多排螺旋ct的临床应用（Clinical application of multi slice spiral CT）

多排螺旋ct的临床应用（Clinical application of multi slice spiral CT） 多排螺旋ct的临床应用(Clinical application of multi slice spiral CT) Clinical application of multi slice spiral CT The invention of the CT is a milepost in twentieth Century the development of medical science, 30 years, the scanning time of CT is more and more fast, from non spiral scan mode to single row detector spiral; from development to row, 4 rows, 6 rows, 8 rows, 10 rows, 16 rows, 32 rows and 64 rows of current. From 71 years of cross sectional images to hundreds of images in a few seconds. CT shortened the scan time from almost 5 minutes to 0.5 seconds. The layer thickness drops from 5mm to 0.5mm. Due to the continuous development of this technology and innovation, today's CT is not a simple diagnostic tool based on cross section morphology, but can be multi planar reconstruction, morphological diagnosis can be carried out in various forms, such as CTA, virtual endoscopy and colon examination etc.. Clinical application of multi slice spiral CT in head CT is widely used in the head, mainly including intracranial tumor, craniocerebral trauma, cerebrovascular disease, brain degeneration disease, congenital malformation, intracranial infectious disease, hydrocephalus, metabolic diseases, etc.. Multi slice spiral CT can show the shape, location and depression degree of skull fracture. Spiral CT angiography (CTA) is an intravenous injection of iodine contrast agent in high speed, filling in the target vessel in the peak period, rapid volume data acquisition using spiral CT images obtained by different postprocessing technique to synthesize 3D vascular image. CTA is a new minimally invasive vascular imaging technique developed with the advent of spiral CT in recent years. It has small trauma and can be rotated at any angle and observe images in various angles. CTA images can clearly show the cerebral artery ring and the anterior, middle and posterior cerebral arteries and some small branches. CTA can also visually display the feeding arteries, drainage veins and malformed blood vessels of AVM (AVM). The three-dimensional structure of the tumor and the course of the tumor carrying artery can be displayed. To create good conditions for surgical planning and radiotherapy planning Clinical application of two and multi slice spiral CT in the neck CT can be used for the diagnosis of cervical cancer in the neck, multinodular goiter and Hashimoto's thyroiditis, adenoma, adenocarcinoma, parathyroid tumor, cervical spondylosis, vertebral artery CTA, laryngeal and tracheal diseases, cervical lymph node lesions and cervical vascular lesions. Cervical spondylosis of vertebral artery type (CSA) is a common type of cervical spondylosis, its incidence after nerve root type cervical spondylosis is a common disease in the elderly, the disease and cervical degeneration, bone hyperplasia; cervical instability, abnormal activity; lumbar disc herniation; vertebral artery wall sympathetic stimulation and other factors about. In addition, the vertebral artery wall atherosclerosis, elasticity decreased, lumen smaller, is also one of the important reasons. The vertebral artery CTA with spiral CT angiography, three-dimensional reconstruction of vertebral artery, can clearly show the vertebral artery and its adjacent structures, using the special analysis software CTA, in volume by marking the method after reconstruction showed the entire vertebral artery and effectively overcome the interference of the spine, will make the judgment of vascular wall calcification more reliable, also can automatically detect stenotic vascular area and can further evaluate the degree of stenosis. It provides the basis for clinical treatment for patients with cervical spondylosis. Compared with magnetic resonance angiography (MRA) and DSA, spiral CT angiography (CTA) has the following characteristics: (1) compared with DSA, CTA has less trauma and fewer complications. After an enhanced scan, arbitrary angle reconstruction can be selected. In this way, the location of the lesion can be imaged in various directions to determine the cause of compression and the degree of compression of the vertebral artery. Compared with MRA, CTA showed bony dominance. Three dimensional imaging can remove the overlapping structure by post-processing, and can display the vertebral artery and the surrounding osseous structure and soft tissue at the same time, which is very helpful for us to judge the cause of vertebral artery compression. The CTA has a good soft tissue contrast, the cross-sectional images, can display the vessel diameter, thrombus and calcification within the lumen, DSA is developing technology, can not display the pipe wall and the outer wall is abnormal, MRA is not on the wall calcification showed clear CTA. Clinical application of three and multi slice spiral CT in chest Spiral CT can be used for the diagnosis of pneumonia, pulmonary tuberculosis, lung cancer, chest trauma, sarcoidosis, pulmonary vascular