can reach the target blood vessel in a concentrated manner quickly after being injected, so that the concentration of the contrast agent in the blood vessel reaches a stable peak value as soon as possible, and the strengthening effect of a contrast image is ensured; in addition, the high-pressure injector can be matched with a CT scanner more accurately, and scanning radiography operation is simpler and more convenient.
Preferably, the saline injection rate is the same as the contrast agent injection rate. The physiological saline is injected at the same injection rate, so that the bolus geometrical curve of the contrast agent is not influenced, the follow-up injection of the physiological saline can push the contrast agent injected subsequently after the contrast agent reaches a peak value in a target blood vessel, the use ratio of the contrast agent is improved, the contrast agent can continuously enter the target blood vessel, the content of the contrast agent in the target blood vessel can be ensured to last for 4-10s in a peak value state, and the sufficient scanning time is ensured.
Compared with the prior art, the application has the beneficial effects that:
(1) Compared with the existing four methods, the method can calculate the personalized delay time of each detected person and the personalized contrast agent dosage required by radiography according to the basic data of different detected persons, can realize head and neck angiography by injecting contrast agent once and exposing once to a patient, and does not need to perform the operations of injecting contrast agent once and scanning once to determine the delay time before formal radiography scanning.
(2) According to the application, the delay time and the contrast agent dosage can be calculated aiming at basic data of different patients, the contrast agent dosage of each patient can be accurately determined according to individual differences, instead of injecting the contrast agent according to experience or injecting excessive contrast agent for completing contrast, the application enables the contrast agent dosage to be minimum as much as possible under the condition of meeting the contrast requirement; can effectively prevent the occurrence probability of anaphylactic reaction of the testees with different physiques.
(3) Compared with the prior art, the application greatly reduces the radiation dose of head and neck angiography and reduces the radiation injury to patients by only carrying out one exposure scanning.
(4) According to the application, the delay time of the contrast agent and the dosage of the contrast agent are determined individually, so that the CT scanner and the high-pressure injector are more closely matched, the contrast agent content in blood vessels is in a peak state in the scanning process, the condition of failure in contrast cannot occur, the enhancement effect of a contrast image is in an optimal state, and the diagnosis of head and neck vascular diseases can be more accurate.
(5) According to the application, the distribution of contrast agent in blood vessels can be reduced by injecting physiological saline, the bolus geometric curve is improved, and harness hardening artifact caused by contrast agent in the brachiocephalic vein and the superior vena cava is reduced, so that the interference factor of contrast is reduced, and the strengthening effect of a contrast image is further improved. The contrast agent is injected with the normal saline, so that the dosage of the contrast agent is greatly reduced, the probability of anaphylactic reaction after the contrast is reduced, and the cost of angiography is also reduced under the condition that the contrast agent in a target blood vessel reaches the requirement of continuously reaching a peak value in the contrast; in addition, the physiological saline can play a role in hydration, reduce the nephrotoxicity of the contrast agent, and prevent the high-viscosity contrast agent from blocking the contrast passage.
Drawings
In order to more clearly illustrate the embodiments of the present application or the technical solutions in the prior art, the drawings used in the description of the embodiments or the prior art will be briefly described below. Like elements or portions are generally identified by like reference numerals throughout the several figures. In the drawings, elements or portions thereof are not necessarily drawn to scale.
FIG. 1 is a flow chart of a head and neck angiography method of the application;
FIG. 2 is an orthotopic VR image of neck angiography obtained in example 1 of the head and neck angiography method of the application;
FIG. 3 is a lateral VR image of another aspect of a cervical angiography obtained in example 1 of the head and neck angiography method of the application;
FIG. 4 is an orthotopic MIP image of a cervical angiography obtained in example 1 of the head and neck angiography method of the application;
FIG. 5 is a top view wills ring MIP image of a transverse location of a head angiography obtained in example 1 of a head angiography method of the application;
FIG. 6 is a top view Wills loop VR image of a transverse location of a head angiography obtained in example 1 of a head angiography method of the application;
FIG. 7 is an orthotopic VR image of a cervical angiography obtained in example 2 of a head and neck angiography method of the application;
FIG. 8 is an orthotopic MIP image of a cervical angiography obtained in example 2 of the head and neck angiography method of the application;
FIG. 9 is a cross-sectional view of a wills loop looking down MIP image of a head angiography obtained in example 2 of a head angiography method of the application;
FIG. 10 is an orthotopic VR image of neck angiography obtained in example 3 of a head and neck angiography method of the application;
FIG. 11 is a transverse MIP image of a head angiography obtained in example 3 of the head angiography method of the application;
fig. 12 is a lateral MIP image of another aspect of a head angiography obtained in example 3 of the head angiography method of the application;
FIG. 13 is an orthotopic VR image of neck angiography obtained in example 4 of the head and neck angiography method of the application;
fig. 14 is a top-down MIP image of a head angiography obtained in method example 4 of head angiography of the application;
fig. 15 is a top view VR image of a head angiography obtained in example 4 of the head angiography method of the application.
