双源CT肠灌注碘成像诊断犬急性肠系膜上动脉栓塞的研究  

Experimental Study of Acute Superior Mesenteric Artery Embolism with Dual Enery CT Intestines Iodine Maps in Dogs

作　　者：张昌立[1] 胡道予[2] 王一民[1] 曹建新[1] 杨诚[1] 王鹏[1] 叶亮[1] 胡隽[1] 

机构地区：[1]解放军161医院放射科,武汉430010 [2]华中科技大学同济医学院附属同济医院放射科,430030

出　　处：《临床放射学杂志》2013年第3期427-431,共5页Journal of Clinical Radiology

摘　　要：目的探讨双源CT(DSCT)肠灌注碘成像诊断犬实验性急性肠系膜上动脉(SMA)栓塞的可行性与准确性。方法对8只犬行腹部DSCT双能量扫描后在DSA下建立6只犬SMA栓塞模型,对照组2只犬SMA内仅注入10 ml生理盐水;对两组犬于术后6～8 h进行DSCT双能量扫描;最后,解剖6只模型犬,观察肠管大体病理改变,剪取部分坏死肠管进行病理检查。采用双能量评估软件将薄层重组数据进行灌注成像分析,将犬肠管自十二指肠至直肠分为9段进行观察,利用t检验分析梗死区术前、术后强化值与CT值差异,以病理结果为金标准,评价MSCT与DSCT肠灌注碘成像诊断肠梗死敏感性、特异性,Kappa分析其结果一致性。结果栓后17种CT征象统计显示DSCT较MSCT有更好空间分辨率。灌注定量分析显示栓塞术前后正常肠管强化值分别是(107.23±12.27)、(110.33±17.78),两者比较差异无统计学意义(t=-0.491,P=0.635);缺血肠管栓塞前后CT值分别是(141.42±23.81)、(76.17±7.68),两者比较差异有统计学意义,(t=4.29,P=0.023);强化值分别是(108.43±8.82)、(36.40±6.67),两者比较差异有统计学意义(t=14.384,P=0)。Kappa分析显示MSCT、DSCT肠灌注碘成像与病理结果具有很好一致性,DSCT的Kappa值高于MSCT。结论 DSCT肠灌注碘成像可用于检测急性SMA栓塞,其准确性与敏感性稍高于MSCT。Objective To investigate the feasibility and accuracy of dual energy CT intestines iodine maps in decting a- cute superior mesenteric artery embolism in dog model. Methods At first, all 8 experimental dogs were underwent both unenhanced and enhanced abdomen DSCT scans, then, acute superior mesenteric artery embolism model of dogs were es- tablished by DSA, 2 dogs of control group were only injected 10ml Sodium Chloride. All dogs were underwent dual energy scans by DSCT in 6 - 8-hours after embolization. At last, 6 model dogs were dissected, gross changes of bowel ischemia, scissor necrotic bowel were observed and delivered to pathologic examination. The thin slice reconstruction data was ana- lyzed by using double energy perfusion software. Dog＇ s bowel was segmented into 9 sections from duodenum to rectum and observed. The difference of contrast enhancement value and CT value of infarct region before and after embolization were compared using t test. Sensitivity, specificity and concordance of diagnosis of intestines infarction were evaluated by MSCT and DSCT intestines idoine maps. Results Statistics of 17 types of CT signs on DSCT had better spatial and density reso- lution than that on MSCT. Perfusion quantitative analysis demonstrated that the contrast enhancement value of normal intes- tines were （ 107.23 ± 12.27 ） HU, （ 110.33 ± 17.78 ） HU before and after embolizati0n. There was no significant difference between them（ t = -0. 491, P = 0,635 ）. The CT value of infarcted gut before and after embolization were 141.42 ± 23.81, 76.17 ± 7.68 . There was significant difference between them （ t = 4.29, P = 0.023 ） ; The contrast enhancement value were （108.43 ±8.82）HU, （36.40 ±6.67）HU,There was significant difference between them（t =14. 384,P=0）. Good con- cordance was existed between MSCT, DSCT and pathology by Kappa analysis, K value of DSCT was highter then that of MSCT. Conclusion DSCT intestines iodine maps is suitable to detect acute superior mesenteric artery embolism,it

关 键 词：肠系膜上动脉栓塞 灌注 体层摄影术 X线计算机 数字减影血管造影 

分 类 号：R657.2[医药卫生—外科学]