Optimizacija urgentnega računalniško tomografskega protokola pri sumu na akutno ishemično možgansko kap : magistrsko delo

Hribar, Teja (avtor), Žibert, Janez (mentor), Avsenik, Jernej (komentor), Mekiš, Nejc (recenzent)

Uvod: Možganska kap je tretji najpogostejši vzrok invalidnosti in drugi najpogostejši vzrok smrtnosti v svetovnem merilu. Za postavitev diagnoze je potreben multidisciplinarni medicinski pristop, med katerega spada tudi slikanje. Protokol slikanja je sestavljen iz nativnega računalniško tomografskega (CT) slikanja glave, CT angiografije (CTA) znotrajlobanjskih in vratnih žil ter CT perfuzije (CTP). Slikanje se vedno začne z nativnim CT glave, nato sledita preostali dve preiskavi. Namen: Namen je bil ugotoviti prednosti oziroma slabosti različnih zaporedij preiskav. Ugotavljali smo, ali izračunana zakasnitev na podlagi CTA pomembno vpliva na optimalno izvedbo CTP. Zanimalo nas je, katera referenčna časovna točka CTA je najbolj optimalna za preračun dodatne zakasnitve pri CTP. Metode dela: V raziskavo je bilo vključenih 120 bolnikov, ki smo jih razporedili v 4 skupine. Referenčno točko skupine smo določili s študijo primera 30-ih bolnikov, kjer smo izmerili povprečni čas, ki ga kontrast potrebuje da doseže merjeno mesto. V prvi skupini smo uporabili povprečni čas z odštetim standardnim odklonom (SD), v drugi vrednost povprečnega časa in v tretji vsoto povprečnega časa in SD. V četrti smo CTP opravili pred CTA. Izračunane dodatne zakasnitve smo dodali standardni zakasnitvi slikanja CTP in po opravljeni preiskavi izmerili vrednosti časa do najvišje atenucaije (TTP) ter ga primerjali z optimalno vrednostjo. Rezultati: Druga skupina se je z najmanjšim relativnim odstopanjem 9,17 % izkazala kot najbolj uspešna. Sledila ji je prva skupina s povprečjem relativnega odstopanja 10,5 %. Veliko manj uspešni pa sta bili tretja skupina z 28,67 % in četrta skupina s 27,5 % povprečno vrednostjo relativnih odstopanj. Dokazali smo statistično značilne razlike med skupinami, torej je referenčni čas za preračun zakasnitve pomemben faktor za izvedbo optimalne CTP. Razprava in zaključek: Za izračun dodatne zakasnitve je najprimernejša povprečna vrednost časa (16,03s). Najmanj primerna referenčna vrednost je, če povprečnemu času prištejemo standardni odklon in če je CTP opravljen pred CTA, kar pomeni, da ni upoštevanih dodatnih zakasnitev. Zaključimo lahko, da zakasnitev perfuzijskega slikanja, izračunana na podlagi predhodno opravljene CTA pomembno vpliva na uspešnost izvedbe CTP in s tem na kakovost radiološke obravnave bolnika z akutno IMK.

• Jezik: Slovenski jezik
• Ključne besede: magistrska dela, radiološka tehnologija, CT protokol slikanja pri akutni ishemični možganski kapi, nativni CT glave, CTA znotrajlobanjskih in vratnih arterij, CTP, zaporedje protokola CT slikanja
• Vrsta gradiva: Magistrsko delo/naloga
• Tipologija: 2.09 - Magistrsko delo
• Organizacija: ZF - Zdravstvena fakulteta
• Kraj izida: Ljubljana
• Založnik: [T. Hribar]
• Leto izida: 2022
• Št. strani: 51 str., [3] str. pril.
• PID: 20.500.12556/RUL-142020
• UDK: 616-07
• COBISS.SI-ID: 125827075
• Datum objave v RUL: 16.10.2022

Sekundarni jezik

• Jezik: Angleški jezik
• Naslov: Optimization of emergency computed tomography in patients with suspected acute ischemic stroke : master thesis

Izvleček

Introduction: Stroke is the third most common cause of disability and the second leading cause of death worldwide. The diagnosis requires a multidisciplinary medical approach, including computed tomography (CT) imaging. The imaging protocol consists of a non-contrast head CT, CT angiography (CTA) of the intracranial and carotid arteries, and CT perfusion (CTP). The imaging always begins with a non-contrast head CT, followed by the other two examinations. Purpose: The aim of the study was to identify the advantages and disadvantages of a different order of imaging protocols. We have investigated whether the calculated CTA-based delay would have a significant impact on the optimal performance of the CTP. We were interested in which CTA reference time point is the most optimal for calculating the additional delay for CTP. Methods: The study consisted of 120 patients who were randomly assigned to 4 groups. The reference time point of the group was determined by a case study of 30 patients, where the required average time for contrast to reach the measured spot was measured. The first group was assigned with the average time with subtracted standard deviation, the second group with the average time, and the third group with the sum of the average and standard deviation. In the fourth group, CTP was performed before CTA. The calculated delays were added to the initial CTP imaging delay and the time to peak (TTP) values were measured after the examination and compared with the optimal value. Results: The second group was proven to be the most successful with the smallest relative deviation of 9,17 %. This was followed by the first group with the average relative deviation of 10,5 %. Much less successful were the third group with 28,67 % and the fourth group with 27,5 % average value of relative deviations. The analysis showed statistically significant differences between all groups, which means that the reference time for the calculation of delay is an important factor for performing optimal CTP. Discussion and conclusion: The average value of the time (16,03 s) is the most appropriate for calculating the additional delay. The least appropriate reference value is when standard deviation is added to the mean values, and when the CTP is performed before the CTA, which means that no additional delay is added. In conclusion, the calculated delay of perfusion imaging based on a previously performed CTA has a significant impact on the performance of CTP and thus the quality of CT imaging in suspected acute ischemic stroke.

• Ključne besede: master's theses, radiologic technology, CT imaging protocol in acute ischemic stroke, non-contrast head CT, CTA of intracranial and carotid arteries, CTP, order of CT imaging protocol