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研究生:林郁珮
研究生(外文):Lin, Yu-Pei
論文名稱:以雙能量電腦斷層血管攝影自動去骨技術量化頸動脈狹窄度及斑塊形態
論文名稱(外文):Automatic Subtract of Bone and Calcified Plaques Using Dual Energy CT for Carotid Artery Angiography to Quantify the Stenosis Grade and Morphology
指導教授:趙敏趙敏引用關係
指導教授(外文):Chao, Min
口試委員:姚俊旭林靜瑩
口試委員(外文):Yao, Chun-HsuLin, Jing-Ying
口試日期:2014-07-02
學位類別:碩士
校院名稱:中臺科技大學
系所名稱:醫學影像暨放射科學系暨研究所
學門:醫藥衛生學門
學類:醫學技術及檢驗學類
論文種類:學術論文
論文出版年:2014
畢業學年度:102
語文別:中文
論文頁數:91
中文關鍵詞:雙能量電腦斷層血管攝影頸動脈狹窄三維最大強度投影骨性及鈣化斑塊減贅
外文關鍵詞:Dual-energy CT angiographyCarotid artery stenosisThree-dimensional maximum intensity projectionsubtraction of bone and calcified plaques
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多切面電腦斷層血管攝影(multislice computed tomographic angiography, MDCTA)對於頸動脈狹窄的檢出率頗高,但礙於空間解析度限制,對於顯著性狹窄( ≥50% )的頸動脈且伴隨硬化斑塊時,在影像判讀上鈣化所導致之部分容積效應會影響斑塊密度的測量,並限制了鑑別斑塊的可靠性,進而影響血管狹窄管腔的量測。故本研究旨在利用雙能量電腦斷層掃描血管攝影(dual-energy computed tomographic angiography, DECTA)依據不同kV值的取像方式,去除影像上鈣的成份(subtraction of bone and calcified plaques, PBS ),當動脈硬化斑塊的鈣化成份被去除之後,即可以三維最大強度投影影像(3D maximum intensity projection, 3D-MIP)演算技術探討頸動脈狹窄及斑塊形態的臨床診斷價值。此研究採回溯性方式收集常規頸動脈彩色杜卜勒超音波及B模式超音波檢查,其篩檢結果為雙側頸動脈狹窄度呈陽性之患者,總計得40位受檢者,藉由3D-MIPPBS影像、及北美症狀性頸動脈內膜切除術試驗(North America Symptomatic Carotid Endarterectomy Trial, NASCET)規範判定頸動脈狹窄度、及狹窄處之表面斑塊形態,並以頸動脈超音波檢查報告為準則,再請兩位放射專科醫師對影像進行專家模式評分,最後利用變異數單變量分析實驗結果再以t-test做檢定,驗證此研究的可信度;並以接收者操作特徵曲線(receiver operating characteristic curve, ROC曲線)之曲線下面積(area under the curve , AUC)鑑別3D-MIPPBS影像於頸動脈臨床診斷應用的價值。共取得80條頸動脈分叉處之血管片段,經專家模式評分其3D-MIPPBS平均狹窄率分別為75.2%±19.1、75.1%±19.3,kappa 統計量數為0.891。有7段血管為假性閉鎖,求得線性迴歸中的決定係數 (R2)為0.716,截距項為11.168,(sig=0.000,表示P< 0.001)所以3D-MIPPBS演算法會高估頸動脈分叉處的狹窄率!另以接收者操作特徵曲線判別各後處理軟體在頸動脈狹窄率≥50%、≥70%的敏感度及特異性,其半自動血管分析軟體(AVA)、矢狀面面重組多平面影像(sagMPR)、3D-MIPPBS的曲線下面積值分別為0.98、0.96、0.93和0.93、0.91、0.88,以半自動血管分析軟體的鑑別力最好!而血管表面鈣化斑塊與管徑狹窄度並無直接關係(Spearman相關係數-0.101,p> 0.05),表示血管壁外層鈣化的發生與引起頸動脈血管管管徑明顯的狹窄並無顯著的關係。但將鈣化結構移除後,造成中度以上狹窄的斑塊形態多為潰瘍形斑塊(48%),次為不規則形斑塊(33%),而平滑形斑塊僅佔(19%)。故雙能量電腦斷層血管攝影自動去除骨性及鈣化斑塊的三維最大強度投影(3D-MIPPBS)演算法雖會高估血管狹窄直徑,但卻可克服鈣化性斑塊所導致的部分容積效應,增加鑑別表面斑塊形態的可靠性。

MDCTA has high detection rate for carotid stenosis, but the spatial resolution limit for significant carotid stenosis (≥ 50%) with plaques is limited. The partial volume effects caused by calcification on image interpretation will affect the measured density, limiting the identification plaque, and impact the measurement of vascular lumen. This study aims to assess the DECT 3D-MIPPBS clinical value in the diagnosis of carotid artery stenosis technology and plaque morphology. The method to identify retrospectively 40 patients with carotid artery CDS is positive. Stenosis were quantified according to NASCET criteria on ultrasound report and surface plaques morphology images by two experienced radiologists for each modality on the same planes. To quantify inter-reader reliability, linear weighted Cohen’s kappa was calculated. To avoid overestimation of reliability due to the high number of categories linear weights were chosen over quadratic weights. And to assess 3D-MIPPBS images value of diagnostic, the ROC curve was calculated. Achieved a total of 80 