本文選題：肝 + 包蟲病��； 參考：《石河子大學(xué)》2017年碩士論文

【摘要】：目的:探討能譜CT在診斷囊性肝包蟲中的應(yīng)用價值。方法:收集于我院接受腹部能譜CT掃描的36例患者,共71枚包蟲,其中男21例,女15例;年齡18~83歲,平均(48.67±18.43)歲,BMI(22.34±3.32)kg/m2。36例肝囊性包蟲患者根據(jù)臨床資料、超聲和(或)CT及MRI綜合診斷且Casoni氏試驗陽性以確保診斷的可靠性,其中26例共54枚包蟲(單囊型13枚,多子囊型11枚,內(nèi)囊塌陷型3枚,實變型14枚,鈣化型13枚)均經(jīng)手術(shù)證實(20例行外膜內(nèi)外囊完整剝離術(shù),6例行外囊大部分切除術(shù)),術(shù)后病理均符合細粒棘球蚴。使用GE Discovery 750HD 64排寶石CT機,采用GSI模式行平掃、動脈期、門靜脈期、延遲期掃描,掃描后先產(chǎn)生混合能量120ke V的QC圖像;然后使用影像重組標準算法,重組出40-140 ke V單能量圖像,層厚和層間距均為1.25 mm。應(yīng)用能譜軟件GSI General進行分析,測得肝包蟲與皮下脂肪的最佳對比噪聲比(Contrast to Noise Ratio,CNR)在65 ke V左右。將病灶平均分為10個層面,每份重復(fù)測量三次,取各份算數(shù)平均值,每份相隔層數(shù)=(最大層數(shù)-最小層數(shù))/10,層間距為1.25mm,放置圓形感興趣區(qū)(ROI)盡可能大的包括囊液,盡量避開囊壁和子囊,對實變型和鈣化型選擇整體測量并避開囊壁,盡量避開囊壁、鈣化灶和小子囊,測量65ke V下包蟲囊液的CT值、有效原子序數(shù),鈣(水)濃度,水(鈣)濃度,磷(水)濃度,水(磷)濃度的平均值;由于囊壁較薄ROI面積較小誤差較大,最大值對同一包蟲變化不大,遂選取最大值為其平均值,放置ROI面積為25mm2測量65ke V下囊壁的上述7項指標,并計算能譜曲線的斜率,曲線斜率=CT(40ke V)-CT(100ke V)/60ke V;結(jié)果:包蟲囊液的各項指標在GSI掃描的各型之間差異明顯(P均0.05),除包蟲囊壁水(鈣)濃度在各型之間無差異(P0.05)外,囊壁的各項指標在各型之間差異明顯(P0.05);GSI平掃在65ke V下包蟲CT值小于15.54±4.30,鈣(水)平均濃度小于1.57±0.90mg/cm3,磷(水)平均濃度小于3.04±1.16mg/cm3,能譜曲線斜率小于0.12±0.17時包蟲活性較高,反之則活性較低;GSI平掃在65ke V下包蟲CT值大于37.83±4.36,鈣(水)平均濃度大于5.33±1.78mg/cm3,磷(水)平均濃度大于10.34±2.02mg/cm3,能譜曲線斜率大于0.42±0.37時包蟲無活性。各項指標的ROC曲線對實變型診斷效能最高,對單純囊腫型診斷效能最低。囊液和囊壁的鈣(水)濃度與磷(水)濃度存在顯著相關(guān)性,Pearson相關(guān)系數(shù)均為0.999。結(jié)論:能譜CT的多參數(shù)分析和圖像,較傳統(tǒng)CT有獨特優(yōu)勢,值得在臨床進一步推廣應(yīng)用,尤其是包蟲活性及分型的判斷,對口服藥物或手術(shù)治療的選擇,有重要的指導(dǎo)意義。
[Abstract]:Objective: to evaluate the value of energy dispersive CT in the diagnosis of hepatic hydatid cyst.Methods: a total of 71 hydatidae (21 male and 15 female) were collected from 36 patients with abdominal energy dispersive CT scan in our hospital. The age of 18 to 83 years old (mean 48.67 鹵18.43) years old was 48.67 鹵18.43 years old. According to the clinical data, the patients with hepatic cystic hydatid disease were treated with BMI22.34 鹵3.32)kg/m2.36.In order to ensure the reliability of the diagnosis, there were 54 hydatidae (13 single cyst type, 11 multiple daughter cyst type, 3 collapse type of internal capsule and 14 solid type) in 26 cases, which were diagnosed by ultrasound and / or CT and MRI and positive Casoni's test.All of the 13 calcified ones were confirmed by operation. 20 cases were treated with complete excision of outer and outer capsule and 6 cases with excision of the outer capsule. The pathology of all cases was consistent with that of echinococcus granulosus.GE Discovery 750HD 64 row gemstone CT machine was used to perform plain scan, arterial phase, portal vein phase and delayed phase scanning with GSI mode. After scanning, QC images of mixed energy 120ke V were generated first, and then the standard algorithm of image recombination was used.The single energy images of 40-140ke V were reconstructed, and the thickness and spacing of the layers were 1.25 mm.The best contrast noise ratio of hepatic hydatid and subcutaneous fat was