發(fā)布時間：2018-01-19 19:30

  本文關鍵詞： 甲狀腺病變 體層攝影術(shù) X線計算機 能譜CT 甲狀腺癌 體層攝影術(shù) X線計算機 能譜CT 甲狀腺微小癌 體層攝影術(shù) X線計算機 能譜CT　出處：《北京協(xié)和醫(yī)學院》2017年博士論文　論文類型：學位論文

【摘要】：第一部分能譜CT在甲狀腺良惡性病變診斷及鑒別診斷中的價值目的對甲狀腺良惡性病變的形態(tài)學征象及能譜參數(shù)進行分析,探討能譜CT在甲狀腺病變診斷及鑒別診斷中的價值。材料與方法收集2014年3月至2016年12月以甲狀腺病變行頸部CT掃描的患者。采用GE Discovery 750 HD CT掃描機能譜成像模式進行掃描,獲得常規(guī)混合能量圖像和一組單能量圖像,分別在PACS終端和AW4.6工作站進行病灶形態(tài)學基本征象的評價和能譜分析。在碘基物質(zhì)圖像測量病灶、正常甲狀腺及頸總動脈的碘含量(Iodine Concentration,IC),在水基物質(zhì)圖像上測量病灶、正常甲狀腺及頸總動脈的水含量(Water Concentration,WC),計算動脈標準化碘含量(NICA)、正常甲狀腺標準化碘含量(NICT)和能譜曲線斜率(Slope of SpectralHU curve,λHU)。采用SPSS19.0統(tǒng)計軟件進行統(tǒng)計學分析。通過受試者工作特征(ROC)曲線下面積來確定病變的診斷能力。P0.05為差異有統(tǒng)計學意義。采用Logistic回歸分析,評價能譜參數(shù)和形態(tài)學征象聯(lián)合診斷效能。結(jié)果225名患者共計230個病灶入組(良性57個病灶,惡性173個病灶),良惡性病變在邊界是否清楚、是否有微小鈣化和頸部可疑轉(zhuǎn)移淋巴結(jié)方面差異有統(tǒng)計學意義(P值均0.05),根據(jù)邊界不清楚、出現(xiàn)微小鈣化、頸部可疑淋巴結(jié)轉(zhuǎn)移診斷為甲狀腺癌的敏感度分別為76.3%、25.4%、68.8%,特異度分別為63.2%、96.5%、94.7%,準確度分別為73.0%、43.0%、75.2%。三者聯(lián)合診斷為惡性腫瘤的敏感度、特異度和準確度分別為73.4%、93.0%、82.6%。三組良性病變(甲狀腺腺瘤、結(jié)節(jié)性甲狀腺腫和甲狀腺炎)間除IC差異有統(tǒng)計學意義(P0.05)外,其余各項參數(shù)差異均無統(tǒng)計學意義。結(jié)節(jié)性甲狀腺腫與腺瘤、結(jié)節(jié)性甲狀腺腫與甲狀腺炎間IC差異均無統(tǒng)計學意義,而腺瘤IC明顯高于炎癥IC,差異有統(tǒng)計學意義(P=0.006,P0.05)。結(jié)節(jié)性甲狀腺腫與惡性腫瘤、甲狀腺腺瘤與惡性腫瘤在病灶IC,NICT和λHU方面差異有統(tǒng)計學意義(P0.05),而甲狀腺炎與惡性腫瘤在所分析諸參數(shù)差異均無統(tǒng)計學意義(P0.05)。將IC3.2mg/ml,NICT0.55和λHU3.73作為診斷甲狀腺惡性腫瘤的能譜參數(shù)指標,敏感度分別為71.1%、46.2%、68.2%,特異度分別為 68.4%、84.2%、75.4%,準確度分別為 70.4%、55.7%、70.0%。能譜參數(shù) IC、NICT、λHU聯(lián)合形態(tài)學邊界不清、出現(xiàn)微小鈣化灶及頸部可疑轉(zhuǎn)移淋巴結(jié),對惡性腫瘤的診斷效能較高,敏感度、特異度和準確度分別為86.1%、86.0%和83.9%。結(jié)論能譜CT能夠定量評估甲狀腺病變碘含量情況,對良惡性鑒別有一定的價值。聯(lián)合能譜參數(shù)與形態(tài)學特征,對良惡性病變鑒別診斷的效能較高。第二部分不同病理類型甲狀腺惡性腫瘤的能譜參數(shù)初步研究目的探討不同病理類型的甲狀腺惡性腫瘤的影像表現(xiàn)及能譜參數(shù),以提高對各病理類型甲狀腺惡性腫瘤的認識和診斷水平。材料與方法回顧性分析67例甲狀腺惡性腫瘤(乳頭狀癌44例,濾泡癌2例,髓樣癌9例,未分化癌7例,原發(fā)甲狀腺淋巴瘤5例)的形態(tài)學表現(xiàn)及能譜參數(shù)。采用GE Discovery 750HD CT掃描機能譜模式進行掃描,在最佳單能量圖像上對病灶進行形態(tài)學分析。采用能譜分析與測量軟件對不同病理類型的病灶碘含量(IC)、水含量(WC)、能譜曲線斜率(λHU)等參數(shù)進行計算和分析,采用SPSS19.0軟件進行統(tǒng)計學處理。結(jié)果甲狀腺惡性腫瘤形態(tài)學表現(xiàn)為單發(fā)57例(85.1%),形態(tài)不規(guī)則46例(68.7%),邊界不清楚45例(67.2%),密度不均勻48例(71.6%),出現(xiàn)鈣化灶21例(31.3%)。不同病理類型的甲狀腺惡性腫瘤的病灶IC及λHU值差異有統(tǒng)計學意義(P0.05),WC差異無統(tǒng)計學意義(P0.05)。乳頭狀癌、濾泡癌、髓樣癌的IC及λHU值均高于未分化癌和淋巴瘤,差異均有統(tǒng)計學意義(P0.05),病灶IC從多到少分別為濾泡癌、髓樣癌、乳頭狀癌、淋巴瘤及未分化癌,斜率的高低也與之一致。乳頭狀癌、濾泡癌、髓樣癌參數(shù)兩兩之間在IC、λHU方面差異均無統(tǒng)計學意義(P0.05),淋巴瘤與未分化癌參數(shù)比較差異無統(tǒng)計學意義(P0.05),而乳頭狀癌、濾泡癌、髓樣癌三組分別與淋巴瘤、未分化癌參數(shù)比較,差異有統(tǒng)計學意義(P0.05)。結(jié)論不同病理類型甲狀腺惡性腫瘤形態(tài)學表現(xiàn)及能譜參數(shù)有一定差異,了解其差異有助于該類病變的診斷及鑒別診斷。第三部分能譜CT對甲狀腺微小癌診斷價值的初步研究目的分析甲狀腺微小乳頭狀癌的能譜CT影像,旨在探討能譜CT在微小癌檢出和診斷中的價值。材料與方法回顧性分析我院2015年1月至2016年1月行頸部能譜CT掃描并經(jīng)手術(shù)病理證實甲狀腺微小癌33例(35枚病灶),采用GE Discovery 750HD CT掃描機,通過能譜掃描和GSIViewer圖像分析軟件獲得:140kVp混合能量圖像(A組);最佳單能量圖像(B組);最佳單能量圖像與物質(zhì)分離(碘基)圖像融合獲得的圖像(C組)。