carotid artery, the 3D-MIPPBS images rated by the expert mode ,the average stenosis rate was 75.2% ± 19.1,75.1% ± 19.3, kappa value is 0.891. There are seven sections of carotid artery was pseudo atresia, the R2 of 0.716, an intercept of 11.168, it will overestimate stenosis rate. ROC curve with each other post-processing software to determine the rate of carotid artery stenosis ≥ 50%, ≥ 70% . The sensitivity and specificity of the AVA, sagMPR, 3D-MIPPBS the AUC were 0.98, 0.96, 0.93 and 0.93, 0.91, 0.88, the AVA discernment best. Surface calcified plaque and diameter stenosis were no statistical relationship (Spearman correlation coefficient -0.101, p> 0.05). But the calcified structures removed, moderate stenosis the mostly ulcerated plaque (48%), followed by irregular patches (33%), smooth plaque was only 19%. PBS facilitated the evaluation of grade of the stenosis in all cases. Nevertheless, after PBS stenosis were overrated in 3D-MIPPBS in comparison to ultrasound and axMPR. Moreover, plaque morphology, as an independent risk factor for stroke, can be evaluated even in calcified plaques after PBS. Therefore dual energy CTA with plaque subtraction has the potential to identify patients with vulnerable plaques better than conventional CTA.
第一章 前言…………………………………………………………1
1.1 研究背景……………………………………………………..1
1.2 研究動機……………………………………………………..1
1.3 研究目標……………………………………………………..3
1.4 論文架構……………………………………………………..4
第二章 文獻回顧………………………………………………….…5
2.1 頸動脈狹窄和梗塞性腦中風的相關性…………………......5
2.1.1 梗塞性腦中風的前因………………………………………….…5
2.1.2 動脈粥樣硬化的形成與形態…………………………………….8
2.1.3 國內梗塞性腦中風的近況……………………………………...10
2.2 頸動脈狹窄之評估方式…………………………………..11
2.2.1 頸動脈血管攝影………………………………………………...11
2.2.2 頸動脈超音波…………………………………………………...12
2.2.2.1 頸動脈超音波和血管攝影的一致性……………………..14
2.2.3 頸動脈磁振血管攝影………………………………………….15
2.2.4 頸動脈電腦斷層血管攝影…………………………………….16
2.3 雙能量電腦斷層血管攝影自動去骨技術的應用…………20
第三章 材料與方法………………………………………………...22
3.1 研究材料及設備……………………………………………22
3.1.1 受試者選擇……………………………………………..…….....22
3.1.2 雙能量電腦斷層頸動脈血管攝影………………………….....23
3.1.3 頸動脈超音波……………………………………………….....27
3.2 系統架構與研究流程規劃…………………………………31
3.2.1 系統架構…………………………………………………….....31
3.2.2 研究流程簡介……………………………………………….....33
3.3 影像評分標準………………………………………………34
3.3.1 顱外頸動脈之分段………………………………………….....34
3.3.2 血管狹窄率測量………………………………………………..35
3.3.3 血管斑塊形態分析………………………………………….....36
3.4 資料分析…………………………………………………....36
3.4.1 Kappa統計量檢定……………………………………………..37
3.4.2 Spearman相關係數…………………………………………….37
3.4.3 一般線性迴歸模型………………………………………….....38
第四章 結果……..………………………………………………...40
4.1 受試者基本資料…………………………………………..40
4.2 血管狹窄率……………………………………………......43
4.3 斑塊形態…………………………………………………..49
第五章 討論……………………………………………………...54
5.1 影像分析…………………………………………………..…54
5.1.1 常規頸動脈超音波影像與3D-MIPPBS影像之比較………….54
5.1.2 3D-MIPPBS影像修正的可能性………………………………...57
5.1.2.1 改善顯影劑劑量…………………………………………57
5.1.2.2 信號/雜訊比(S/N ratio)增加……………………………..59
5.1.2.3 後處理反投影濾器(kernels)的選擇……………………..60
5.1.3 AVA、sagMPR與3D-MIPPBS影像之比較…………………...61
5.2 3D-MIPPBS演算法於斑塊形態之探討…………………...62
5.2.1 頸動脈之潰瘍形斑塊分析…………………………………….62
5.2.2 表面斑塊形態與血管狹窄率的相關性……………………….64
5.2.3 血管表面鈣化斑塊與頸動脈狹窄率之關係………………….64
第六章 結論…………………………………………………….65
第七章 未來展望……………………………………………….68
參考文獻…………………………………………………………...69

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