disease, pulmonary cyst and pulmonary sequestration in the chest. Mediastinal tumors, vascular lesions and metastatic lesions. Pericardial diseases, pleural effusion, pleural mesothelioma, pleural metastasis and so on. The multi-slice spiral can complete a thin scan of the whole lung in one breath. The quality of post processing images can be guaranteed. Application of four and multi slice spiral CT in the heart Coronary heart disease is one of the major causes of death in most countries. Although conventional coronary angiography is the best way to determine the extent of coronary artery stenosis, it is a traumatic examination, and it is dangerous. Therefore, the search for an accurate, reliable and practical noninvasive coronary artery examination method has attracted more and more attention in recent years. With multi slice spiral CT (MSCT) was due to its fast scanning speed and scanning thickness, ECG gating and reconstruction function, powerful postprocessing workstation, the MSCT can be used in the coronary artery. Multi slice spiral C T is the only method of treatment by recombinant display coronary artery plaque of coronary artery SVR showed clear, strong sense of three-dimensional, three-dimensional reconstructed images can be arbitrary rotation angle between coronary artery and heart clearly show the spatial relationship between CPR can be curved coronary artery pull straight, visual display In the past two years, a preliminary study has been carried out in this field. The results show that MSCT has high clinical value in the screening of coronary artery calcification, coronary CT angiography, soft plaque examination and so on. MSCT coronary angiography is an ideal means of noninvasive coronary artery stenosis. The main advantage of MSCT coronary angiography: (1) the image of high spatial resolution, can clearly and accurately show the left main coronary artery and its main branches of the anterior descending and circumflex branch; (2) image can be arbitrary rotation angle observation; (3) can precisely display vascular wall calcification; (4) no trauma safe and easy, inspection time is short, low cost. Clinical application of five and multi slice spiral CT in abdomen Applicable to the liver, gallbladder, spleen, kidney, adrenal gland, pancreas and other organs of the benign and malignant tumors, infectious diseases, liver focal hyperplasia, liver cirrhosis, abdominal trauma, biliary calculi in urinary system, identification of obstructive jaundice, choledochal cyst, liver, spleen and kidney of congenital lesions, gastrointestinal tumors and the range and degree of invasion of the tumor to the surrounding. Retroperitoneal tumor, retroperitoneal fibrosis, abdominal aortic aneurysm and so on. The three phase scan of the liver can also reconstruct the lesions and related blood vessels effectively through three-dimensional reconstruction, providing help for the localization and qualitative diagnosis, and providing guidance for clinical surgery or other treatment options. Multi slice spiral CT can be done with one breath holding The volume scanning of the liver enables the CT 3D angiography of the portal vein to be realized. The reconstruction time is shortened and the image quality is improved. At the same time, local lesion and portal vein of liver. This imaging provides a great help for accurate preoperative localization and surgical planning. Superior mesenteric vein thrombosis or tumor thrombus can be diagnosed by spiral CT enhanced scan. Serious damage to the rescue, when the condition is allowed and atypical symptoms need differential diagnosis, or need to estimate the damage degree and the range of emergency interventional treatment and late complications were observed, according to the condition of the selection of reliable and feasible diagnostic imaging method. CT is an important method to diagnose liver injury, and can accurately judge liver laceration, hepatic and hematoma under film. Clinical application of six and multi slice spiral CT in the pancreas Multi slice spiral CT in one breath can be a complete scan of the pancreas, to avoid respiratory motion artifacts, to maintain the continuity of the image, do not overlap or omissions, and optional reconstruction interval, can detect tiny lesions, better resolution structures such as small peripancreatic vessels, pancreatic duct so, to improve the image quality. Multiplanar reconstruction and 2D and 3D CT angiography can be performed. Clearly showing the differences and characteristics of normal pancreas, tumor and peripheral vascular enhancement. Multi slice spiral CT is a fast and accurate method for the diagnosis and preoperative evaluation of pancreatic tumors because of its fast scanning speed and dual phase scanning of the pancreas. The display of the common bile duct and the main pancreatic duct is more clear because of the increase of spatial resolution, which improves the ability of locating and qualitative diagnosis of obstructive jaundice. Seven. Clinical application of renal artery CTA