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Research purposes. Explore the dual-source CT (DSCT) coronary imaging sequence of image quality assessment of pulmonary vein imaging and heart rate. 2 of DSCT pulmonary vein anatomical classification. 3 of DSCT coronary angiography sequence the opening of the pulmonary vein diameter measurement. Materials and Methods 1. GENERAL INFORMATION 1.1 DSCT coronary angiography sequence of image quality assessment of pulmonary vein imaging and anatomical classification of 150 cases of pulmonary vein imaging by the DSCT coronary artery imaging sequence, male 104 cases, 46 females, aged 29 to 84 years, an average of 57.89 ± 11.55 years of age. All subjects were in sinus rhythm, heart rate 40 to 136bpm average heart rate was 74.70 ± 15.68 bpm. Rule out the standard: coronary heart disease, non-sinus rhythm or significantly irregular heart beats, breathing bad breath-hold, can not cooperate with the inspection, heart and kidney dysfunction and those who are allergic to iodine contrast agent, thoracic deformity, mediastinal tumors and chemotherapy-induced pulmonary fibrosis , lung consolidation, atelectasis, pericardial effusion and pleural effusion, severe vascular disease, and congenital heart disease can affect or alter the morphology and diameter of the pulmonary vein size. Enhanced scan signed informed consent. 1.2 DSCT coronary imaging sequence, the object of this study measured the diameter of the pulmonary vein opening the body of the second part of the pulmonary vein anatomy sub-type of non-variant type \150 cases of pulmonary vein typing \11.24 years old. All subjects were sinus rhythm, check the heart rate range of 46 to 118 BPM, average heart rate was 73.55 ± 14.82 bpm. 2. Instruments and methods of instrument: Siemens Somatom Definition dual-source CT with retrospective ECG gating technology for coronary heart scan imaging of pulmonary vein; ECG monitor using the the the DSCT scan bed built-in ECG; United States Mallinckrodt Duplex High Pressure the syringes and 370mgI/ml nonionic contrast agent. The scan preparation: before scanning subjects with fasting, water deprivation for 4 to 8 hours, do not use beta-Luck lower heart rate drug. Scan 5min before the routine use of nitroglycerin sublingual aerosol spray, spray / times. Subjects breathing exercises. Scanning methods and parameters: Select coronary artery imaging scan sequence (DS_Coronary CTA Routine_Adult), placed in accordance with the standard position before scanning ECG Cable, normal heart rate after the first sweep positioning like. DSCT data acquisition: 18G trocar superficial vein at the elbow of 4.5-5.5 ml / s flow led a delegation to Note 60 to 80ml of the contrast agent, followed by injection of 50 to 60 ml of normal saline, the use of artificial intelligence to trigger the sweep, trigger point level aortic root level of the pulmonary trunk, the trigger threshold value of 100 HU delay 6s scan. Scan range from the tracheal bifurcation to the heart diaphragmatic surface of about 1cm, breath-hold scan. Scan parameters: 120 kV, 550mA, collimation 32 × 0.6mm, level acquisition thickness 64x0.6mm tube rotation time 0.33s, pitch 0.20 to 0.47 (heart rate is automatically adjusted), effective slice thickness 0.75 mm, reconstruction interval 0.5 mm, scan time 7 ~ 13s. 3 images restructuring, image quality evaluation of image processing and observation evaluation of of 3.1 pulmonary vein imaging scan is complete, best-year phase selection by DSCT automation software (Best phase) restructuring the best systolic (BestSyst, phase) and diastolic (BestDiast phase) in the image. Reconstructed image slice thickness 0.75mm layer from 0.5mm, the convolution function value B26F image matrix 512x512. The DSCT post-processing workstation, this two-phase data image reconstruction process, the application of different imaging methods including volume rendering (VR), multiplanar reformation (MPR) and maximum intensity projection (MIP), select the posterior-anterior observation, combined with cross-sectional images, the left atrium and pulmonary veins, and its opening comprehensive judgment. All images by two experienced imaging department doctors double-blind method carried observed, respectively, four pulmonary veins on each case that the upper left pulmonary vein (LSPV), left lower pulmonary vein (LIPV), right upper pulmonary vein (RSPV) and lower right pulmonary vein (RIPV) image quality score, inconsistent results and then discuss reached the same conclusion; each case, four pulmonary veins then calculate average score (total score divided by 4) to represent a composite score of image quality level. Pulmonary vein image quality scoring criteria: 4 of 5 stars: Excellent, sharp edges, no motion artifacts, fully imaging evaluation; 3: Good, minor artifacts, the performance of local edge slightly fuzzy or a slight split-level, good diagnostic quality imaging evaluation; 2: fair, moderate artifacts, the vessel edges blurred or split-level, but the image quality is still acceptable, and can still meet the diagnostic; 1: can not be evaluated, serious artifacts, the accurate evaluation of the impact of the lumen and opening. 