本文關(guān)鍵詞：能譜CT對(duì)肺內(nèi)占位良惡性診斷價(jià)值的研究　出處：《石河子大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 結(jié)核球 肺癌 炎癥 鑒別 能譜成像

【摘要】：目的本研究是利用能譜CT多參數(shù)成像技術(shù)(包括碘濃度、能譜曲線斜率、70kev單能量CT值和有效原子序數(shù))來分析能譜CT對(duì)肺內(nèi)良惡性占位性病變?cè)\斷的可行性,探索能譜CT在肺部良惡性占位性病變的診斷及鑒別診斷中的應(yīng)用價(jià)值。材料和方法第一部分:能譜CT在不典型結(jié)核球與肺癌中的診斷價(jià)值對(duì)經(jīng)病理證實(shí)的11例肺結(jié)核與34例肺癌患者行寶石能譜CT掃描:平掃、動(dòng)脈期(arterial phase,AP)及靜脈期(venous phase,VP)。將平掃、AP及VP圖像進(jìn)行能譜薄層重建,并將薄層圖像傳至ADW(Advanced Workstation)4.6工作站上,雙盲法測(cè)量各能譜參數(shù)。選取70ke V薄層能譜圖像測(cè)量平掃、動(dòng)脈期和靜脈期CT值,動(dòng)脈期和靜脈期碘濃度(iodine concentrations,IC),動(dòng)脈期和靜脈期能譜曲線斜率(λHU),同時(shí)測(cè)量同層面主動(dòng)脈期的降主動(dòng)脈或鎖骨下動(dòng)脈的碘濃度(IC動(dòng)脈)。計(jì)算病灶標(biāo)準(zhǔn)化碘濃度值(normalized iodine concentrations,NIC)及病灶動(dòng)、靜脈期的70ke V圖像凈增CT值。感興趣區(qū)(Region of interest,ROI)放置在病變密度均勻的層面,避開空洞、鈣化及血管。為保證數(shù)據(jù)盡可能的準(zhǔn)確,所有數(shù)據(jù)測(cè)量均在連續(xù)3個(gè)ROI層面上,并取其平均值。第二部分:能譜CT對(duì)炎性病變與肺癌的鑒別診斷價(jià)值選取經(jīng)病理證實(shí)的49例肺占位患者(肺炎性病變15例,肺癌34例)行能譜CT掃描。首先進(jìn)行能譜平掃,然后于造影劑注射后8s-16s及25s-32s分別行肺動(dòng)脈期和主動(dòng)脈期能譜掃描。將平掃、肺動(dòng)脈期和主動(dòng)脈期圖像進(jìn)行能譜薄層重建,并將薄層圖像傳至ADW 4.6工作站上,雙盲法測(cè)量各能譜參數(shù)。選取70ke V薄層能譜圖像測(cè)量平掃、肺動(dòng)脈期和主動(dòng)脈期CT值和IC。計(jì)算病灶肺動(dòng)脈期和主動(dòng)脈期凈增碘濃度值(d IC)及病灶肺動(dòng)脈期和主動(dòng)脈期的70ke V圖像凈增CT值(d CT)。ROI放置在病變密度均勻的層面,避開空洞、鈣化及血管。為保證數(shù)據(jù)盡可能的準(zhǔn)確,所有數(shù)據(jù)測(cè)量均在連續(xù)3個(gè)ROI層面上,并取其平均值。結(jié)果第一部分:能譜CT在不典型結(jié)核球與肺癌中的診斷價(jià)值1)CT表現(xiàn)結(jié)果:11例結(jié)核球患者,獲取病理結(jié)果前均考慮肺癌可能。其中5例分布不典型,分別位于上葉前段、中葉及下葉各基底段區(qū);4例可見分葉征;5例邊緣有不同程度的毛刺狀突起;9例無鈣化灶;4例周圍無衛(wèi)星灶;3例明顯強(qiáng)化。2)能譜參數(shù)結(jié)果:NIC、70ke V圖像的凈增CT值(AP和VP)以及λHU(AP和VP),肺癌組均高于不典型結(jié)核球組,差異有統(tǒng)計(jì)學(xué)意義(P㩳0.05);但平掃CT值兩組無統(tǒng)計(jì)學(xué)差異(P㧐0.05)。3)能譜參數(shù)ROC曲線分析:選取有統(tǒng)計(jì)學(xué)意義的能譜參數(shù)生成ROC曲線,得到相應(yīng)能譜參數(shù)鑒別兩組病灶的最佳診斷閾值、靈敏度和特異度。其中,NIC的診斷價(jià)值最大,閾值為0.105,靈敏度和特異度分別為82.4%和90.9%。第二部分:能譜CT對(duì)炎性病變與肺癌的鑒別診斷價(jià)值1)能譜參數(shù)結(jié)果:炎性病變組與肺癌組比較,肺動(dòng)脈期IC、d IC和70ke V圖像d CT值依次為(11.95±2.52和6.40±3.18)、(9.77±2.13和4.23±2.51)(100ug/ml)和(11.70±3.41和6.16±3.75)HU;主動(dòng)脈期IC和d IC分別為(23.36±5.37和15.84±4.65)和(21.18±6.06和13.64±3.29)(100ug/ml)。以上能譜參數(shù)炎性病變組均高于肺癌組,差異有統(tǒng)計(jì)學(xué)意義(P㩳0.05)。主動(dòng)脈期70ke V圖像d CT值和有效原子序數(shù)分別為(35.64±9.30和29.11±12.83)(100ug/ml)和(7.70±0.17和7.71±0.18),差異無統(tǒng)計(jì)學(xué)意義(P㧐0.05)。2)能譜參數(shù)ROC曲線分析:選取有統(tǒng)計(jì)學(xué)意義的能譜參數(shù)生成ROC曲線,得到相應(yīng)能譜參數(shù)鑒別兩組病灶的最佳診斷閾值、靈敏度和特異度。其中,肺動(dòng)脈期的d IC的診斷價(jià)值最大,閾值為7.385(100ug/ml),靈敏度和特異度分別為93.3%和91.2%。結(jié)論1)能譜CT碘濃度值、70ke V單能量CT值及能譜曲線斜率對(duì)不典型結(jié)核球與肺癌的鑒別診斷有幫助,尤其是NIC值診斷價(jià)值較高。2)能譜CT碘濃度值及70ke V單能量CT值有助于炎性病變和肺癌的鑒別診斷,尤其是肺動(dòng)脈期d IC值診斷價(jià)值較高。