Renal artery CTA can clearly show renal artery and renal trunk artery. It can rotate at any angle and observe images in different angles. A method for the diagnosis of gross pathology of renal vessels. Renal artery CTA can make the correct diagnosis for the clinic, and can replace the DSA examination to a great extent. The advantage of CTA over DSA is that the former can observe the renal artery and its branches from different angles, and many angles can not be achieved by DSA. It is complementary to DSA and will improve the diagnostic level of renal artery disease. Clinical application of eight and CTU The upper urinary tract includes the kidney and ureter. Surgical diseases of upper urinary tract are common in children, congenital malformations, hydronephrosis, etc., a wide variety of complex manifestations. The diagnosis mainly relies on imaging examination. Routine examinations such as ultrasound, intravenous urography, single photon emission computed tomography (SPECT) have different emphases and lack of complete examination of the urinary system, often require several conventional imaging combination to complete. Even so, the diagnosis of some cases is still difficult, which poses difficulties for the establishment of surgical protocols. The advent of the CT spiral CT 3D imaging, spiral CT scanning was carried out in the secretory phase of upper urinary tract with high density contrast, the computer postprocessing three-dimensional image synthesis of urinary tract, called CT urography (CTU). Intravenous urography (IVU) and spiral CT urography (CTU) and magnetic resonance urography (MRU) analysis of contrast urography: IVU, CTU, MRU imaging principle of three kinds of different technologies, the different display technology of the upper urinary tract is not consistent. IVU, CTU display of normal urinary tract of each part is better than that of MRU, IVU and CTU for renal function imaging on renal function better, then contrast the urinary tract of the urinary tract is thicker, more easily, and the MRU of the urinary tract and urinary water sensitive normal less water content. It is difficult to display by MRU, especially ureter. There is bone overlap in the middle and lower ureter, which greatly reduces the development ability of IVU. This condition has little effect on CTU, and because of the high resolution of CTU tissue, it can also eliminate the overlapping of bones, even if the kidney function is poor, the CTU can also be displayed. The hydronephrosis of the urinary tract enhanced the development ability of MRU, and the MRU developed better in the middle and lower ureter than in the IVU, but there was no significant difference between the CTU. CTU in the diagnosis of urinary tract disease of children's value: children with upper urinary tract diseases are different from adults, showed abnormal urinary organ size, shape, location and number of the main system is a collection of congenital anomalies. Only a clear display of the whole urinary tract can be correctly diagnosed. CTU can clearly display the normal kidney, ureter and the duplication of kidney and ureter with poor function and hydronephrosis, so as to make clear the diagnosis of duplication of renal and ureter deformity. The three-dimensional reconstruction of CTU and the original cross section images can clearly show the ectopic opening and the location and size of the ureter. The analysis is related to the high tissue resolution of CT and the interference of reconstructed images from gas and bone. When the MIP CTU image due to bladder overlap is not easy to clearly show the ectopic ureter or cyst, in addition to combining the observation of original image, after rotating MIP or volume rendering, respectively from the side or rear can accurately observe the ureter into position on the sidelines of the image, intuitive, vivid. Renal hypoplasia is a difficult point in surgical diagnosis. Hypoplasia of the kidney is less than 50% of the normal kidney, the smallest can be like the size of Vicia faba, located in the normal kidney fossa or pelvic cavity. The clinical manifestations can be asymptomatic, or renal hypertension caused by renal vascular malformations, or urinary incontinence or urinary tract infection due to ectopic ureteral openings. Because the kidney is small and low, it overlaps with the appendix or pelvis of the spine in front and back direction, and IVU is extremely difficult to display; B ultrasound is difficult to detect small kidney because of low resolution and abdominal organ disturbance. And because the upper urinary tract is not dilated, MRU is also difficult to display. For the past, not the diagnosis often taken by cystoscope or ectopic opening of retrograde urography diagnosis or laparotomy, sometimes dysplasia ectopic ureteral opening is difficult to find the whole kidney. CTU and accurate positioning, multi-dimensional display agenesis of kidney and ureter and abnormal opening, to solve the problem, clinical diagnosis is very intuitive, provide the basis for the location