3.2 of pulmonary vein anatomy parting observation select the best systolic reorganization image raw data all cases dealt with by the DSCT workstation, BestSyst phase of recombinant data import Inspace software, VR, MPR and MIP three ways imaging. Removal of bone mode (Bone Removal) InSpace software kit to extract pulmonary vein image in VR image, and cutting image, multi-angle rotation, cut the pulmonary vein image is saved for further observation and analysis. 3.3 pulmonary vein opening measurement method selected BestSyst phase and BestDiast phase reconstruction images respectively import Inspace software, take advantage of the Inspace Software Toolkit Bone Removal to extract pulmonary vein image on the VR image; through vascular analysis software (syngo InSpace 4D the WITH Advanced Vessel Analysis) in the vessel lumen measurement (\opening index (ie, most trails / maximum diameter, 0 lt; ratio ≤ 1 opening index = 1 means opening round), the two sets of data were statistically analyzed. 4 grouping heart rate 75 bpm is bounded all the cases were divided into two groups: low heart rate group (heart rate ≤ 75 bpm), high heart rate group (heart rate gt; 75 bpm); DSCT Bestphase software best Phase divided into two groups, i.e. systolic group and best diastolic groups. 5 data records and statistical analysis of the of 5.1 pulmonary vein imaging image quality assessment and heart rate under each of the two best-Phase group ratings compare image quality of high and low heart rate group, according to the level of the same heart rate group on Best the systolic group, best diastolic group of image quality rating for comparison. All statistical analysis using the SPSS version 13.0 for analysis. Measurement data as mean ± standard deviation. All cases divided into groups of low heart rate and high heart rate, using independent sample t-test (Independent Samples T-Test) compared heart rate between the groups in the best systolic and diastolic best mid-term image quality score difference; same image quality score between the heart rate group level the systolic group and best diastolic group compared with paired samples t-test (Paired Samples T-Test). Optimal systolic, diastolic best image quality and heart rate hierarchical relationship of each bivariate Spearman's correlation analysis for testing. P lt; 0.05 was considered statistically significant difference. 5.2 DSCT pulmonary vein the anatomical sub-type experience from two Department of Radiology, doctors, respectively, on the 150 cases after treatment reconstruction of the left atrium and pulmonary veins VR, MIP and MPR images carry out analysis, observe the pulmonary vein and its with the left atrium connected way, recording the number of pulmonary veins, pulmonary vein number of openings in the presence or absence of Vice pulmonary vein, with or without pulmonary vein to the opening. Connection of the pulmonary vein and left atrium anatomical classification case of disagreement to discuss reunification. 5.2.1 Secondary pulmonary vein, or pulmonary vein opening recognized most cases, the human 4 pulmonary veins, respectively, opening in the left atrium, the left and right each 2, i.e., upper left, lower left pulmonary vein, top-right, bottom-right pulmonary vein. Rare cases, variation, manifested as pulmonary vein more or less than four, the extra pulmonary vein called the sub-pulmonary vein. When the ipsilateral, when the distance between the inferior pulmonary vein (d) ≤ 5 mm, defined as common opening of the pulmonary vein. 5.2.2 pulmonary vein types and the definition of specific divided into four types, as follows: (1) standard type: 4 pulmonary veins separate import the left atrium, the ipsilateral pulmonary vein distance> 0.5cm; ② lung vein common open type: in the standard basis formed on the joint opening of the pulmonary vein; according to the ipsilateral pulmonary vein openings in the left atrium whether the confluence divided into three subtypes, together opening (not confluent), length of dry (confluence, the opening from the pulmonary vein bifurcation> 1.0cm) and short common trunk (convergence, openings from the pulmonary vein and the Ministry of ≤ 1.0cm): According to the common position of the opening is divided into three subtypes, namely, the left, right and bilateral common open type; (3) Vice pulmonary vein type: on the basis of the standard type multi-appear one or more vice pulmonary vein is divided into three subtypes according to the position of Vice pulmonary vein appears, that left Vice pulmonary vein type, the right side of vice pulmonary vein-type and most pulmonary vein