Philips_CT_CTA技术

CTApplicationsDec11,2010CTA扫描质量控制及注意事项CTApplications,July4,2010CompanyConfidential影响CTA扫描图像质量的因素•扫描前准备•扫描启动时间选择•扫描时长与循环时间的匹配•造影剂总量控制和注射速率匹配•造影剂入路选择CTApplications,July4,2010CompanyConfidential3•当我们再谈论注射参数时，存在一点争议：在CTA扫描时，选择右侧肘静脉还是左侧肘静脉,尤其是颈动脉及肺动脉CTA•建议从右侧肘静脉注射，因为如果从左侧肘静脉注射，由于左侧无名静脉从三根毛血管前经过，会有造影剂浓度过高伪影.造影剂入路选择影响CTA扫描图像质量的因素CTApplications,July4,2010CompanyConfidential4介绍•肺动脉CTA–常见的协议参数–注射参数–病例•头颈部CTA–常见协议参数–注射参数–病例•腹部，肾脏，下肢CTA–常见协议参数–注射参数–病例CTApplications,July4,2010CompanyConfidential肺动脉CTA扫描•常见的扫描协议参数•注射参数•病例图像展示CTApplications,July4,2010CompanyConfidential6肺动脉CTA扫描肺动脉CTA扫描参数61664iCThelicalhelicalhelicalhelicalCollimation6x1.516x1.564xo.625128x0.625Pitch0.9000.9380.9380.938Thickness0.90.90.90.9Increment0.450.450.450.45Kv120120120120Mas250250250250ResolutionstandardstandardstandardstandardRotationtime0.750.50.50.5FilterBBBBthreshold100-150100-150100-150100-150CTApplications,July4,2010CompanyConfidential7•肺动脉CTA注射参数—传统的注射参数•80-100ml造影剂–部分病例也可以通过具体的计算公式给出造影剂总量•350-370mg/ml造影剂可以得到最好的图像–威斯派克320也可以使用，并能得到好的图像•肘前静脉注射是首选的最佳注射位置•4.0–5.0ml/sec的注射速率–有些医院曾经对体格较大的患者使用5.0–6.0ml/sec注射•双筒注射器注射效果很好肺动脉CTA扫描CTApplications,July4,2010CompanyConfidential8传统肺动脉CTA检查监测点放置CTApplications,July4,2010CompanyConfidential9肺动脉栓塞病例造影剂用量较多，静脉干扰明显CTApplications,July4,2010CompanyConfidential10•Philips常用的肺动脉注射参数•建议使用双筒注射器•选择高浓度造影剂(Isovue370,Omnipaque350)•20-30ml造影剂，30ml生理盐水•4.0-5.0ml/sec•右肘前臂静脉注射•造影剂跟踪：ROI感兴趣区设置在头臂静脉或上腔静脉•100-150阈值肺动脉CTA扫描CTApplications,July4,2010CompanyConfidentialPhilips目前常用肺动脉CTA扫描方案监测点放置CTApplications,July4,2010CompanyConfidential12肺动脉图像纯肺动脉影像，无肺静脉伪影干扰CTApplications,July4,2010CompanyConfidential头颈部CTA扫描•常见的扫描协议参数•注射参数•图像展示CTApplications,July4,2010CompanyConfidential15头颈部CTA扫描61664iCThelicalhelicalhelicalhelicalCollimation6x0.7516x0.7564xo.625128x0.625Pitch0.9000.9380.9380.938Thickness0.90.90.90.9Increment0.450.450.450.45Kv120120120120Mas250250250250ResolutionstandardstandardstandardstandardRotationtime0.750.50.50.5FilterBBBBthreshold100-150100-150100-150100-150头颅CTA扫描参数CTApplications,July4,2010CompanyConfidential16头颈部CTA扫描颈部CTA扫描参数61664iCThelicalhelicalhelicalhelicalCollimation6x1.516x1.564xo.625128x0.625Pitch0.9000.9380.9380.938Thickness0.90.90.90.9Increment0.450.450.450.45Kv120120120120Mas250250250250ResolutionstandardstandardstandardstandardRotationtime0.750.50.50.5FilterBBBBthreshold100-150100-150100-150100-150CTApplications,July4,2010CompanyConfidential17头颈部CTA扫描•选择高浓度造影剂(Isovue370,Omnipaque350)•药量：iCT及64排CT：40-50ml16排CT：90ml造影剂•注射速率：4-5ml/sec•右肘前臂静脉注射•ROI感兴趣区设置在主动脉弓下降主动脉一侧•100-150阈值•自动最短延迟时间头颈部CTA注射参数CTApplications,July4,2010CompanyConfidential18头颈部CTA扫描头颈部CTA图像CTApplications,July4,2010CompanyConfidential体部CTA扫描•常见的扫描协议参数•注射参数•图像展示CTApplications,July4,2010CompanyConfidential21主动脉CTA扫描参数61664iCThelicalhelicalhelicalhelicalCollimation6x1.516x1.564xo.625128x0.625Pitch0.9000.9380.9380.938Thickness0.90.90.90.9Increment0.450.450.450.45Kv120120120120Mas250300250250ResolutionstandardstandardstandardstandardRotationtime0.750.750.50.5FilterBBBBthreshold150150150150CTApplications,July4,2010CompanyConfidential22主动脉CTA血管造影•全主动脉及胸主动脉扫描：ROI感兴区设定在降主动脉上•腹主动脉扫描：ROI感兴区设定在腹主动脉上.CTApplications,July4,2010CompanyConfidential23肾动脉CTA扫描参数61664iCThelicalhelicalhelicalhelicalCollimation6x0.7516x0.7564xo.625128x0.625Pitch0.9000.9380.9380.938Thickness0.90.90.90.9Increment0.450.450.450.45Kv120120120120Mas250300250250ResolutionstandardStandardstandardstandardRotationtime0.750.750.50.5FilterBBBBthreshold150150150150CTApplications,July4,2010CompanyConfidential24肾动脉CTA血管造影•注意事项：肾动脉CTA扫描必须憋气，否则会出现呼吸伟影，影响图像质量•ROI感兴趣区设定在肾动脉水平处.CTApplications,July4,2010CompanyConfidential25下肢动脉CTA扫描参数61664iCThelicalhelicalhelicalhelicalCollimation6x1.516x1.564xo.62564x0.625Pitch0.9000.9380.760.76Thickness2211Increment110.70.7Kv120120120120Mas180180250250ResolutionstandardstandardstandardstandardRotationtime0.750.750.750.75FilterBBBBthreshold150150150150CTApplications,July4,2010CompanyConfidential体部CTA检查的注射参数•高浓度造影剂（首选350mgI/100ml或370mgI/100ml造影剂)•造影剂量：16排：主动脉，上、下肢动脉：90-100ml64排：主动脉70ml，上、下肢动脉90-100mliCT：主动脉50-60ml，上、下肢90ml•注射速度：主动脉、肾动脉4-5ml/s，上、下肢动脉4ml/s•阈值：150HU•启动时间：主动脉、肾动脉选择自动最短延时上肢到达阈值后延时8s扫描，下肢到达阈值后延时12-15s启动扫描CTApplications,July4,2010CompanyConfidential27下肢动脉CTA血管解剖SuperficialFemoralPoplitealArteryAnteriorTibialPeronealArteryPosteriorTibialCTApplications,July4,2010CompanyConfidential28主动脉,肾动脉和下肢动脉血管图像CTApplications,July4,2010CompanyConfidential29主动脉,肾动脉和下肢动脉血管图像CTApplications,July4,2010CompanyConfidentialCTApplications,July4,2010CompanyConfidential31CTApplications,July4,2010CompanyConfidential32下肢CTV直接法：造影剂稀释：造影剂：生理盐水=1：5-6足背静脉注射稀释后造影剂总量80ml注射速率1.5-2.0ml/s使用Bloustracking，监测点至于下腔静脉，阈值150CTApplications,July4,2010CompanyConfidential33间接法：手臂静脉注射高浓度造影剂总量：150ml注射速率：3.0ml/s延迟时间：150s扫描方向：足侧-头侧CTApplications,July4,2010CompanyConfidential34门静脉CTV：造影剂总量：100-150ml，延迟时间45-50s下腔静脉CTV：造影剂总量：120-150ml，延迟时间65-75s