- 學位論文
64-多切面電腦斷層冠狀動脈血管攝影所見之管徑狹窄與核醫心肌灌注掃描之缺血程度相關性研究
The relationship of the luminal stenosis on 64-slice CT coronary angiography and the ischemic degree on radionuclide myocardial perfusion SPECT
摘要
摘 要 目的:本研究主要是在臨床上評估以非侵襲性方式診斷冠狀動脈疾病，提供重要的診斷影像參考，討論臨床上可以提出最好診斷冠狀動脈疾病的攝影掃描，利用統計方法評估冠狀動脈疾病攝影過程中何者為最重要的評估方法，並提供最適當影像參數組合，利用不同功能的診斷利器來提供解剖與生理上的差別，讓冠狀動脈疾病可以容易被發現，不論是使用多切面電腦斷層掃描(Multi-slices computer tomography, MSCT)或是核醫心肌灌注掃描攝影(Myocardial perfusion imaging, MPI)，都可以獲得不同條件之影像來診斷冠狀動脈疾病。 材料與方法：本研究收集2009年1月至2010年4月間共40位無明顯症狀的冠狀動脈疾病之病史的成年男女病患，先給予分數判定心臟冠狀動脈的功能，依統計評估方法歸納為四個族群，即64CT、MPI影像都不明顯的，64CT嚴重狹窄但MPI影像缺血不明顯的，64CT嚴重狹窄不明顯但MPI影像缺血明顯的及64CT嚴重狹窄且MPI影像缺血明顯的四個族群，利用實驗設計中之平均值、標準偏差來計算、one-way ANOVA 進行評估連續的變異。變異數分析之實驗數據與運算結果可以評量出電腦斷層掃描、核醫心臟心肌攝影檢查之最好的參數組合，以何者為最重要之控制因子，最後按照確認的方法以驗證實驗結果之再現性，再經由變異數分析分別統計、評估每一控制因素所影響的各別為何。 結果：對於攝影檢查而言，不論是64 MSCT或是MPI，兩項攝影都可以提供不同功能之影像，利用不同功能的診斷利器提供解剖與生理上的差別，電腦斷層掃描檢查提供解剖與精確度上的差別，核醫心肌灌注掃描提供更清楚心臟心肌功能診斷，兩種檢查方式不論是合併或是個別檢查，均為診斷冠狀動脈疾病之利器。 結論：多切面電腦斷層掃描檢查可以快速提供病症的位置與變異，確實預估心臟病、冠狀動脈疾病的風險；此外，核醫心肌灌注掃描患者注射劑量為3 mCi的201Tl可獲得最佳影像，心肌灌注掃描敏感度高而且可以準確的判斷細微的病灶；另外，本研究亦證實MSCT與MPI聯合技術可以提高冠狀動脈疾病之確診率，亦可作為評估多因子間之影響力與發現最佳評估方法。
並列摘要
ABSTRACT Objective: This study has assessed an optimal, non-invasive method and parameters to evaluate coronary artery diseases for diagnosis in clinic. Estimating coronary artery diseases with myocardial perfusion imaging (MPI) were considered a beneficial assay to analyze coronary artery diseases and statistical methods were used to evaluate the images. The main purpose of this study was to introduce a new insight using statistic methodology in medical image to assess and diagnose the coronary artery diseases. The diagnosis of the images was important not only employed by multi-slice computed tomography (MSCT) but also used MPI in scintigraphy of nuclear medicine. Materials and methods: Forty volunteer male and female patients，from Jan.2009 to April.2010，without evident clinical evidences or have silent myocardial infart (MI) events of coronary artery diseases were enrolled in this study. Functions of coronary artery diseases were evaluated in the study. A one-way ANOVA array was used to generate different designs of angiographic levels. Four groups were cataloged and selected for this study. A statistical analysis, signal-to-noise (S/N) ratio and analysis of variance (ANOVA) were employed to estimate the optimum level of each controllable factor and to analyze the effect of these factors respectively. The average and standard deviations were also analyzed for the factors of the coronary artery diseases. Results: Not only the image diagnosis of MSCT but also MPI in scintigraphy of nuclear medicine could be able to analyze the anatomical or physiological differences in coronary cardiac diseases. The analytical results also indicated that MSCT or MPI was a dominant examination tool to have various clinical diagnoses for the coronary artery and heart patients. Notably, each assay was the most dominant variable, MSCT can also be detected by the clinical anatomy and find the detail findings. No obvious cross interaction can be detected between 64 MSCT and MPI. Both of them are recommended as good methods to detect the coronary artery diseases for the patients. Conclusions: The settings obtain the best image quality for MPI in the scintigraphy. In addition, this study was also showed a revised technique coupled with statistic methodology in medical image field and enabled us to analyze differences of the various angles in the images. Calcifications and stenosis of the coronary arteries were offered by MSCT. Therefore both MSCT and MPI were employed to find the optimal combinations for coronary artery diseases in essential diagnostic medical images.
參考文獻
延伸閱讀
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