type; ④ mixed variant: the pulmonary venous common opening and secondary pulmonary vein. 5.2.3 right pulmonary vein branch in advance confirmation of the definition and the opening position right in the pulmonary vein openings in the upper or lower right pulmonary vein, import at right pulmonary vein opening and the distance of the left atrium (upper or lower right pulmonary vein into the left atrial opening at) ≤ 1.0cm, defined as the branch in advance; such as gt; 1.0cm, compared with early branch. All statistical analysis using the SPSS version 13.0 for analysis. Recorded anatomical classification of the connection of the pulmonary vein and the left atrium, the statistics of the occurrence rate of each sub-type and the subtype composition. X2 test analysis vice pulmonary veins, pulmonary vein opening the emergence of the existence of gender differences. P lt; 0.05 was considered statistically significant. And record the right pulmonary vein (RMPV) whether the branch in advance, and the statistics appear in all cases and typing rate and RMPV the open position. 5.3 DSCT measurement of the diameter of the opening of the pulmonary vein by two experienced radiologists independently completed the measurement of the diameter of the opening of the pulmonary vein to record the best systolic and diastolic best during the pulmonary veins (LSPV, LIPV, RSPV and RIPV) opening individual measured values ??(maximum diameter, minimal diameter, the average diameter of the cross-sectional area and the opening index) and averaged. All statistical analysis using SPSS 13.0 version. Average results of the two groups each pulmonary vein measured values ??are expressed as mean ± standard deviation. Best systolic and optimal diastolic reconstruction results of pulmonary vein opening measured values ??were compared with paired samples t-test (Paired Samples T-Test). P lt; 0.05 was considered statistically significant. Results the DSCT automation of the pulmonary vein in coronary artery imaging sequences included in the analysis of 150 cases of pulmonary vein image quality evaluation and heart rate relationship, a total of 600, part of the case of four intravenous image quality comprehensive score of 150. Optimal systolic group, 114 cases (76.0%) of the pulmonary vein image quality up to the level of excellence, fully imaging evaluation of 149 cases (99.3%) of the image quality of a good level of (3-4); only in 1 case (0.7%) is acceptable to good (2-3 points) level within the imaging evaluation can be conducted. Best diastolic group, 104 cases (69.3%) of the pulmonary vein image quality of the level of excellence, fully imaging evaluation, 144 patients (96.0%) of the image quality of a good level of (3-4), 5 cases (3.3%) in the level of acceptable to good (2-3 points), imaging evaluation can be carried out; only one case (0.7%) image quality score less than 2; optimal systolic image , the high heart rate in the group of image quality scores were 3.84 ± 0.35 (n = 88) and 3.91 ± 0.17 (n = 62), are in excellent image quality levels, there was no difference between the two heart rate group significance (t = -1.716, P = 0.089); Best diastolic images in low and high heart rate group of image quality scores were 3.86 ± 0.39 (n = 88) and 3.74 ± 0.40 points (n = 62) image quality at a good level, the differences between the two heart rate groups not statistically significant (t = 1.922, P = 0.057); low heart rate group, optimal systolic and the Best diastolic image quality score the difference was not statistically significant (t = -0.612, P = 0.542); between high heart rate group, the best systolic Best diastolic image quality score between the difference was statistically significant (t = 3.974 , P = 0.000), high heart rate group best systolic image quality score than the best diastolic high. Heart rate classification and image quality of the best systolic correlation (r value = 0.002, P = 0.984); heart rate classification and best-diastolic image quality was negatively correlated (r = -0.278, P = 0.001). can be considered as the heart rate increased grading, diastolic best image quality is gradually decreased, but the image quality is still at a good level. Explore DSCT pulmonary vein anatomy typing pulmonary vein statistics: 150 cases of subjects with pulmonary vein 621 Article LSPV, LIPV each 150 Article RSPV, RIPV of each Article 150, sub-pulmonary vein total of 21 Article (20 cases); pulmonary vein common opening and Vice pulmonary vein statistics pulmonary vein, opening appeared was 34.7% (52/150), male pulmonary vein common opening emergence rate was 29.8% (31/104) and 45.7% (21/46) for women, pulmonary vein common opening occurrence rate in terms of gender no significant difference (x2 = 3.535, P = 0.060). Vice pulmonary veins was 13.3% (20/150); 19 cases of a sub-pulmonary vein, 1 case of two sub-pulmonary vein. Male vice pulmonary veins was 