本文選題：結(jié)直腸癌　切入點(diǎn)：管狀腺癌　出處：《承德醫(yī)學(xué)院》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:通過能譜參數(shù)的觀察和分析初步探討能譜CT對結(jié)直腸癌病理分型及與潰瘍性結(jié)腸炎鑒別的應(yīng)用價(jià)值。方法:回顧性選取經(jīng)結(jié)腸鏡或術(shù)后病理確診的結(jié)直腸病變63例(結(jié)直腸癌54例,潰瘍性結(jié)腸炎9例),分為結(jié)直腸管狀腺癌組共42例:包括中分化25例、低分化17例;粘液腺癌組12例;潰瘍性結(jié)腸炎組9例。檢查之前簽訂患者知情同意書,應(yīng)用GE寶石能譜CT(Discovery CT 750 HD)在能譜掃描模式(GSI)下進(jìn)行掃描。所有患者均進(jìn)行動脈期、門脈期及靜脈期三期全腹GSI能譜掃描模式掃描,所有患者掃描前均從未進(jìn)行過相應(yīng)治療。掃描范圍從膈肌頂至恥骨聯(lián)合面下緣水平,運(yùn)用GE ADW4.6工作站的能譜分析軟件進(jìn)行能譜圖像分析,得到各組動脈期、門脈期和靜脈期能譜曲線以及各期碘基圖、水基圖、直方圖、散點(diǎn)圖,觀察結(jié)直腸管狀腺癌組、黏液腺癌組以及結(jié)直腸癌組與潰瘍性腸炎組和結(jié)直腸管狀腺癌組中的中分化腺癌與低分化腺癌在各期能譜衰減曲線形態(tài)差異,并比較不同組間病灶的碘濃度、水濃度、標(biāo)準(zhǔn)化碘濃度(normalized iodine concentration,NIC)=病灶的碘濃度/腹主動脈的碘濃度、有效原子序數(shù)(effective atomic number,Eff-Z)及病灶在各期能譜曲線斜率K值=(HU40kev-HU90kev)/(40-90)的差異,并進(jìn)行獨(dú)立樣本t檢驗(yàn)。最后得出結(jié)直腸管狀腺癌(colorectal tubular cancer)中、低不同分化程度的各參數(shù)ROC曲線下面積AUC、敏感度、特異度、最佳診斷閾值及Youden指數(shù),并評價(jià)各項(xiàng)參數(shù)的診斷效能。所有能譜數(shù)據(jù)測量均以病灶最大截面為中心上下測量三次,取其均值。結(jié)果:(1)采用兩個(gè)獨(dú)立樣本t檢驗(yàn)方法進(jìn)行比較,結(jié)直腸管狀腺癌組與黏液腺癌組在動脈期碘濃度、NIC、有效原子序數(shù)及靜脈期NIC差異具有統(tǒng)計(jì)學(xué)意義(P0.05),黏液腺癌組動脈期碘濃度、NIC、有效原子序數(shù)稍高于管狀腺癌組;黏液腺癌組門脈期及靜脈期碘濃度高于動脈期,門脈期及靜脈期碘濃度二者之間相近,不具有統(tǒng)計(jì)學(xué)意義。水濃度在三者間各期均無統(tǒng)計(jì)學(xué)意義。而結(jié)直腸癌組與潰瘍性結(jié)腸炎組比較顯示潰瘍性結(jié)腸炎組動脈期碘濃度雖高于結(jié)直腸癌組,但無統(tǒng)計(jì)學(xué)意義(P=0.336),其它各期潰瘍性結(jié)腸炎組碘濃度、NIC、有效原子序數(shù)均高于結(jié)直腸癌組,具有統(tǒng)計(jì)學(xué)意義(P0.05)。(2)40~90ke V中不同病理類型各期能譜曲線均呈逐漸遞減型(隨Ke V值降低病灶的CT值逐漸增大),能譜曲線斜率均為負(fù)值,結(jié)直腸管狀腺癌組動脈期曲線斜率為-1.54±0.84,黏液腺癌曲線斜率為-1.99±0.35,二者具有統(tǒng)計(jì)學(xué)意義(P=0.01),黏液腺癌曲線斜率的絕對值大于管狀腺癌,能譜曲線圖上粘液腺癌位于管狀腺癌上方,門脈期及靜脈期二者無統(tǒng)計(jì)學(xué)意義。結(jié)直腸癌組與潰瘍性結(jié)腸炎組各期曲線斜率均具有統(tǒng)計(jì)學(xué)意義,能譜曲線圖上潰瘍性結(jié)腸炎位于結(jié)直腸癌上方。(3)采用兩個(gè)獨(dú)立樣本t檢驗(yàn)方法,進(jìn)行中分化腺癌與低分化腺癌二小組間能譜參數(shù)比較,發(fā)現(xiàn)中分化腺癌動脈期碘濃度、NIC、有效原子序數(shù)及能譜曲線斜率(計(jì)算方法同前)均高于低分化腺癌,且二者之間差異均具有統(tǒng)計(jì)學(xué)意義,P值均0.05;而其它兩期所見能譜各參數(shù)大小相近,差異不具有統(tǒng)計(jì)學(xué)意義,水濃度三期均不具有統(tǒng)計(jì)學(xué)意義。動脈期碘濃度、NIC、有效原子序數(shù)、能譜曲線斜率的AUC分別為0.723、0.772、0.750和0.769,當(dāng)其診斷閾值分別設(shè)為5.85(100ug/m1)、0.08、7.95、-1.04時(shí),其判定結(jié)直腸管狀腺癌中、低分化程度的敏感度、特異度分別為(92.3%、52.6%)、(88.5%、73.7%)、(92.3%、68.4%)、(73.7%、88.5%)。結(jié)論:(1)能譜CT碘濃度、NIC、能譜曲線斜率及有效原子序數(shù)對鑒別結(jié)直腸管狀腺癌、粘液腺癌以及結(jié)直腸癌與潰瘍性結(jié)腸炎有價(jià)值,能在一定程度上反應(yīng)其病理特點(diǎn)。(2)水濃度對鑒別結(jié)直腸管狀腺癌、粘液腺癌以及結(jié)直腸癌與潰瘍性結(jié)腸炎意義不大。(3)動脈期的能譜參數(shù)(碘濃度、NIC、有效原子序數(shù)及能譜曲線斜率)可以鑒別管狀腺癌的分化程度,特別是NIC具有更加可靠的診斷效能。
[Abstract]:Objective: through the observation and analysis of spectral parameters of the preliminary study of spectral CT on colorectal cancer pathological typing and identification of ulcerative colitis application. Methods: a retrospective selection through colonoscopy or postoperative pathological diagnosis of colorectal lesions in 63 cases (54 cases of colorectal cancer, 9 cases of ulcerative colitis). Divided into colorectal adenocarcinoma group: a total of 42 cases including 25 cases in moderate differentiation, 