Detailed Description
Embodiments of the technical scheme of the present application will be described in detail below with reference to the accompanying drawings. The following examples are only for more clearly illustrating the technical aspects of the present application, and thus are merely examples, and are not intended to limit the scope of the present application.
It is noted that unless otherwise indicated, technical or scientific terms used herein should be given the ordinary meaning as understood by one of ordinary skill in the art to which this application belongs.
Reference herein to "an embodiment" means that a particular feature, structure, or characteristic described in connection with the embodiment may be included in at least one embodiment of the application. The appearances of such phrases in various places in the specification are not necessarily all referring to the same embodiment, nor are separate or alternative embodiments mutually exclusive of other embodiments. Those of skill in the art will explicitly and implicitly appreciate that the embodiments described herein may be combined with other embodiments.
Example 1
Referring to fig. 1, 1) acquiring basic data: basic data of the subject 1 including sex is obtained: male, set male = 1, age 65 years, heart rate 79 times/min, systolic pressure 128mmHg and diastolic pressure 67mmHg;
2) Calculating the peak time PT: substituting the data of the subject acquired in the step 1) into the PT time calculation formula: pt=22.860+0.055×65+1.591×1-0.080×79-0.029×128+0.041×67; the calculated PT time was 20.741 seconds, with a one-decimal PT time of 20.7 seconds.
3) Determining a scan/exposure time T: defining a scanning range as a head and neck blood vessel according to the specific examination purpose of the examinee 1, and determining a scanning/exposure time to be 5.1 seconds through the defined scanning range;
4) Calculating the total amount of the contrast agent: the peak time PT was calculated to be 20.7 seconds according to step 2), and the scanning/exposure time was determined to be 5.1 seconds according to step 3); the injection rate of the contrast agent is 4ml/s, the total injection time is 25.8 seconds according to the peak reaching time PT of 20.7 seconds plus the scanning/exposure time T of 5.1 seconds, the total injection amount is 103.2ml according to the condition of the blood vessel of the tested person, the total injection amount = total injection amount-physiological saline and total injection amount, 40ml is taken from the physiological saline and total injection amount, and the total contrast agent amount is 63.2ml is calculated;
5) Angiography is completed: setting the scanning delay time to 20.7 seconds on a CT scanner, starting an exposure key of the CT scanner and a contrast agent injector simultaneously, pre-injecting 16ml of physiological saline according to the injection rate of 4ml/s to observe whether a contrast passage is unobstructed before formally checking injection, then starting to inject 63.2ml of the contrast agent obtained in the step 4), and then continuously injecting the physiological saline with 40ml of the contrast agent, wherein the injection rate of the physiological saline is the same as that of the contrast agent and is 4ml/s; after the automatic exposure is completed when the CT scanner reaches the delay time, the image is processed to obtain the images shown in figures 2, 3, 4, 5 and 6.
As can be seen from fig. 2, 3, 4, 5 and 6, the case of the examinee 1 is as follows: the left internal carotid artery siphoning part is provided with spot calcified spots, and the lumen is not provided with obvious stenosis; localized mixed plaque was seen at the bilateral common carotid bifurcation, with slight lumen stenosis (stenosis < 20%); the bilateral vertebral artery, middle cerebral artery, anterior cerebral artery, posterior cerebral artery and right internal carotid artery have good blood vessel development, natural running and uniform thickness, and the initial part and the branch pipe cavity have no stenosis or abnormal dilatation and no abnormal blood vessel display. The left posterior traffic artery is open. The plaque fills the sinus cavity in the maxillary sinus, ethmoid sinus, frontal sinus on the left side, and sphenoid sinus on the right side. The aortic arch and the beginning of the left subclavian artery are calcified, and the lumen is not obviously narrowed. Therefore, the image in example 1 can be imaged clearly, the image can completely meet the clinical medical diagnosis standard, and the head and neck blood vessel lesion can be diagnosed according to the image.
