本文選題：寶石能譜CT成像　切入點(diǎn)：胃癌　出處：《揚(yáng)州大學(xué)》2014年碩士論文　論文類(lèi)型：學(xué)位論文

【摘要】：第一部分探討能譜CT術(shù)前評(píng)估胃癌病理類(lèi)型的應(yīng)用價(jià)值 目的探討寶石能譜CT術(shù)前評(píng)估胃癌病理類(lèi)型的臨床應(yīng)用價(jià)值。 方法回顧性分析2012年2月至2013年12月期間經(jīng)我院胃鏡診斷為胃癌并且于術(shù)前經(jīng)寶石CT能譜成像(gemstone spectral imaging, GSI)雙期增強(qiáng)掃描的患者91例,分別于動(dòng)脈期及靜脈期測(cè)量病灶的碘濃度、水濃度及能譜曲線(xiàn)斜率,并對(duì)不同病理類(lèi)型胃癌之間的能譜特征參數(shù)進(jìn)行單因素方差分析,與術(shù)后病理結(jié)果相對(duì)照。結(jié)果在91例胃癌患者中,管狀腺癌38例,印戒細(xì)胞癌27例,粘液腺癌16例。動(dòng)脈期管狀腺癌、印戒細(xì)胞癌、粘液腺癌的平均碘濃度分別為(11.57±3.54)×l00ug/cm3、(9.53±3.25)×100ug/cm3、(5.31±1.33)×100ug/cm3,三者之間均有統(tǒng)計(jì)學(xué)差異(P0.001)；靜脈期管狀腺癌、印戒細(xì)胞癌、粘液腺癌的碘濃度分別為(22.46±8.32)×100ug/cm3、.07±1.82)×100ug/cm3、(18.06±2.92)×100ug/cm3,管狀腺癌分別與印戒細(xì)胞癌及粘液腺癌比較有統(tǒng)計(jì)學(xué)差異(P0.001),而印戒細(xì)胞癌與粘液腺癌之間無(wú)明顯統(tǒng)計(jì)學(xué)差異(P=0.99)。標(biāo)準(zhǔn)化后的碘濃度也呈現(xiàn)上述規(guī)律,即動(dòng)脈期三者間均有統(tǒng)計(jì)學(xué)差異(P0.001),而靜脈期印戒細(xì)胞癌及粘液腺癌之間無(wú)統(tǒng)計(jì)學(xué)差異(P=0.85)。動(dòng)脈期管狀腺癌、印戒細(xì)胞癌、粘液腺癌三組的平均能譜曲線(xiàn)斜率依次降低,分別為(-1.36±0.46)、(-1.16±0.39)、(-0.64±0.16),均有統(tǒng)計(jì)學(xué)差異(P0.001)；靜脈期管狀腺癌(-2.70±1.00)分別與印戒細(xì)胞癌(-2.20±0.23)及粘液腺癌(-2.17±0.35)相比均有統(tǒng)計(jì)學(xué)差異(P0.05),而印戒細(xì)胞癌及粘液腺癌之間的斜率無(wú)統(tǒng)計(jì)學(xué)差異(P=0.86)。 結(jié)論寶石CT能譜成像有利于術(shù)前胃癌病理類(lèi)型的評(píng)估。 第二部分探討能譜CT對(duì)胃癌術(shù)前T分期的應(yīng)用價(jià)值 目的探討寶石CT能譜成像判斷胃癌術(shù)前T分期的臨床應(yīng)用價(jià)值。 方法回顧性分析2012年2月至2013年12月期間經(jīng)我院胃鏡診斷為胃癌并且于術(shù)前經(jīng)寶石CT能譜成像(gemstone spectral imaging, GSI)雙期增強(qiáng)掃描的患者91例。將觀(guān)察者分為A、B兩組,A組觀(guān)察者通過(guò)分析混合能量圖像對(duì)91例患者進(jìn)行胃癌術(shù)前T分期的判斷；B組觀(guān)察者通過(guò)分析最佳單能量圖像及碘-水圖像進(jìn)行T分期的判斷。以術(shù)后病理分期為標(biāo)準(zhǔn),分析兩組圖像對(duì)胃癌術(shù)前T分期的準(zhǔn)確性,采用卡方檢驗(yàn)比較兩者是否有統(tǒng)計(jì)學(xué)差異,以P0.05為差異有統(tǒng)計(jì)學(xué)意義。 結(jié)果本研究中所測(cè)得動(dòng)脈期胃癌病灶最佳單能量的平均值為53±6keV靜脈期的平均值為58±8keV。A組觀(guān)察者通過(guò)混合能量圖像對(duì)胃癌術(shù)前T分期總的準(zhǔn)確率為61.5%(56/91),T1期為91.2%(83/91),T2期為78.0%(70/.91),T3期為73.6%(67/91),T4期為80.2%(73/91)；B組觀(guān)察者通過(guò)最佳單能量圖像和碘-水圖像進(jìn)行分析判斷,對(duì)胃癌T分期總的準(zhǔn)確率為76.9%(70/91),T1期為94.5%(86/91),T2期為84.6%(77/91),T3期為83.5%(76/91),T4期為91.2%(83/91)�？ǚ綑z驗(yàn)顯示兩種觀(guān)察方法對(duì)胃癌術(shù)T分期總的準(zhǔn)確率有統(tǒng)計(jì)學(xué)差異(P=0.036),但對(duì)T1-T4期的差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。 結(jié)論與混合能量圖像相比能譜成像對(duì)胃癌術(shù)前T分期的準(zhǔn)確率較高。能譜CT在術(shù)前判斷胃癌浸潤(rùn)深度的研究中具有重要臨床應(yīng)用價(jià)值。
[Abstract]:The first part discusses the application value of CT preoperative assessment of the pathological types of gastric cancer
Objective to evaluate the clinical value of gems CT preoperative assessment of the pathological types of gastric cancer.
Methods Retrospective analysis of February 2012 to December 2013 in our hospital for gastric cancer diagnosed by gastroscopy and preoperative spectral CT imaging (gemstone spectral, imaging, GSI) dual phase enhanced scans of 91 patients, the iodine concentration in the arterial phase and venous phase measurement of lesions, the concentration of water and energy spectrum curve slope, and the spectral characteristic parameters of single factor analysis of variance between the different pathological types of gastric cancer, and postoperative pathology. Results in 91 cases of gastric cancer, 38 cases of tubular adenocarcinoma, 27 cases of signet ring cell carcinoma, 16 cases of mucinous adenocarcinoma. Arterial tubular adenocarcinoma, signet ring cell carcinoma, mean the iodine concentration of mucinous carcinoma respectively (11.57 + 3.54) * l00ug/cm3 (9.53 + 3.25) * 100ug/cm3 (5.31 + 1.33) * 100ug/cm3, were statistically significant difference between the three (P0.001); venous phase of tubular adenocarcinoma, signet ring cell carcinoma, iodine concentration ade - nocarcinoma respectively (22.46 + 8 .32)脳100ug/cm3,.07鹵1.82)脳100ug/cm3,(18.06鹵2.92)脳100ug/cm3,綆＄姸鑵虹檶鍒嗗埆涓庡嵃鎴掔粏鑳?yōu)鐧屽強(qiáng)绮樻恫鑵虹檶姣旇緝鏈壘l熻瀛﹀樊寮，

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