本文關(guān)鍵詞： 肺結(jié)節(jié) 體層攝影術(shù) X線計(jì)算機(jī) 診斷 鑒別　出處：《安徽醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的探討能譜電子計(jì)算機(jī)斷層掃描(CT)成像定量分析對肺癌與肺結(jié)核及肺結(jié)核以外炎性病變的鑒別診斷及肺癌病理類型鑒別診斷的應(yīng)用價(jià)值。方法選取129例經(jīng)病理證實(shí)的肺結(jié)節(jié)/腫塊的患者,其中肺癌99例(腺癌49例、鱗癌37例,小細(xì)胞肺癌13例),炎性病變19例,肺結(jié)核11例;對所有患者進(jìn)行寶石CT能譜成像模式三期增強(qiáng)掃描并重建,將1.25mm層厚的單能量圖像傳至A w4.5工作站,由兩位高年資影像科診斷醫(yī)師分別進(jìn)行能譜圖像分析,并分別測量動(dòng)脈期(30s)、靜脈期(60s)及延遲期(90s)病灶的標(biāo)準(zhǔn)化碘濃度(NIC)、(40kev)CT值以及能譜曲線斜率,比較肺癌、肺炎、肺結(jié)核各參數(shù)間的差異。數(shù)據(jù)的統(tǒng)計(jì)學(xué)分析軟件采用SPSS16.0;首先對數(shù)據(jù)進(jìn)行正態(tài)分布檢驗(yàn),若數(shù)據(jù)為正態(tài)分布再檢驗(yàn)其方差齊性;方差齊時(shí),數(shù)據(jù)的組間差異比較采用單因素方差分析(L SD-t)法;方差不齊時(shí),數(shù)據(jù)的組間差異比較采用兩樣本的校正t檢驗(yàn)法;以P0.05為差異有統(tǒng)計(jì)學(xué)意義。再分別測量動(dòng)脈期(30s)、靜脈期(60s)肺腺癌與鱗癌的標(biāo)準(zhǔn)化碘濃度(NIC)、(40kev)CT值以及能譜曲線斜率,比較二者參數(shù)間的差異。采用兩獨(dú)立樣本的t檢驗(yàn)比較肺腺癌與鱗癌(40kev)CT值,能譜曲線斜率、標(biāo)準(zhǔn)碘基值的差異性;以P0.05為差異有統(tǒng)計(jì)學(xué)意義。繪制特性曲線(RO C),計(jì)算曲線下面積(AUC),并分析各指標(biāo)診斷效能,求得鑒別肺腺癌與鱗癌的各能譜CT定量指標(biāo)的閾值。結(jié)果125例患者經(jīng)手術(shù)或纖維支氣管鏡取得病理證實(shí),4例炎性病變患者由隨訪結(jié)果證實(shí),所有患者資料齊全;共分為三大組:肺癌組、炎性組、結(jié)核組;其中肺癌組再分為腺癌組和鱗癌組。動(dòng)脈期、靜脈期及延遲期肺癌組、炎性組、結(jié)核組的NIC值、(40kev)CT值以及能譜曲線斜率(40-80kev)基本為炎性組最高,均為結(jié)核組最低,肺癌組居中。結(jié)核組與其他兩組進(jìn)行比較,病灶在三期掃描中N IC值、(40kev)CT值及能譜曲線斜率差異均有統(tǒng)計(jì)學(xué)意(P0.05);炎性組與肺癌組比較,僅在延遲期NIC值及(40kev)CT值差異有統(tǒng)計(jì)學(xué)意義(P0.05),其它數(shù)據(jù)無統(tǒng)計(jì)學(xué)意義。肺腺癌組與鱗癌組進(jìn)行比較,腺癌組在雙期掃描中NIC值、(40kev)CT值及能譜曲線斜率均大于鱗癌組,差異均有統(tǒng)計(jì)學(xué)意(P0.05)。ROC曲線分析顯示:動(dòng)脈期能譜曲線斜率下面積最大,為0.746;當(dāng)閾值為105.5時(shí),動(dòng)脈期(40kev)CT值對鑒別腺癌與鱗癌的特異度最高,為78%;當(dāng)閾值為0.247時(shí),靜脈期標(biāo)準(zhǔn)化碘濃度對鑒別腺癌與鱗癌的敏感度最高,為76%。結(jié)論能譜CT成像定量參數(shù)在肺癌、炎性病變、肺結(jié)核之間及腺癌與鱗癌之間差異均有統(tǒng)計(jì)學(xué)意義,對其鑒別診斷提供了可靠的幫助;能譜CT成像定量分析對肺癌的診斷及鑒別診斷存在很大臨床應(yīng)用價(jià)值。
[Abstract]:Objective to evaluate the value of quantitative analysis of energy dispersive computed tomography (ECDT) imaging in the differential diagnosis of lung cancer from pulmonary tuberculosis and pulmonary tuberculosis and the differential diagnosis of lung cancer pathological types. Methods 129 cases of lung cancer were selected by pathology. Confirmed pulmonary nodules / masses, Among them, 99 cases of lung cancer (49 cases of adenocarcinoma, 37 cases of squamous cell carcinoma, 13 cases of small cell lung cancer, 19 cases of inflammatory lesions, 11 cases of pulmonary tuberculosis) were performed three phase enhanced scanning and reconstruction of sapphire CT energy dispersive imaging. A single energy image with a thickness of 1.25 mm was transferred to workstation Aw4.5, and the energy spectrum image was analyzed by two senior imaging diagnostics. The CT value and the slope of energy spectrum curve of the lesions of 30 s, 60 s of arterial phase, 60 s of venous phase and 90 s of delayed phase were measured respectively, and the lung cancer and pneumonia were compared. SPSS 16.0 is used to analyze the data. First, the normal distribution of the data is tested, and if the data is normal distribution, the homogeneity of variance is tested. The method of single factor analysis of variance (ANOVA) was used to compare the differences between groups, and when the variance was not equal, the