of surgical incision, provides the possibility for the development of minimally invasive surgical techniques. Nine. Application in adrenal diseases For adrenal examination, CT showed almost 100% of the bilateral adrenal glands, and the patients with more fat showed better results. Tumors larger than 0.5cm can be found. C T has become the preferred method for adrenal gland examination. Adrenal tumors are more common, has certain guiding significance in anatomy of adrenal 3D reconstruction on preoperative estimation, lesion surgery, the lesions less than 6cm in adrenal lesions is a good indication of laparoscopic surgery. It is generally believed that the majority of benign adrenal lesions are less than 6cm. Therefore, the majority of adrenal lesions can be treated with minimally invasive laparoscopic surgery. It is an important guarantee to define the operation mode, find the lesion quickly and perform the operation before the operation to clear the spatial location and the relationship of the adrenal lesions before operation. CT for adrenal tumor localization accuracy rate is 96.9%, but in the transverse CT images is difficult to get the surgeons and lesions in the stereoscopic view of adrenal surgery, resulting in relatively difficult. The position of the kidney and adrenal gland in surgery is the most concern of surgeons. The post-processing technique of CT can be used to process the adrenal posterior scan images, which can provide more direct and three-dimensional images for the clinic. Three dimensional reconstruction of adrenal CT can be seen in a number of positions in the adrenal gland adjacent relationship, complete performance relationship, and adrenal lesions and the adjacent space shape of the renal artery, has important significance for the separation of laparoscopic surgery. Clinical application of ten and multi slice spiral CT in gastrointestinal tract Colon cancer is a common disease in the past, the diagnosis relies mainly on enema and colonoscopy in barium, two of the lesions inside the examination has certain advantages, but there are still many limitations of the intestinal wall and tumor infiltration etc. in recent years, with the emergence of many slice CT, more and more radiologists using CT for the diagnosis of colon tumor and staging and preoperative evaluation. Check and other methods are complementary and can not only find the intraluminal lesions through axial images and reconstructed images were observed in the intestinal wall and cavity disease, preoperative assessment of tumor, provide a detailed plan for clinical surgery. The spiral can scan the entire straight and colon with 1mm thickness within 10 seconds. This layer is thick enough for very high quality volume rendering (VR) and CT endoscopy (CTE). More detailed information is provided for the CT display of gastrointestinal lesions. Hollow viscera such as spiral CT scanning and the simulation of the stomach and colon endoscope reconstruction technology has almost become a routine examination method, colon technology software may open a new census in the early census of colon cancer the situation. A spiral volume scanning in addition to VG and 3D image can also get more information from the transverse scanning image, not only can measure the size of the lesion, but also provide whether the primary focus, also provides information of lymph node and distant metastasis, is conducive to the patient underwent preoperative staging and prognosis assessment for decision making patients and clinicians to provide more information for further treatment measures. CT technology is now transparent CT workstation dedicated a software technology, it is not difficult, his advantage is that it can fully show the wall hollow viscera, and this is the other method cannot do, such as wall lesions caused by discontinuity and filling defect, external pressure change impressio the cause can be displayed, but it also has shortcomings, can not fully display the masses, so it is complementary to other means of CT examination, it is often associated with conventional CT scanning, MPR, virtual endoscopy and VS combined method. Clinical application of eleven and multi slice spiral CT in pelvic cavity Can be used for anger but bladder stone, bladder tumor, prostatic hyperplasia and tumor, prostate stone, uterine fibroids, uterine cancer, adnexal cyst and tumor. Dual phase spiral CT scan is a valuable diagnostic method at present, can fully display the relationship between tumor in pelvic internal, surgical approach for further treatment and pointed out the direction, can accurately show the characteristics of pelvic tumors, is conducive to the diagnosis and differential diagnosis. Clinical application of twelve and multi slice spiral CT in Department of orthopedics Occult fracture occurred in the main good anatomical structure and complex parts, due to the interference of overlapping projection, the conventional X-ray cannot find such fractures, this type of fracture is not uncommon, the fracture is often