重症肺炎患者的CT扫描策略

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<section data-role="outer" label="Powered by gulangu"><section data-role="outer" label="Powered by gulangu"><section data-tools="gulangu" data-id="90402"><section><section><section><p><img src="image/20201019/88672fe8dae3499a645001c1b3615a31_1.jpg" /></p></section><section><section><span><strong><span>2019 年 12 月以来，武汉市部分医院相继发现了多例不明原因肺<span>炎病例，现已证实为一种新型冠状病毒感染引起的急性呼吸道传染病</span>。</span></strong></span></section></section><section><p><span>2020年1月23日，国家卫健委发布的《新型冠状病毒感染的肺炎诊疗方案（试行第三版）》中指出，该传染病胸部影像可表现为：早期呈现多发小斑片影及间质改变，以肺外带明显。进而发展为双肺多发磨玻璃影、浸润影，严重者可出现肺实变，胸腔积液少见。CT作为评估肺内病变累及程度与范围的首要检查方法，在临床诊疗工作中起到了重要作用。</span></p><p><strong><span><span><br  /></span></span></strong></p><p><strong><span><span>对于重症肺炎患者，我们有必要采取相应的扫描策略，以应对图像质量与辐射剂量问题。</span></span></strong></p><h2><strong><span><span></span></span></strong></h2></section></section></section></section><section data-tools="gulangu" data-id="96627"><section data-width="100%"><section><section><section data-brushtype="text"><span><strong><span>减少胸部呼吸运动伪影&nbsp; &nbsp;&nbsp; &nbsp;</span></strong></span></section></section><section data-bgless="darken" data-bglessp="30%"><section><section>0<span data-original-title="" title="">1</span></section><section data-brushtype="text"><br  /></section></section></section><section><br  /></section></section></section></section><section data-role="paragraph" data-width="95%"><h2><span>病毒感染肺炎早期，肺内多呈间质改变，呼吸运动伪影是鉴别的难点，并且此类患者多屏气困难，因此，选择合适的扫描方案很重要。</span></h2><p><br  /></p><section data-tools="gulangu" data-id="94088"><section><section><section data-brushtype="text"><strong><span>双源CT扫描方案选择</span></strong></section><section><section></section><section>●</section><section data-bgless="spin" data-bglessp="280" data-width="100%"><br  /></section><section><br  /></section><section>○</section></section></section></section></section><h2><span>双源CT独有的大螺距扫描模式，亚秒内完成胸部扫描，不受呼吸运动影响，获得优秀的图像质量。双源CT推荐扫描方案如下：</span></h2><p><p><img src="image/20201019/07b0495803b853ac0702ab2ee04a045e_2.jpg" /></p></p><p><br  /></p></section><section data-tools="gulangu" data-id="94088" data-width="95%"><section><section><section data-brushtype="text"><span><strong><span>单源CT扫描方案选择</span></strong></span></section><section><section></section><section>●</section><section data-bgless="spin" data-bglessp="280" data-width="100%"><br  /></section><section><br  /></section><section>○</section></section></section></section></section><section data-role="paragraph" data-width="95%"><p><span>单源CT可选择胸部常规扫描方案。对屏气不好的患者，通过适当增加螺距的方法缩短扫描时间，减少呼吸运动伪影影响。并且，西门子医疗CT专利技术SureView^TM可在螺距增加时自动提高管电流，保持了图像质量一致。</span></p><p><p><img src="image/20201019/b51f4425b00e86cbdc6ea5b4ddaef04f_3.jpg" /></p></p></section><section data-role="paragraph"><p><br  /></p></section><section data-tools="gulangu" data-id="94088" data-width="95%"><section><section><section data-brushtype="text"><span><strong><span>扫描方向的选择—从足至头</span></strong></span></section><section><section></section><section>●</section><section data-bgless="spin" data-bglessp="280" data-width="100%"><br  /></section><section><br  /></section><section>○</section></section></section></section></section><section data-role="paragraph" data-width="95%"><p><span>由于肺底部呼吸运动幅度大于肺尖部，尤其是单源CT，对不能长时间憋气的重症患者可将扫描方向改为足到头，以尽量减少呼吸运动影响。</span></p><p><span><p><img src="image/20201019/3a2b86324d5f32113ffb2df167faa633_4.jpg" /></p></span></p></section><section data-role="paragraph" data-width="95%"><p><strong><span><span>SOMARIS5/7</span><span>系列</span></span></strong></p><p><strong><span><span>（</span><span>Emotion/Scope/Perspective/AS/Edge/Flash/Drive/Force</span><span>）</span></span></strong><strong><span><span>扫描方向界面</span></span></strong></p><p><br  /></p><p><span><span><p><img src="image/20201019/198c08c205e6552acc21b833e47728a5_5.jpg" /></p></span></span></p></section><section data-role="paragraph"><p><strong><span><span>SOMATOM go.</span><span>系列扫描方向界面</span></span></strong></p></section><section data-role="paragraph"><p><br  /></p></section><section data-tools="gulangu" data-id="96626"><section data-width="100%"><section><section><br  /></section><section data-bgless="darken" data-bglessp="30%"><section><section>0<span data-original-title="" title="">2</span></section><section data-brushtype="text"><br  /></section></section></section><section><section data-brushtype="text"><span>优化辐射剂量</span></section></section></section></section></section><section data-role="paragraph" data-width="95%"><h2><span>临床工作中，肺感染患者有可能多次复查胸CT观察病变进展情况，因此控制CT检查辐射剂量对保护患者安全十分重要。