本文選題：灌注 + 體層攝影術(shù)��； 參考：《青島大學(xué)》2017年碩士論文

【摘要】：目的探討基于320排CT灌注采用DICTp模型區(qū)分肺內(nèi)病變的兩套循環(huán)血供,并對(duì)肺內(nèi)孤立性結(jié)節(jié)(SPN)的定性診斷進(jìn)行分析研究。方法收集青島大學(xué)附屬醫(yī)院2014年6月至2016年6月69例SPN患者,采用CT雙入口灌注模式,以CT值范圍為-80—150HU(組1)、-200—150HU(組2)和-300—150HU(組3)分別進(jìn)行計(jì)算,輸入動(dòng)脈為肺動(dòng)脈、降主動(dòng)脈;肺循環(huán)和體循環(huán)的分界線為左心房峰值時(shí)間,手動(dòng)繪制病灶內(nèi)的ROI,得到肺動(dòng)脈血流量(pulmonary flow,PF)、支氣管動(dòng)脈血流量(bronchial flow,BF)及血流灌注指數(shù)[perfusion index,PI=PF/(PF+BF)]。由兩名高年資醫(yī)師采用雙盲法獨(dú)立分析灌注參數(shù),并繪制ROC曲線,分析不同低閾值對(duì)灌注結(jié)果的影響,并比較灌注參數(shù)的特異性和敏感度,評(píng)價(jià)最佳灌注指數(shù)的實(shí)用性。結(jié)果以手術(shù)病理或隨訪資料作為金標(biāo)準(zhǔn),8例臨床資料失訪。61例最終診斷為惡性病變有42例,非惡性病變有19例。PF在不同CT值范圍中具有統(tǒng)計(jì)學(xué)差異,惡性病變PF(42.5-84)ml/min/100ml良性病變(41.8-55.6)ml/min/100ml,而B(niǎo)F、PI僅在A組具有統(tǒng)計(jì)學(xué)差異。其中A組肺惡性腫瘤的灌注參數(shù)為:PF(42.59±23.15)ml/min/100ml,BF(56.19±26.89)ml/min/100ml,PI(24.56±20.86)%。良性腫瘤的灌注參數(shù)為:PF(51.70±31.41)ml/min/100ml,BF(38.40±19.92)ml/min/100ml,PI(65.54±26.23)%。進(jìn)一步分析ROC曲線發(fā)現(xiàn),PI值最能鑒別良惡性。PI是三組灌注參數(shù)中最大的曲線下面積,為0.873,其靈敏度94.9%,特異度57.9%,陽(yáng)性似然比是6.25,陰性似然比是0.08。結(jié)論肺癌有體循環(huán)和肺循環(huán)供血,其中體循環(huán)血供所占比例較大;而良性病變則為肺循環(huán)占優(yōu)勢(shì)。雙入口灌注的PI指數(shù)可以作為一個(gè)有價(jià)值的判斷良惡性的指標(biāo),其可能潛在具有對(duì)肺癌的治療指導(dǎo)及放療的療效評(píng)估價(jià)值。
[Abstract]:Objective to study the diagnosis of pulmonary solitary nodule (SPN) by using DICTp model to distinguish two sets of circulating blood supply of pulmonary lesions based on 320 slice CT perfusion. Methods Sixty-nine patients with SPN from June 2014 to June 2016 in affiliated Hospital of Qingdao University were collected. Ct double-portal perfusion model was used. The CT values were calculated in the range of -80-150 HUU (group 1) and -300-150 HUU (group 3). The input artery was pulmonary artery. The dividing line of descending aorta and pulmonary circulation and systemic circulation was the peak time of left atrium. The pulmonary artery blood flow (pulmonary flow), bronchial flow (BF) and perfusion index (perfusion index) were obtained by drawing the ROI in the lesion by hand. Two senior doctors used double blind method to independently analyze perfusion parameters and draw ROC curves to analyze the effects of different low thresholds on perfusion results. The specificity and sensitivity of perfusion parameters were compared to evaluate the practicability of the best perfusion index. Results there were 42 cases of malignant lesions and 19 cases of non-malignant lesions. There were statistical differences in different CT values between 8 cases of missing clinical data and 61 cases of failure of clinical data, and 19 cases of non-malignant lesions. Malignant PF(42.5-84)ml/min/100ml benign lesions were 41.8-55.6ml / min / 100ml, while BFS Pi was only statistically different in group A. In group A, the perfusion parameters of lung malignant tumors were 42.59 鹵23.15ml / min / 100ml / min / 100 ml / min = 56.19 鹵26.89ml / min / 100ml / min / 100 ml / min = 24.56 鹵20.86g / min respectively, and the perfusion parameters of group A were 42.59 鹵23.15ml / min / 100ml / min respectively. The perfusion parameters of benign tumors were 51.70 鹵31.41 ml / min / 100 ml / min, 38.40 鹵19.92 ml / min / 100 ml / min = 65.54 鹵26.23. Further analysis of ROC curve showed that Pi value was the largest area under the curve in the three groups of perfusion parameters. The sensitivity was 94.9 and the specificity was 57.9. The positive likelihood ratio was 6.25 and the negative likelihood ratio was 0.08. Conclusion there are systemic circulation and pulmonary circulation blood supply in lung cancer, in which the proportion of systemic circulation blood supply is larger, while the benign disease is the dominant pulmonary circulation. The Pi index of double inlet perfusion can be used as a valuable index for the diagnosis of benign and malignant tumor. It may have potential value in guiding the treatment of lung cancer and evaluating the curative effect of radiotherapy.
【學(xué)位授予單位】：青島大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R734.2;R730.44

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