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Part I: 64-slice spiral CT angiography neck cerebrovascular imaging scan delay time Objective: To explore the best scanning technology to predict the 64-slice spiral CT angiography in carotid and cerebral angiography scan delay time. MATERIALS AND METHODS: 129 patients divided into three groups A, B, C, 43 cases in each group. Same contrast agent concentration, dosage, injection speed, were used to experience forecast scan delay time technology (A group), CTP-CTA (computed tomography perfusion of-computed tomography angiography) scan technology (B group), the Test-bolus scanning technology ( Group C) to predict the scanning of carotid and cerebral vascular CTA in delay time. A group delay time to experience the estimated set the scanning is generally 15-20s; group B according to the perfusion peak time to determine the scan delay time; C-groups according to the peak time of the test to determine the scan delay time. By a senior radiologist measurements and compare three groups of carotid and cerebral vascular CTA C4 vertebral level, the left common carotid artery, the left internal jugular vein CT value both the CT difference, the left side of the saddle on the pool level proximal M1 segment of the middle cerebral artery, superior sagittal sinus CT value of both CT difference recorded simultaneously and compare group B and group C scan automatically survival dose-length product (dose length product, DLP). By the two seniority of radiologist compare three sets of double-blind method carotid and cerebral vascular image quality. Results: A genome scan delay time (17.12 ± 1.52) s B genome scan delay time (20.65 ± 3.09) s the C genome scan delay time (18.33 ± 5.34) s. Pairwise comparison, group B and A, C groups scan delay time differences were statistically significant (p lt; 0.05), group A and group C, the difference was not statistically significance (p gt; 0.05) by one-way ANOVA, group B scan delay time than A, C leader. CT difference between the groups A and group B, C C4 vertebral level of the left common carotid artery CT values ??and the same layer of the left internal jugular vein and the in suprasellar cistern level left middle cerebral artery M1 segment proximal CT values ??and sagittal sinus CT difference differences were statistically significant (p lt; 0.05), with the same layer on two sets of carotid and cerebral arteries of group B and group C showed no significant difference (p gt; 0.05), B, C strengthen the values ??were higher than group A, B, C, two groups in the same layer than those in Group A clear arteriovenous contrast. Group B and group C scan DLP average were 2031.24mGy.cm, 80.13 mGy.cm is the B genome scan radiation dose was significantly greater than in group C. The two senior radiologist in the carotid artery, skull base arterial ring and intravenous artifact display Kappa values ??were 0.889,0.872,0.882. The image quality ratings of the three groups of patients on the carotid artery, skull base arterial ring and intravenous artifacts show the non-parametric Mann-Whitney U test, group A and B and C the two groups in the carotid artery, skull base arterial ring and intravenous artifacts score differences were statistically significant (p lt; 0.05) on the display better than group A, group B and group C showed no significant difference (p gt; 0.05), B, C two sets of image quality. Conclusions: Test-bolus technique to predict the 64-slice spiral CT angiography neck cerebral angiography scan delay time scanning technology, fully embodies the individualized optimization principle, has greatly increased the success rate of multi-slice spiral CTA scan effectively improve the image quality of 3D vascular reconstruction. Part II: the purpose of clinical application of 64-slice spiral CT angiography digital subtraction carotid and cerebral angiography: application of 64-slice spiral CT angiography digital subtraction technology carotid and cerebral angiography, the introduction of the R \u0026 D of Neusoft Medical Bone -Subtraction CT Angiography Tool software for three-dimensional subtraction to explore the feasibility and clinical value of the subtraction software. Materials and Methods: 71 patients with carotid and cerebral vascular digital subtraction CTA in first Test-bolus scan, to determine the optimal scan delay time; then plain and enhanced simultaneously scan both scan parameters and scan position is completely consistent tube repeated exposure interval for tube rotation time 0.5s even integer multiple of unenhanced and conventional CTA images. First, the workstation comes with the Add / Sub software 2D subtraction 2D subtraction CTA images; then using the Neusoft Medical R \u0026 D the Bone-Subtraction CT Angiography Tool software for three-dimensional subtraction to obtain three-dimensional subtraction CTA images. Recorded by a senior radiologist and conventional CTA, 2D subtraction CTA, three-dimensional three technologies subtraction CTA VR and MIP post-processing time by two senior radiologists using double-blind method comparison of three the CTA Technical the reconstruction proceeds neck cerebrovascular image quality. Comparing observations of which 49 patients with DSA, using a paired design χ2 test evaluate three the CTA technologies and the DSA whether differences in the diagnosis of carotid and cerebral vascular disease, respectively statistics the three kinds CTA sensitivity of the diagnosis of carotid and cerebral vascular disease, specificity , positive predictive value, negative predictive value, and the correct rate. Results: pairwise comparisons by one-way ANOVA analysis, 2D subtraction CTA conventional CTA, three techniques for 3D subtraction CTA VR and MIP processing time between any two of the differences were significant statistical significance (p lt; 0.05 processing time), three-dimensional subtraction CTA shortest dimensional subtraction CTA followed conventional CTA longest. The two senior radiologist Kappa in three kinds of the CTA technologies the reconstruction proceeds neck cerebrovascular display value of 0.845. Three CTA technology for three-dimensional reconstruction proceeds neck cerebrovascular image score after the non-parametric Mann-Whitney U test, pairwise differences were statistically significant (p lt; 0.05), and the image quality is better than the two-dimensional three-dimensional subtraction CTA subtraction CTA and conventional CTA, 2D subtraction CTA image quality superior to conventional CTA. Paired design χ2 test, three CTA technology in the diagnosis of 49 cases of carotid and cerebral vascular lesions on DSA difference was not statistically significant (p gt; 0.05). DSA as the reference standard, the sensitivity of conventional CTA diagnosis of 49 cases of carotid and cerebral vascular disease, specificity, positive predictive value, negative predictive value and accuracy rate were 92.86%, 71.43%, 95.12%, 62.50%, 89.80%, and second dimensional and three-dimensional subtraction CTA diagnosis of 49 cases of carotid and cerebral vascular disease, the sensitivity, specificity, positive predictive value, negative predictive value, and consistent and correct rate higher than that of conventional CTA, 95.24%, 85.71%, and 97.56%, respectively, 75.00%, 93.88%. Conclusion: 64-slice spiral CT angiography digital subtraction technology significantly shorten the image processing time, and the image quality has improved significantly, and can basically replace DSA in the diagnosis of carotid and cerebral vascular disease; especially Neusoft Medical software developed 3D subtraction The clinical application is feasible, as a new software subtraction has broad application prospects.
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