11.5% (12/104) and 17.4% (8/46) for women, Vice pulmonary vein occurrence rate was no significant difference in gender (x2 = 0.945, P = 0.331). Pulmonary vein sub-type in accordance with the pulmonary vein the number of openings in the left atrium, pulmonary vein to the opening and the case of sub-pulmonary vein to its divided into four, namely: Standard, pulmonary vein common opening type, type of sub-pulmonary vein, mixed variant, each type of emergence rate 56.7% (85/150), 30.0% (45/150), 8.7% (13/150) and 4.7% (7/150). In the common pulmonary vein opening, according to whether the opening in the left atrial confluence divided into three subtypes, namely common opening (not confluence, 57.8%), long common trunk (convergence, accounting for 33.3%), short common trunk (convergence, accounting for 8.9%), greater chance of jointly opening subtypes appear; According to the common position of the opening is divided into three subtypes, that is, the left common open type (66.7%), the right common open type (13.3%), bilateral common open type (20%), to the left opening the subtypes chance. Vice pulmonary vein type, according to the position of Vice pulmonary vein appears to be divided into three subtypes that left Vice pulmonary vein type (accounting for 7.7%), the right side of vice pulmonary vein type (accounting for 69.2%), the most on the pulmonary vein-type (accounting for 15.4%) , there are cases of the two vice pulmonary vein, the opening position at the right side of the left atrium and the uppermost (7.7%); to right vice pulmonary vein type is most prevalent. Right pulmonary vein ahead of the branch its opening position right in the pulmonary vein branch in advance rate of 18% (27/150). And the rate of emergence of each pulmonary vein anatomy sub-type, respectively, to: Standard (14.1%, 12/85), pulmonary vein common opening type (24.4%, 11/45), Vice pulmonary vein-type (23.1%, 3/13), hybrid variant (14.3%, 1/7). Opening is located the RSPV, RIPV, RSPV, and RIPV and left atrium by RMPV ratio were 89.3%, 2.7%, 1.3% and 6.7%, to opening in RSPV majority. The DSCT Best phase software on the opening of the pulmonary vein diameter measurement value measured in 85 patients with pulmonary vein \Diameter of the pulmonary vein openings in the measurement results, in addition to the the RIPV opening index, the top systolic and best diastolic phase two sets of maximum diameter of the opening portion of each pulmonary vein, the minimum diameter, the average diameter of the cross-sectional area and the opening index difference were statistically significant (t value P value See text Table 3-2), i.e. in addition to the outer the RIPV opening index, the best systolic measured pulmonary vein individual measured values ??than those best diastolic The measured value, suggesting that the opening of the heart in systolic pulmonary vein becomes a circle change and the diameter increases, the diastolic pulmonary vein opening becomes oval or change becomes flat and narrow diameter. And index for RIPV opening in both groups was no significant difference (t = -0.115, P = 0.909), to prompt the right RIPV opening form phase change in two of the best period. For best systolic Group, the average diameter and cross-sectional area of ??each pulmonary vein opening maximum diameters of RSPV, the lspv followed, LIPV the diameter of the smallest; largest RSPV opening index, followed by RIPV, LSPV minimum pulmonary vein The smaller the index, the opening shape of the opening portion Movement more oval or elliptical shape change. Conclusion I. of DSCT coronary artery imaging sequence, to ensure image quality under the premise, also observed the relationship between pulmonary vein morphology, size, diameter measurement and left atrium. By automation best-Phase software to select the optimal systolic and best diastolic phase will be eligible for the pulmonary vein and left atrium excellent image quality image. (2) when the heart rate ≤ 75 bpm, you can choose the best systolic and best-diastolic image reconstruction assess pulmonary vein. But when the heart rate gt; 75 bpm, image reconstruction is better than the best systolic With the increase in heart rate, speed, best-diastolic image quality will gradually decline. Therefore, in clinical work to identify pulmonary vein, heart rate, speed, optimal systolic reconstruction image is better. DSCT with a variety of three-dimensional reconstruction can clearly show the pulmonary vein, a good correlation with the classical anatomical control. On this basis, the pulmonary veins the four anatomical classification of radiofrequency ablation of pulmonary vein isolation preoperative or surgery, familiarize yourself with the left atrium and pulmonary veins form the foundation. 4. In DSCT 3D reconstructed image based on the measurement of the diameter of the opening line of the \
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