對A、B組影像質(zhì)量進行客觀評價,并對3組影像檢出性能進行主觀評分。對所有病灶的影像表現(xiàn)及能譜參數(shù)進行分析和測量。使用SPSS19.0統(tǒng)計軟件對數(shù)據(jù)進行統(tǒng)計學分析。結(jié)果本組病灶的最佳CNR能量水平為62～75keV,平均(65.96±4.01)keV。能譜CT最佳單能量圖像的CNR高于混合能量圖像(t=-5.626,P=0.000),噪聲低于混合能量圖像(t=12.00,P=0.000),差異均有統(tǒng)計學意義(P0.05)。3組影像對微小病灶的檢出率分別為 A 組 91.4%(32/35)、B 組 97.1%(34/35)、C 組 100%(35/35)。三組圖像主觀評分分別為2.54±1.15、3.31±0.93、3.46±0.74,單能量與碘基融合影像(C組)在病灶的檢出方面優(yōu)于混合能量CT(A組),并與單能量影像相仿(B組)。微小癌表現(xiàn)為形態(tài)不規(guī)則19枚(54.3%),邊緣不清楚24枚(68.6%),密度不均勻24枚(68.6%)、可見微小鈣化灶(16枚,45.7%)。20例出現(xiàn)頸部淋巴結(jié)轉(zhuǎn)移(20/33,60.6%)。病灶碘含量范圍0.9～4.3mg/ml,平均2.5±1.0mg/ml,能譜曲線斜率范圍-0.83～5.38,平均 2.99±1.59。結(jié)論能譜CT單能量圖像較混合能量圖像具有更好的圖像質(zhì)量,能譜CT單能量圖像與碘基物質(zhì)圖像融合影像可為甲狀腺微小癌診斷提供更多信息,有助于病灶的檢出與診斷。
[Abstract]:The purpose of the first part the value of spectral CT in the diagnosis and differential diagnosis of thyroid benign and malignant lesions in the morphological features of benign and malignant thyroid lesions and spectral parameters were analyzed, to investigate the spectrum of CT in the diagnosis and differential diagnosis of thyroid lesions. Materials and methods from March 2014 to December 2016 with thyroid disease patients underwent CT scan using GE Discovery 750. HD CT scanning imaging mode scanning spectrum function, obtain conventional mixed energy images and a set of monochromatic images, respectively in the PACS terminal and AW4.6 workstation for evaluation of the basic signs of lesion morphology and energy spectrum analysis. The iodine based material image measurement of lesions, the iodine content of normal thyroid and carotid artery (Iodine Concentration, IC), was measured in the water-based material image, water content of normal thyroid and common carotid artery (Water, Concentration, WC), the calculation of dynamic The content of iodine pulse Standardization (NICA), standard normal thyroid iodine content (NICT) and energy spectrum curve slope (Slope of SpectralHU curve, 2 HU). Using the statistical analysis software SPSS19.0. The receiver operating characteristic (ROC) area under the curve to determine the diagnosis ability of.P0.05 for statistical difference meaning. Using Logistic regression analysis, evaluation of spectral parameters and morphological features of combined diagnostic efficiency. Results a total of 225 patients with 230 lesions group (57 benign lesions and 173 malignant lesions), benign and malignant lesions in the boundary is clear, whether small calcification and cervical lymph node metastasis suspected there was a significant difference (the P value was 0.05), according to the boundary is not clear, micro calcification, neck lymph node metastasis diagnosis for suspected thyroid cancer sensitivity of 76.3% and 25.4% respectively, 68.8%, specificity respectively 63.2%, 96.5%, 94.7%, accuracy Were 73%, 43%, 75.2%. three combined diagnosis of malignant tumor sensitivity, specificity and accuracy were 73.4%, 93%, 82.6%. three were benign lesions (thyroid adenoma, nodular goiter and Hashimoto thyroiditis) except IC had significant difference (P0.05), the other parameters had no statistical difference meaning. Nodular goiter with adenoma, nodular goiter and the difference of IC between thyroiditis were not statistically significant, while IC was significantly higher than that in adenoma inflammation of IC, the difference was statistically significant (P=0.006, P0.05). Nodular goiter and thyroid adenoma with malignant tumor, malignant tumor lesions in IC, NICT and the difference was statistically significant a HU (P0.05), and in the analysis of thyroiditis and malignant tumor parameters showed no significant difference (P0.05). IC3.2mg/ml, NICT0.55 and HU3.73 as a diagnosis of malignant thyroid tumor spectrum parameters The index, the sensitivity was 71.1%, respectively, 46.2%, 68.2%, the specificity was 68.4%, 75.4%, 84.2% respectively, the accuracy was 70.4%, 55.7% respectively, the 70.0%. spectrum parameters IC, NICT, HU combined with lambda morphological boundary is not clear, micro calcification and cervical lymph node metastasis is higher, suspicious, diagnostic efficacy of malignant tumor the sensitivity, specificity and accuracy were 86.1%, 86% and 83.9%. conclusion spectral CT to quantitatively assess the iodine content in thyroid disease, have a certain value for differentiating benign and malignant. Combined with spectral parameters and morphological characteristics, the high efficiency of the differential diagnosis of benign and malignant lesions. Imaging findings of different pathological types objective to investigate the spectrum of thyroid malignant tumor parameters second different pathological types of thyroid malignant tumor and spectral parameters, to improve the understanding and diagnostic level of various pathological types of thyroid malignant tumors. Materials and Methods a retrospective analysis of 67 cases of thyroid malignant tumor (44 cases, 2 cases of papillary carcinoma, 9 cases of follicular carcinoma, medullary carcinoma and 7 cases of undifferentiated carcinoma, 5 cases of primary thyroid lymphoma) the morphological and spectral parameters. Using GE Discovery 750HD CT scanning function spectral model for scanning, in the best single energy images of lesions by morphological analysis. Using spectrum analysis and measurement software focus on the iodine content of different pathological types (IC), water content (WC), energy spectrum curve