17 cases of poorly differentiated mucinous adenocarcinoma; 12 cases; 9 cases of ulcerative colitis group. Patients signed informed consent before the examination, the application of GE (Discovery gemstone CT CT 750 HD) in the spectrum scanning mode (GSI) under scanning. All patients underwent arterial phase, portal venous phase and venous phase three whole abdominal GSI spectrum scanning scanning mode, all patients were never before scanning the corresponding treatment. The scanning range from the diaphragm to the pubic symphysis of the lower edge of the top level, the use of GE ADW4.6 work station spectrum analysis software Energy spectrum image analysis, get the each arterial phase, portal venous phase and venous phase spectrum curve and the iodine kitu, water-based map, histogram, scatter plot, observation group of colorectal tubular adenocarcinoma, mucinous adenocarcinoma, colorectal cancer group and ulcerative enteritis group and colorectal tubular adenocarcinoma group in differentiated adenocarcinoma and low differentiated adenocarcinoma in the spectrum attenuation curve of morphological differences, and compare the different iodine concentration, water concentration between groups of lesions, the normalized iodine concentration (normalized iodine, concentration, NIC) concentration of iodine iodine concentration / = abdominal aortic lesions, effective atomic number (effective atomic, number, Eff-Z) and the focus in the period of energy spectrum curve slope K = (HU40kev-HU90kev) / (40-90) differences, and independent samples t test. Finally the colorectal tubular adenocarcinoma (colorectal tubular cancer) in the area, the parameters of ROC curve of low differentiated AUC, The sensitivity, specificity and Youden index, the best diagnostic threshold, and to evaluate the diagnostic efficacy of various parameters. All spectrum data measurements were using maximum section lesions centering on the three measurements, the mean value. Results: (1) using two independent sample t test method, colorectal adenocarcinoma group with mucinous adenocarcinoma in iodine concentration, arterial NIC, significant effective atomic number and venous phase difference of NIC (P0.05), mucinous adenocarcinoma group, arterial iodine concentration, NIC, effective atomic number is slightly higher than that of tubular adenocarcinoma; mucinous adenocarcinoma and iodine concentration in portal venous phase and venous phase than in arterial phase similar, between the portal venous phase and venous phase iodine concentration two, not statistically significant. The concentration of water in between the three periods were not statistically significant. While the colorectal cancer group and ulcerative colitis group comparison showed that iodine concentration in ulcerative colitis group was higher than that in colorectal arterial phase Colorectal cancer group, but no statistical significance (P=0.336) and other ulcerative colitis group iodine concentration, NIC, effective