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Development of Upright Computed Tomography With Area Detector for Whole-Body Scans: Phantom Study, Efficacy on Workflow, Effect of Gravity on Human Body, and Potential Clinical Impact.

带面积探测器的直立计算机断层扫描全身扫描的开发: 体模研究,对工作流的功效,重力对人体的影响,以及潜在的临床影响。

  • 影响因子:6.73
  • DOI:10.1097/RLI.0000000000000603
  • 作者列表:"Jinzaki M","Yamada Y","Nagura T","Nakahara T","Yokoyama Y","Narita K","Ogihara N","Yamada M
  • 发表时间:2020-02-01
Abstract

OBJECTIVES:Multiple human systems are greatly affected by gravity, and many disease symptoms are altered by posture. However, the overall anatomical structure and pathophysiology of the human body while standing has not been thoroughly analyzed due to the limitations of various upright imaging modalities, such as low spatial resolution, low contrast resolution, limited scan range, or long examination time. Recently, we developed an upright computed tomography (CT), which enables whole-torso cross-sectional scanning with 3-dimensional acquisition within 15 seconds. The purpose of this study was to evaluate the performance, workflow efficacy, effects of gravity on a large circulation system and the pelvic floor, and potential clinical impact of upright CT. MATERIALS AND METHODS:We compared noise characteristics, spatial resolution, and CT numbers in a phantom between supine and upright CT. Thirty-two asymptomatic volunteers (48.4 ± 11.5 years) prospectively underwent both CT examinations with the same scanning protocols on the same day. We conducted a questionnaire survey among these volunteers who underwent the upright CT examination to determine their opinions regarding the stability of using the pole throughout the acquisition (closed question), as well as safety and comfortability throughout each examination (both used 5-point scales). The total access time (sum of entry time and exit time) and gravity effects on a large circulation system and the pelvic floor were evaluated using the Wilcoxon signed-rank test and the Mann-Whitney U test. For a large circulation system, the areas of the vena cava and aorta were evaluated at 3 points (superior vena cava or ascending aorta, at the level of the diaphragm, and inferior vena cava or abdominal aorta). For the pelvic floor, distances were evaluated from the bladder neck to the pubococcygeal line and the anorectal junction to the pubococcygeal line. We also examined the usefulness of the upright CT in patients with functional diseases of spondylolisthesis, pelvic floor prolapse, and inguinal hernia. RESULTS:Noise characteristics, spatial resolution, and CT numbers on upright CT were comparable to those of supine CT. In the volunteer study, all volunteers answered yes regarding the stability of using the pole, and most reported feeling safe (average rating of 4.2) and comfortable (average rating of 3.8) throughout the upright CT examination. The total access time for the upright CT was significantly reduced by 56% in comparison with that of supine CT (upright: 41 ± 9 seconds vs supine: 91 ± 15 seconds, P < 0.001). In the upright position, the area of superior vena cava was 80% smaller than that of the supine position (upright: 39.9 ± 17.4 mm vs supine: 195.4 ± 52.2 mm, P < 0.001), the area at the level of the diaphragm was similar (upright: 428.3 ± 87.9 mm vs supine: 426.1 ± 82.0 mm, P = 0.866), and the area of inferior vena cava was 37% larger (upright: 346.6 ± 96.9 mm vs supine: 252.5 ± 93.1 mm, P < 0.001), whereas the areas of aortas did not significantly differ among the 3 levels. The bladder neck and anorectal junction significantly descended (9.4 ± 6.0 mm and 8.0 ± 5.6 mm, respectively, both P < 0.001) in the standing position, relative to their levels in the supine position. This tendency of the bladder neck to descend was more prominent in women than in men (12.2 ± 5.2 mm in women vs 6.7 ± 5.6 mm in men, P = 0.006). In 3 patients, upright CT revealed lumbar foraminal stenosis, bladder prolapse, and inguinal hernia; moreover, it clarified the grade or clinical significance of the disease in a manner that was not apparent on conventional CT. CONCLUSIONS:Upright CT was comparable to supine CT in physical characteristics, and it significantly reduced the access time for examination. Upright CT was useful in clarifying the effect of gravity on the human body: gravity differentially affected the volume and shape of the vena cava, depending on body position. The pelvic floor descended significantly in the standing position, compared with its location in the supine position, and the descent of the bladder neck was more prominent in women than in men. Upright CT could potentially aid in objective diagnosis and determination of the grade or clinical significance of common functional diseases.