slight, diagnosis is difficult, radiology and surgeons are often felt one of difficult problem. Ordinary CT can still be missed or displayed unsatisfied with X ray parallel fracture or complicated anatomic fracture. Multi slice spiral CT has incomparable advantages in the diagnosis of occult fracture with the characteristics of scanning thickness, rapid speed, reconstruction of arbitrary angle level, and powerful computer post-processing technology. The volume data obtained by fast scanning of multi-slice spiral CT can obtain high-quality 2D images and arbitrary angle 3D images by post-processing technology. MPR and MIP reconstruction can better display the fracture site and its relationship with adjacent structures. VRT and SSD stereoscopic display fracture, image intuitive. Two dimensional and three-dimensional can be complementary advantages, is the best way to diagnose occult fracture. Fractures can be shown more fully. To minimize the misdiagnosis and missed diagnosis, it is very important to make accurate diagnosis for the cases with clinical suspicion of fracture and ordinary X-ray can not be diagnosed as fracture, and have important value for the choice of treatment plan and prognosis estimation. If the patient loses consciousness, he can not complain about the discomfort of the body. It's hard to determine where the CT scan should scan. At present, the patient's needs and spiral can quickly carry out large range scanning function based on the design of a spiral from head to lower extremity fast scanning procedures, fast scan of trauma patients, to detect a variety of potential trauma. 3D images of spiral CT can demonstrate the three-dimensional anatomy of adjacent bones, a doctor can easily judge the fracture degree and range of the design can reach the fracture site, and is beneficial for the operation, with as much as possible to reduce the damage to structures around the joint surgical approach. Clinical application of thirteen and multi slice spiral CT in spine It can be used for spinal trauma, fracture, observation of fracture in the spinal canal, spinal canal deformation, stenosis, spinal tuberculosis, tumor, degenerative degeneration of the joint, bulging and protrusion of the intervertebral disc, etc.. Scoliosis is a common disease in children and adolescents, mainly in the 6-14 years old school-age children and adolescents. The common causes for hypoplasia, muscle imbalance, scoliosis the infant's height was significantly lower than that of their peers, scoliosis can cause severe chest and rib bone dysplasia, affect the heart the pulmonary function, or cause abdominal pelvic dysplasia, more serious occurrence of spinal cord compression and paralysis, affect the quality of life. Various causes of scoliosis can only be corrected by surgery. In the past, plain radiographs were used to diagnose scoliosis, and it was difficult to display the whole picture of the spine completely. It is difficult to make the operation method. With the advent of multidetector row CT, subsequent processing techniques have shown unique advantages in the display of spinal lesions. MPR reconstruction not only shows the contour and local bone lesions of the vertebral body, but also can continuously observe the adjacent tissues of the spine, especially the display ability of the spinal canal structure. SSD reconstruction can be used to construct a three-dimensional structure model, which is mainly used to observe the bony structure of scoliosis. Such as lateral bending angle measurement, vertebral rotation degree evaluation and vertebral bone lesions, etc.. In particular, the overall view of scoliosis is very consistent with the clinical needs. In the VRT reconstruction images, the thoracic and lumbar vertebrae can be observed, and the angles of the vertebral column, the end vertebra and the scoliosis, vertebral rotation and parameters can be measured. It can reflect the degree of lateral bending and the relation of surrounding tissue. Provide intuitive information for treatment. Clinical application of fourteen and multi slice spiral CT in otorhinolaryngology Can be used to check the orbital inflammation, eyes disease, orbital tumor, orbital trauma and orbital foreign body, the external ear, middle ear and inner ear malformation; temporal bone trauma, otosclerosis, otitis media, static ball artery aneurysm; sinusitis and sinus cyst and nasal polyps, and nasopharyngeal cancer, laryngeal carcinoma, salivary gland tumor and inflammation. All the teeth can be expanded by the curved surface reconstruction of the jaw, and the crown, tooth root and alveolar bone are observed. 