method of corrected t test was used to compare the differences between groups of data with two samples. The difference was statistically significant (P0.05). The standardized iodine concentrations of lung adenocarcinoma and squamous cell carcinoma were measured in arterial phase 30 s and vein phase 60 s, respectively, and the CT value and the slope of energy spectrum curve of 40 kevs of lung adenocarcinoma and squamous cell carcinoma were measured, respectively. T test of two independent samples was used to compare the difference of CT value, slope of energy spectrum curve and standard iodine base value between lung adenocarcinoma and squamous cell carcinoma. The difference was statistically significant. The characteristic curve was drawn, the area under the curve was calculated, and the diagnostic efficacy of each index was analyzed. Results 125 cases of lung adenocarcinoma and squamous cell carcinoma were proved pathologically by operation or fiberoptic bronchoscopy, 4 cases of inflammatory lesions were confirmed by follow up results, all the data were complete. The lung cancer group was divided into three groups: lung cancer group, inflammatory group, tuberculosis group, the lung cancer group was divided into adenocarcinoma group and squamous cell carcinoma group, arterial stage, venous phase and delayed stage lung cancer group, inflammatory group, The CT value of NIC and the slope of energy spectrum curve were the highest in the inflammatory group, the lowest in the tuberculosis group and the middle in the lung cancer group. The tuberculosis group was compared with the other two groups. There were significant differences in the CT value and the slope of the energy spectrum curve between the Nic value and the 40 kevel CT value of the lesion in the third phase scan, and the difference between the inflammatory group and the lung cancer group was significant (P 0.05). The difference of NIC value and CT value in delayed phase was significant (P 0.05), but there was no significant difference in other data. Compared with squamous cell carcinoma group, the CT value of NIC and the slope of energy spectrum curve in adenocarcinoma group were higher than those in squamous cell carcinoma group. The difference was statistically significant (P 0.05) .ROC curve analysis showed that the area under the slope of the arterial phase energy spectrum curve was the largest (0.746); when the threshold value was 105.5, the CT value of 40 kevel in arterial phase had the highest specificity in differentiating adenocarcinoma from squamous cell carcinoma, and when the threshold was 0.247, The sensitivity of standardized iodine concentration in venous phase to differentiating adenocarcinoma from squamous cell carcinoma was 76.Conclusion the quantitative parameters of energy dispersive CT imaging have statistical significance among lung cancer, inflammatory lesions, pulmonary tuberculosis and adenocarcinoma and squamous cell carcinoma. The quantitative analysis of energy dispersive CT imaging has great clinical value in the diagnosis and differential diagnosis of lung cancer.
【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R734.2;R730.44

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