Example 2
Referring to fig. 1, 1) acquiring basic data: basic data of the examiner 2 including sex are obtained: male, set male = 1, age 60 years, heart rate 78 times/min, systolic pressure 135mmHg and diastolic pressure 78mmHg;
2) Calculating the peak time PT time: substituting the data of the checked person obtained in the step 1) into the PT time calculation formula: pt=22.860+0.055×60+1.591×1-0.080×78-0.029×135+0.041×78; the calculated PT time was 20.794 seconds, with a one-decimal PT time of 20.8 seconds.
3) Determining a scan/exposure time T: defining a scanning range as a head and neck blood vessel according to the specific examination purpose of the examinee 2, and determining a scanning/exposure time to be 5.1 seconds through the defined scanning range;
4) Calculating the total amount of the contrast agent: the peak time PT was calculated to be 20.8 seconds according to step 3), and the scanning/exposure time was determined to be 5.1 seconds according to step 4); selecting the injection rate of the contrast agent to be 3.5ml/s according to the vascular condition of the puncture point of the tested person, calculating the total injection amount to be 90.7ml according to the total injection time to be 25.9 seconds and the injection rate to be 3.5ml/s, wherein the peak time PT to be 20.8 seconds plus the scanning/exposure time T to be 5.1 seconds, and calculating the total injection amount to be 30ml of the contrast agent and the total injection amount to be 60.7ml;
6) Angiography is completed: setting the scanning delay time to 20.8 seconds on a CT scanner, starting an exposure key of the CT scanner and a contrast agent injector simultaneously, pre-injecting 16ml of physiological saline according to the injection rate of 3.5ml/s to observe whether a contrast passage is unobstructed before formally checking injection, then starting to inject 60.7ml of the contrast agent obtained in the step 5), and then continuously injecting 30ml of physiological saline with the injection amount, wherein the injection rate of the physiological saline is the same as that of the contrast agent and is 3.5ml/s; the image inspected by the automatic exposure completion when the CT scanner reaches the delay time is shown in fig. 7, 8 and 9.
From the images in fig. 7, 8 and 9, it can be seen that the case of the examinee 2 is as follows: aortic arch, bilateral carotid sinus, bilateral carotid siphon calcified plaque formation, luminal mild stenosis (stenosis < 50%); the left internal carotid artery traffic segment is locally slightly dilated; mixed plaque formation in the intracranial segment of the right vertebral artery, slight stenosis of the lumen (stenosis < 25%), tortuosity in the initial segment of the left vertebral artery and the intracranial segment of the bilateral vertebral artery. The anterior right cerebral artery A1 segment is not explicitly shown. The right embryo type brain runs naturally. The thickness is uniform, the initial part and the branch pipe cavity do not have stenosis and abnormal expansion, and abnormal blood vessels are not displayed. The left frontal scalp tuberosity has a diameter of about 6mm. Multiple nodular dense shadows appear under the scalp of the forehead and the temporal region on the right side. The right lobe and isthmus of the thyroid gland are not clearly shown, and the left lobe has a nodular relatively low strengthening effect and a diameter of about 7mm. Therefore, the image in example 2 can be clearly imaged, the image can completely reach the standard of clinical medical diagnosis of diseases, and the head and neck blood vessel can be diagnosed according to the image.
Example 3
Referring to fig. 1, 1) acquiring basic data: basic data of the examiner 3 including sex are obtained: male, set male = 1, age 77 years, heart rate 79 times/min, systolic pressure 138mmHg and diastolic pressure 90mmHg;
2) Calculating the peak time PT: substituting the data of the checked person obtained in the step 1) into the PT time calculation formula: pt=22.860+0.055×77+1.591×1-0.080×79-0.029×138+0.041×90; the calculated PT time was 22.054 seconds, with a one-decimal PT time of 22.1 seconds.
3) Determining a scan/exposure time T: defining a scanning range as a head and neck blood vessel according to the specific examination purpose of the examinee 3, and determining a scanning/exposure time to be 5.1 seconds through the defined scanning range;
4) Calculating the total amount of the contrast agent: the peak time PT was calculated to be 22.1 seconds according to step 2), and the scanning/exposure time was determined to be 5.1 seconds according to step 3); selecting the injection rate of the contrast agent to be 4ml/s according to the vascular condition of the puncture point of the tested person, calculating the total injection amount to be 108.8ml according to the total injection time to be 27.2 seconds obtained by adding the scanning/exposure time T to be 5.1 seconds to the peak reaching time PT to be 22.1 seconds and the injection rate to be 4ml/s, and calculating 45ml of the total injection amount to be 63.8ml of the total injection amount;
6) Angiography is completed: setting the scanning delay time to 22.1 seconds on a CT scanner, starting an exposure key of the CT scanner and a contrast agent injector simultaneously, pre-injecting 16ml of physiological saline according to the injection rate of 4ml/s to observe whether a contrast passage is unobstructed before formally checking injection, then starting to inject 63.8ml of the contrast agent obtained in the step 4), and then continuously injecting 45ml of physiological saline together with the contrast agent, wherein the injection rate of the physiological saline is the same as that of the contrast agent and is 4ml/s; the image inspected by the automatic exposure completion when the CT scanner reaches the delay time is shown in fig. 10, 11 and 12.