[Abstract]:The purpose of this study is to use the energy spectrum of CT multi parameter imaging techniques (including iodine concentration, energy spectrum curve slope, 70kev single energy CT value and effective atomic number) to analyze the spectrum of CT in benign and malignant pulmonary space occupying lesion of the feasibility, explore the energy spectrum CT accounted for malignant diagnosis and differential diagnosis of lesions in the benign lung. Materials and methods the first part: the diagnostic value of spectral CT in atypical tuberculoma and lung cancer in 11 cases with pulmonary tuberculosis confirmed by pathology and 34 cases of lung cancer underwent gemstone spectral CT scanning: plain scan, arterial phase (arterial phase, AP (venous) and portal venous phase phase, VP). The AP and VP scan, image spectrum reconstruction and thin, thin image to the ADW (Advanced Workstation) 4.6 workstation, double blind method to measure the spectral parameters. Select the 70ke V thin spectral image measurement scan, arterial phase and venous phase CT, arterial phase and vein During the period of iodine concentration (iodine concentrations, IC), arterial phase and venous phase spectrum curve slope (2 HU), simultaneous measurement of the same level of aortic phase and descending aorta or subclavian artery iodine concentration (IC artery) were calculated. The normalized iodine concentration value (normalized iodine concentrations, NIC) and the lesion, vein the 70ke V CT. Net value of image region of interest (Region of, interest, ROI) placed in the lesion density level, avoid holes, calcification and blood vessels. In order to ensure the data is as accurate as possible, all the data were measured in 3 consecutive ROI level, and their average value. The second part: the CT spectrum for diagnosis and differential diagnosis of inflammatory lesions and lung cancer were selected from 49 cases of lung pathology lesions (15 cases of pneumonia, 34 cases of lung cancer lesions) underwent CT scanning spectrum. First spectrum scan, and then to the contrast agent injection after 8s-16s and 25s-32s respectively for pulmonary arterial phase And spectrum scanning. The arterial phase scan, pulmonary arterial and aortic phase image spectra and thin layer reconstruction, thin layer images were transferred to ADW 4.6 workstation, double blind method to measure the spectral parameters. Select the 70ke V thin spectral image measurement scan, pulmonary arterial and aortic CT value and IC. calculate the net increase of iodine concentration in pulmonary artery and aortic lesions (D IC) and the value of pulmonary artery and aortic lesions during the period of the 70ke V image (D CT) CT net value of.ROI is placed in the lesion density level, avoid holes, calcification and blood vessels. In order to ensure the data is as accurate as possible, all measurement data are in for the 3 ROI level, and their average values. Results the first part: the spectrum of CT in atypical tuberculoma and lung cancer in the diagnostic value of 1 CT) results: 11 cases of tuberculosis patients, pathological results were obtained including 5 cases of lung cancer may be considered. The distribution of typical, are located in the 涓婂彾鍓嶆,涓彾鍙?qiáng)涓嬪彾鍚勫熀搴晫D靛尯;4渚嬪彲瑙佸垎鍙跺緛;5渚嬭竟緙樻湁涓嶅悓紼嬪害鐨勬瘺鍒虹姸紿佽搗;9渚嬫棤閽欏寲鐏，

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