3DCT reconstruction is a new imaging technique, which has attracted more and more attention in the qualitative, quantitative, preoperative and postoperative planning of lesions. You can obtain three-dimensional images including more information such as blood vessels, nerves, tendons, bones, pelvic lesions on the diagnosis, classification and surgical approach and fixation methods, provide a sufficient basis and has a good application prospect. Fracture of head and face often occurs with orbital bone fracture and other complications. If the treatment is not timely, the patient will be disabled, so the fracture should be evaluated timely and accurately, so as to make a treatment plan. The direct sign of orbital fracture is bone disruption and bone suture separation, which is the only standard for the diagnosis of orbital fracture. Multi slice spiral CT is the best way to show orbital fracture. In the past, the X-ray examination of the orbit was made only by X-ray film, because the structure of the open bone was complicated and overlapped, and it was difficult to detect the fracture. For non conventional CT volume scanning, coronal or sagittal reconstruction images are of poor quality, direct coronal scanning time, patients by X-ray irradiation, serious symptoms of patients and children can't match, it is difficult to fully observe orbital bone fracture. Multi slice spiral CT scan, can be obtained in axial, coronal and sagittal MPR images of arbitrarily angle, location, scope, clearly show the fracture dislocation, and whether ocular incarcerated, can show the orbital fat and change, there is no optic nerve gas, bleeding, foreign body so, to reduce the misdiagnosis. It meets the requirement of multi view observation of orbital fracture. Three dimensional imaging can be used to observe the fracture line in the three-dimensional image, which provides a good guarantee for the surgery and the designation of the operation plan. Fifteen. Spiral CT angiography of arteries The technique of spiral CT angiography of arterial vessels is very mature, and the good imaging of it is the basis of correct diagnosis. The Z axis direction of the thin layer coverage and short scan time, the aortic length can be in contrast agent filling in good condition, complete with a scan, and can reconstruct the volume of high quality reproduction (VR) and vertical fault Sixteen. Perfusion imaging (perfusion CT) CT perfusion (CT perfusion) is a new imaging technology developed recently, it is in the intravenous injection of contrast agent at the same time, for the selected level through continuous scanning to obtain time density curve of each pixel, according to different mathematical models to calculate the pixels of the cerebral blood flow, cerebral blood volume maps, mean transit time of contrast agent, the peak time of contrast agent, the pseudo color processing the parameter map. Multi slice spiral can evaluate perfusion at multiple levels simultaneously, which greatly improves the possibility of correct evaluation. Perfusion imaging of other organs, such as heart, liver and kidney, can be performed. Tumor perfusion is to observe the effect of radiotherapy and chemotherapy according to the change of perfusion volume. Seventeen, for health examination 20% - 25% of the lung field and rib were overlapped due to chest radiography, and 15% - 20% of the lung field was covered by lateral radiography. So long considered as the only feasible radiological screening method for lung cancer, there is actually a blind spot. The relationship between traditional CT radiation damage, not used for lung cancer screening, and multi slice spiral CT (4 layer, 8 layer, 16 layer) can be achieved due to low dose scanning, creating conditions for lung cancer screening. Exposure amount of available 20mA 30mA, obtained with traditional CT and mA scan in the diagnosis of the same high quality information. In addition, the transverse, coronal, sagittal and other thin layer reconstructions can be performed according to the requirements. Multi axial observation can eliminate the blind spot of plain film examination. Low dose spiral CT examination from the early detection and prevention of missed diagnosis of the overall effect, is in line with the principles of health economics, so some developed countries are listed in the medical insurance recognized projects. In the same way, low dose screening of multi-slice spiral CT is also applied to screening and screening of colon cancer. The development of multi slice spiral CT provides a new method for whole spine imaging, and can be widely used in clinical work. In conclusion, multi slice spiral CT has gained clinical recognition for its excellent quality. It has achieved a large amount of thin layer acquisition in a short time, which can greatly reduce the misdiagnosis and misdiagnosis rate of the lesions. The 3D and multiplanar reconstruction can become routine, shows a different effect according to the needs from different organizations, and more convenient for diagnosis. In the next 10-20 years, the development direction of CT is CT (Volume CT) volume scanning, each scan will no longer be single or multiple, but the overall scanning of a specific anatomical range and this will greatly facilitate analysis of CT images, improve the level of diagnosis, reduce the work intensity of doctors. It is foreseeable that the development of medical imaging in twenty-first Century will be more exciting.