摘要

目的: 人体多个系统受到重力的极大影响,并且许多疾病症状会因姿势而改变。然而,由于各种直立成像方式的局限性,如空间分辨率低、对比度分辨率低、扫描范围有限或检查时间长等,对站立时人体的整体解剖结构和病理生理学还没有进行彻底的分析。最近,我们开发了一种直立的计算机断层扫描 (CT),它能够在15秒内通过三维采集实现整个躯干横截面扫描。本研究的目的是评估性能,工作流程功效,重力对大循环系统和盆底的影响,以及直立CT的潜在临床影响。 材料和方法: 我们比较了仰卧和直立CT之间的噪声特征、空间分辨率和CT数字。32名无症状志愿者 (48.4 ± 11.5岁) 在同一天用相同的扫描方案前瞻性地接受了两次ct检查。我们对这些接受直立ct检查的志愿者进行了问卷调查,以确定他们对整个采集过程中使用电杆的稳定性的看法 (封闭式问题),以及每次检查的安全性和舒适性 (均使用5分量表)。使用Wilcoxon符号秩检验和Mann-Whitney U检验评估总进入时间 (进入时间和退出时间的总和) 以及重力对大循环系统和骨盆底的影响。对于大循环系统,在3个点 (上腔静脉或升主动脉,在膈肌水平,下腔静脉或腹主动脉) 评估腔静脉和主动脉的区域。对于盆底,评估从膀胱颈到耻骨尾骨线和肛门直肠交界处到耻骨尾骨线的距离。我们还检查了直立式CT在腰椎滑脱、盆底脱垂和腹股沟疝功能性疾病患者中的应用。 结果: 直立CT的噪声特征、空间分辨率和CT数字与仰卧CT相当。在志愿者研究中,所有志愿者就使用电杆的稳定性回答是,并且大多数人报告在整个直立ct检查中感觉安全 (平均评分为4.2) 和舒适 (平均评分为3.8)。与仰卧位CT相比,直立位CT的总进入时间显著减少56% (直立位: 41 ± 9秒vs仰卧位: 91 ± 15秒,P <0.001)。直立时,上腔静脉面积比仰卧位小80% (直立: 39.9 ± 17.4毫米vs仰卧: 195.4 ± 52.2毫米,P <0.001),膈肌水平面积相似 (直立: 428.3 ± 87.9毫米vs仰卧:426.1 ± 82.0毫米,P = 0.866),下腔静脉面积大37% (直立: 346.6 ± 96.9毫米vs仰卧: 252.5 ± 93.1毫米,P <0.001),而主动脉面积在3个级别之间没有显著差异。相对于仰卧位的水平,站立位的膀胱颈和肛门直肠连接部显著下降 (分别为9.4 ± 6.0毫米和8.0 ± 5.6毫米,均P <0.001)。女性的膀胱颈下降趋势比男性更明显 (女性为12.2 ± 5.2毫米,男性为6.7 ± 5.6毫米,P = 0.006)。在3例患者中,直立CT显示腰椎间孔狭窄,膀胱脱垂和腹股沟疝; 此外,它以常规CT不明显的方式阐明了疾病的分级或临床意义。 结论: 直立CT与仰卧位CT在身体特征上相当,并且显著减少了检查的进入时间。直立CT可用于阐明重力对人体的影响: 重力根据身体位置不同地影响腔静脉的体积和形状。与仰卧位相比,站立位的盆底明显下降,女性的膀胱颈下降比男性更为突出。直立CT可能有助于常见功能性疾病的客观诊断和分级或临床意义的确定。

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DOI:10.1007/s00330-019-06319-0
作者列表:["Delattre BMA","Boudabbous S","Hansen C","Neroladaki A","Hachulla AL","Vargas MI"]

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影响因子:2.98
发表时间:2020-01-01
DOI:10.1136/neurintsurg-2019-014962
作者列表:["Guo W","Liu H","Tan Z","Zhang X","Gao J","Zhang L","Guo H","Bai H","Cui W","Liu X","Wu X","Luo J","Qu Y"]

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DOI:10.1002/jcu.22762
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