<strong>建议常规胸部扫描采用以下技术</strong>。</span></h2><section data-tools="gulangu" data-id="94088" data-width="95%"><section><section><section data-brushtype="text"><span><strong><span>自动管电流技术</span></strong></span></section><section><section></section><section>●</section><section data-bgless="spin" data-bglessp="280" data-width="100%"><br  /></section><section><br  /></section><section>○</section></section></section></section></section><h2><span>自动管电流技术是目前各大厂家充分成熟的技术。西门子医疗自动管电流技术称为CAREDose4D，根据患者体型、Z轴方向及XY方向进行管电流调制，能保证图像质量的同时最大程度优化管电流。由于该技术的计算基于患者定位相，因此保证患者摆位置于孔径中央是该技术准确调制的前提条件。</span></h2><p><br  /></p><section data-tools="gulangu" data-id="94088" data-width="95%"><section><section><section data-brushtype="text"><span><strong><span>自动管电压技术</span></strong></span></section><section><section></section><section>●</section><section data-bgless="spin" data-bglessp="280" data-width="100%"><br  /></section><section><br  /></section><section>○</section></section></section></section></section><h2><span>众所周知，管电压与辐射剂量成指数级关系，因此降低管电压可明显减少辐射剂量。自动管电压技术是西门子医疗最早用于临床的自动管电压选择技术，该技术根据患者体型、检查目的、参考条件自动推荐管电压，减少了人为选择误差，提高工作效率。新一代的双源CT及go.Top&amp;All CT管电压步进为10kV，更加精准适合不同体型患者。</span></h2><p><p><img src="image/20201019/19a4a16c68dc7c605fd49c56052a63bb_6.jpg" /></p></p><p><strong><span><span>SOMATOM Force CAREkV</span><span>界面</span></span></strong></p></section><section data-role="paragraph"><p><br  /></p></section><section data-role="paragraph" data-width="95%"><p><p><img src="image/20201019/965aaacd8294ef228211a8a45c93744e_7.jpg" /></p></p></section><section data-role="paragraph"><p><strong><span><span>SOMATOM go.Top&amp;All CARE kV</span><span>界面</span></span></strong></p></section><section data-role="paragraph" data-width="95%"><p><br  /></p><section data-tools="gulangu" data-id="94088" data-width="95%"><section><section><section data-brushtype="text"><span><strong><span>迭代重建技术</span></strong></span></section><section><section></section><section>●</section><section data-bgless="spin" data-bglessp="280" data-width="100%"><br  /></section><section><br  /></section><section>○</section></section></section></section></section><h2><span>辐射剂量优化后会不同程度增加图像噪声，迭代重建算法有效降低了图像噪声。西门子医疗迭代重建技术SAFIRE和ADMIRE除提高图像信噪比外，还能在原始数据域矫正图像伪影。</span></h2><p><p><img src="image/20201019/65429d6ac5f5e46b342763f4f8f8e1c5_8.jpg" /></p></p><p><span><strong><span><span>SOMATOM Force </span><span>迭代重建界面</span></span></strong></span></p></section><section data-role="paragraph" data-width="95%"><p><br  /></p><p><p><img src="image/20201019/149663278abdc2b93eaf79c9459ee4ce_9.jpg" /></p></p></section><section data-role="paragraph"><p><span><strong><span><span>SOMATOM go.</span><span>系列迭代重建界面</span></span></strong></span></p></section><section data-role="paragraph" data-width="95%"><p><br  /></p><p><br  /></p><section data-tools="gulangu" data-id="93985"><section><section><section><br  /></section></section><section><section><br  /></section><section><br  /></section></section><section><section data-autoskip="1"><h2><span></span></h2><h2><span>本次新型冠状病毒疫情发展迅速，及时准确评估患者病情能够正确指导临床诊疗决策。针对不同患者，需要选择合适的扫描方案及参数，才能获得良好图像质量，做出准确诊断。</span></h2><h2><strong><span>如您在工作中遇到更多CT应用相关问题，请及时拨打西门子医疗热线服务电话4008105888寻求支持。</span></strong></h2></section></section><section><section><br  /></section><section><br  /></section></section></section></section></section><section data-role="paragraph"><p><br  /></p></section></section></section><section data-tools="gulangu" data-id="93040"><section data-width="100%"><p><img src="image/20201019/83eeef47bfc19489311aca28e3f6c612_10.gif" /></p></section></section><section data-role="paragraph"><p><br  /></p></section><section data-tools="gulangu" data-id="93354"><section><section data-width="100%"><section><section data-width="45%"><p><img src="image/20201019/f077c734bf4162a9cdc0e540692d2ae0_11.jpg" /></p></section><section><section><section><p><img src="image/20201019/cc9dd9194d1696f7a36e03c7d1d78bcf_12.jpg" /></p></section><section data-width="100%"><section data-brushtype="text"><span>扫码关注西门子医疗客户服务</span></section><section data-width="80%"><br  /></section><section data-brushtype="text"><span>常连常通&nbsp; 心系客户</span></section></section></section></section></section></section></section></section>