It can be seen from the images in fig. 10, 11 and 12 that the case of the examinee 3 is as follows: aortic arch, bilateral carotid siphon, bilateral vertebral intracranial segment calcified plaque formation, narrowest lumen medium-severe stenosis (stenosis degree > 70%); bilateral carotid sinus mixed plaque formation, lumen restenosis (stenosis < 50%). Bilateral anterior cerebral artery and middle cerebral artery are uneven in thickness. The basilar artery and the bilateral posterior cerebral arteries are uneven in thickness, and the P1 segment of the left posterior cerebral artery is locally and doubtfully expanded, and the diameter is about 3mm. The right soybean vein artery is rarer than the left one. The residual blood vessels are well developed, run naturally and have uniform thickness, the initial part and the branch pipe cavity do not have stenosis or abnormal expansion, and abnormal blood vessels are not displayed. Therefore, the image in example 3 can be clearly imaged, the image can completely meet the standard of clinical medical diagnosis of diseases, and the head and neck blood vessel can be diagnosed according to the image.
Example 4
Referring to fig. 1, 1) acquiring basic data: basic data of the person to be inspected 4 including sex are obtained: female, female=0, age 84 years old, heart rate 75 times/min, systolic pressure 133mmHg and diastolic pressure 75mmHg;
2) Calculating the peak time PT: substituting the data of the checked person obtained in the step 1) into the PT time calculation formula: pt=22.860+0.055×84+1.591×10-0.080×75-0.029×133+0.041×75; the calculated PT time was 20.698 seconds, with a one-decimal PT time of 20.7 seconds.
3) Determining a scan/exposure time T: defining a scanning range as a head and neck blood vessel according to the specific examination purpose of the examinee 4, and determining a scanning/exposure time to be 5.1 seconds through the defined scanning range;
4) Calculating the total amount of the contrast agent: the peak time PT was calculated to be 20.7 seconds according to step 2), and the scanning/exposure time was determined to be 5.1 seconds according to step 3); selecting the injection rate of the contrast agent to be 4.5ml/s according to the vascular condition of the puncture point of the tested person, calculating the total injection amount to be 116.1ml according to the total injection time to be 25.8 seconds and the injection rate to be 4.5ml/s, wherein the total injection amount = total injection amount-physiological saline and total injection amount, the physiological saline and total injection amount to be 50ml, and calculating the total contrast agent to be 66.1ml;
6) Angiography is completed: setting the scanning delay time to 20.7 seconds on a CT scanner, starting an exposure key of the CT scanner and a contrast agent injector simultaneously, pre-injecting 16ml of physiological saline according to the injection rate of 4.5ml/s to observe whether a contrast passage is smooth before formally checking injection, then starting to inject 66.1ml of the contrast agent obtained in the step 5), and then continuously injecting 50ml of physiological saline with the injection amount, wherein the injection rate of the physiological saline is the same as that of the contrast agent and is 4.5ml/s; the image inspected by the automatic exposure completion when the CT scanner reaches the delay time is shown in fig. 13, 14 and 15.
From the images in fig. 13, 14 and 15, it can be seen that the case of the examinee 4 is as follows: the intracranial segment of the right vertebral artery has calcified plaque and the lumen has no obvious stenosis. Bilateral internal carotid siphons were seen with multiple calcification spots and lumen intensity stenosis (stenosis < 20%). The bilateral internal carotid segments were subject to localized mixed plaque and the lumen was not significantly stenosed. Mixed plaques were seen at the bilateral common carotid bifurcation, with narrow lumen intensity (stenosis < 30%). The blood vessels of the middle cerebral artery, the anterior cerebral artery, the posterior cerebral artery and the left vertebral artery on both sides are well developed, the running is natural, the thickness is uniform, the initial part and the branch pipe cavity are not subjected to stenosis and abnormal expansion, and abnormal blood vessels are not displayed. Aortic arch, bilateral subclavian artery initiation were multiple calcified plaques, with the upper right lung lobe seen in a high density patch, approximately 2.4 x 3.3cm in size. Therefore, the image in example 4 can be clearly imaged, the image can completely meet the standard of clinical medical diagnosis of diseases, and the head and neck blood vessel can be diagnosed according to the image.