atomic number was higher than that in colorectal cancer group, with statistical significance (P0.05). (2) 40~90ke V in different pathological types of the spectrum curve showed a gradually decreasing (to reduce the CT values of lesions with increasing Ke value of V), energy spectrum curve slope were negative, colorectal adenocarcinoma group, the arterial phase slope of the curve is -1.54 + 0.84, mucinous adenocarcinoma curve slope is -1.99 + 0.35, the two groups was statistically significant (P=0.01), the absolute value of the slope of the curve is greater than that of mucinous adenocarcinoma of tubular adenocarcinoma, energy spectrum the graph of mucinous adenocarcinoma of tubular adenocarcinoma located above the portal venous phase and two was not statistically significant. Colorectal cancer group and ulcerative colitis group in each stage of the slope of the curve was statistically significant, energy spectrum curve on ulcerative colitis in colorectal cancer (3) collected above. Two independent samples t test, comparison of spectral parameters of moderately differentiated adenocarcinoma and poorly differentiated adenocarcinoma were found between the two groups, the iodine concentration in differentiated adenocarcinoma, arterial phase NIC, effective atomic number and energy spectrum curve slope (calculation method with) were higher than that of low differentiated adenocarcinoma, and the difference between the two were statistically significant, P value was 0.05; while the other two see spectral parameters of similar size, the difference was not statistically significant, the water concentration of three was not statistically significant. The iodine concentration, arterial NIC, effective atomic number, energy spectrum curve of AUC 0.723,0.772,0.750 and 0.769 respectively, when the diagnosis the threshold was set to 5.85 (100ug/m1), 0.08,7.95, -1.04, the determination of colorectal tubular adenocarcinoma, low differentiation degree of sensitivity and specificity were respectively (92.3%, 52.6%), (88.5%, 73.7%), (92.3%, 68.4%), (73.7%, 88.5%). Conclusion: (1) energy spectrum CT iodine concentration, NIC, Energy spectrum curve slope and the effective atomic number in the differential diagnosis of colorectal tubular adenocarcinoma, mucinous adenocarcinoma, colorectal cancer and ulcerative colitis can have value, the pathological features of reaction to a certain extent. (2) the water concentration in differential diagnosis of colorectal tubular adenocarcinoma, mucinous adenocarcinoma, colorectal cancer and ulcerative colitis significance (a little. 3) spectral parameters of arterial phase (iodine concentration, NIC, effective atomic number and energy spectrum curve slope) can identify the degree of differentiation of tubular adenocarcinoma, especially NIC has diagnostic performance more reliable.

【學(xué)位授予單位】：承德醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R735.34;R730.44

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