slope (lambda HU) to calculate and analyze the parameters of statistical processing by using SPSS19.0 software. The results showed the morphology of thyroid malignant tumor one in 57 cases (85.1%), irregular shape in 46 cases (68.7%), the boundary is not clear in 45 cases (67.2%), uneven density in 48 cases (71.6%), appearance of calcification in 21 cases (31.3%). The different pathological types of thyroid malignant tumor lesions in IC and a HU value difference was statistically significant (P0.0 5), there was no significant difference of WC (P0.05). Papillary carcinoma, follicular carcinoma, medullary carcinoma and IC lambda HU value is higher than that of undifferentiated carcinoma and lymphoma, the differences were statistically significant (P0.05), IC lesions from more to less were follicular carcinoma, medullary carcinoma, papillary carcinoma, lymphoma and undifferentiated carcinoma, slope height also consistent with papillary carcinoma, follicular carcinoma, medullary carcinoma between 22 parameters in IC, the differences were not statistically significant in terms of lambda HU (P0.05), lymphoma and anaplastic carcinoma parameters showed no significant difference (P0.05), papillary carcinoma, follicular carcinoma the three groups were medullary carcinoma, undifferentiated carcinoma and lymphoma, parameter comparison, the difference was statistically significant (P0.05). The morphology of different pathological types of thyroid malignant tumor showed and energy spectrum parameters have certain difference, helpful to the diagnosis and differential diagnosis of such lesions the difference. The third part spectrum CT on thyroid microcarcinoma Objective to investigate the diagnostic value of cancer spectrum analysis of CT imaging of papillary thyroid microcarcinoma, aims to explore the spectrum of CT in the detection and diagnosis of small cancer. Materials and methods of analysis of our hospital from January 2015 to January 2016 for the neck spectrum CT scan and pathologically confirmed thyroid microcarcinoma 33 cases (35 foci) by GE Discovery, 750HD CT scanner, through spectrum scanning and GSIViewer image analysis software: 140kVp mixed energy images (A group); the best single energy image (group B); optimal monochromaticenergy image and separation of substances (iodine based) image fusion obtained (group C). The A. The objective evaluation of image quality of B group, and 3 groups of image detection performance. The subjective scores of all lesions imaging and spectral parameters were analyzed and measured. The data were statistically analyzed using SPSS19.0 statistical software. The results of this group of diseases 鐏剁殑鏈，

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