In summary, by using the angiography method of the present application, the embodiment 1, 2, 3 and 4 can illustrate that the contrast agent injection and the exposure scanning can be performed only once for the examinee, and the usage amount of the contrast agent for each individual examinee can be accurately controlled, so that serious contrast agent anaphylaxis caused by excessive contrast agent usage for the patient is avoided, and meanwhile, the steps of head and neck angiography are simplified, and meanwhile, the angiography obtained image can completely meet the standard of clinical medical diagnosis, the condition of contrast failure can not occur, and the angiography imaging effect is better.
Finally, it should be noted that: the above embodiments are only for illustrating the technical solution of the present application, and not for limiting the same; although the application has been described in detail with reference to the foregoing embodiments, it will be understood by those of ordinary skill in the art that: the technical scheme described in the foregoing embodiments can be modified or some or all of the technical features thereof can be replaced by equivalents; such modifications and substitutions do not depart from the spirit of the application, and are intended to be included within the scope of the appended claims and description.
Claims (7)
1. A method of head and neck angiography, the method comprising the steps of:
1) Basic data are acquired: obtaining basic data of a subject, the basic data comprising: gender, age, heart rate, systolic and diastolic pressure; wherein male=1, female=0, and the unit of heart rate is: the units of systolic and diastolic blood pressure are: mmHg;
2) Calculating the peak time PT: and (3) superposing the basic data acquired in the step (1) into a PT time calculation formula: pt= 22.860+0.055 x age+1.591 x gender-0.080 x hr-0.029 x sbp+0.04dbp; PT time units are: second, wherein the second is; age, gender, HR, SBP, DBP, diastolic pressure, age, sex, heart rate, systolic pressure, diastolic pressure, and diastolic pressure;
3) Determining a scan/exposure time T: defining a scanning range according to the specific examination purpose of the examined person, and determining a scanning/exposure time T through the defined scanning range;
4) Calculating the total amount of the contrast agent: calculating the arrival peak time PT according to step 2), and determining the scanning/exposure time T according to step 3); selecting the injection rate of the contrast agent to be 3.0-5.0ml/s according to the vascular condition of the puncture point of the tested person, obtaining the total injection time according to the peak reaching time PT plus the scanning/exposure time T, calculating the total injection quantity according to the injection rate, and calculating the total contrast agent amount = total injection quantity-normal saline and total injection quantity;
5) Angiography is completed: setting the scanning delay time to be the value of the peak reaching time PT calculated in the step 2) on a CT scanner, starting an exposure key of the CT scanner and a contrast agent injector simultaneously, injecting the total amount of the contrast agent obtained in the step 4), then continuing to inject normal saline along with the total amount of the contrast agent, and completing the exposure of the CT scanner to obtain an inspection image.
2. The head and neck angiography method according to claim 1, characterized in that the injection rate of the contrast agent in step 4) is 3.5-4.5ml/s.
3. The head and neck angiography method according to claim 1, wherein the total saline bolus is 30-50ml.
4. The head and neck angiography method according to claim 1, wherein said contrast agent injector is a high-pressure injector.
5. The head and neck angiography method according to claim 2, characterized in that the injection rate of the contrast agent in step 4) is 4ml/s.
6. A head and neck angiography method according to claim 3, characterized in that the total saline bolus is 35-45ml.
7. The head and neck angiography method according to claim 1, 2 or 5, characterized in that the physiological saline injection rate is the same as the contrast agent injection rate.
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| CN103083035A (en) * | 2013-01-14 | 2013-05-08 | 包头市中心医院 | Heart blood vessel and heart-and-neck blood vessel combination imaging method for Flash double-source computer tomography (CT) in coarse pitch scan mode |
| CN106175806A (en) * | 2016-07-01 | 2016-12-07 | 王刚 | A kind of method of the medical image definition improving double artery of lower extremity CT imaging |
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| CN102119856A (en) * | 2010-01-08 | 2011-07-13 | 姜卫剑 | Method for calculating brain blood volume on basis of stable status method |
| CN103083035A (en) * | 2013-01-14 | 2013-05-08 | 包头市中心医院 | Heart blood vessel and heart-and-neck blood vessel combination imaging method for Flash double-source computer tomography (CT) in coarse pitch scan mode |
| CN106539589A (en) * | 2015-09-17 | 2017-03-29 | 王燕侠 | A kind of research method of 640 layers of CT blood vessel imagings of cerebral arterial circle aneurysm |
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