measured by GSI General software. The ratio of Contrast to Noise Ratio C was about 65 Kev.The lesions were divided into 10 layers on average, measured three times each time, and the mean values of each number of arithmetic were taken, and each interval was as large as possible, including sac fluid (maximum layer number, minimum layer number, interval of 1.25 mm, circular ROI).Avoid the cyst wall and ovary as far as possible, measure and avoid the cyst wall as a whole for solid and calcified type selection, avoid the cyst wall, calcified foci and small cyst as far as possible, measure the CT value of hydatid fluid under 65ke V, effective atomic number, and calcium (water) concentration.The average value of water (calcium) concentration, phosphorus (water) concentration, water (phosphorus) concentration, and the maximum value for the same hydatid was chosen as the average value because of the smaller error of the thinner ROI area of the cyst wall.The ROI area was placed to measure the above 7 indexes of the inferior wall of 65ke V by 25mm2, and the slope of the energy spectrum curve was calculated.Results: the indexes of hydatid cyst fluid were significantly different among the types of GSI scanning (P < 0.05), except the water (Ca) concentration of hydatid cyst wall was not different among the different types (P 0.05).There were significant differences in the indexes of the cyst wall between different types. The CT value of hydatid was less than 15.54 鹵4.30 under 65ke V, the average concentration of calcium (water) was less than 1.57 鹵0.90 mg / cm ~ 3, the average concentration of phosphorus (water) was less than 3.04 鹵1.16 mg / cm ~ (3), the slope of energy spectrum curve was less than 0.12 鹵0.17, and the activity of hydatid was higher when the average concentration of phosphorus (water) was less than 3.04 鹵1.16 mg / cm ~ (3).On the contrary, under 65ke V, the CT value of hydatid worms was more than 37.83 鹵4.36, the average concentration of calcium (water) was more than 5.33 鹵1.78 mg / cm ~ 3, the average concentration of phosphorus (water) was more than 10.34 鹵2.02mg / cm ~ (-3), and the slope of energy spectrum curve was larger than 0.42 鹵0.37.The ROC curve of each index was the most effective for solid variant diagnosis and the lowest for simple cyst type.There was significant correlation between calcium (water) concentration and phosphorus (water) concentration in cyst fluid and wall. Pearson correlation coefficient was 0.999.Conclusion: the multiparameter analysis and image of EDS CT have unique advantages compared with traditional CT. It is worth popularizing and applying in clinic, especially the judgement of hydatid activity and classification, which has important guiding significance for the choice of oral medicine or surgical treatment.
【學(xué)位授予單位】：石河子大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R532.32

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本文編號：1757291