本文選題：孤立性肺結(jié)節(jié)　切入點：體層攝影技術(shù)　出處：《延邊大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的探討320排CT首過雙入口灌注技術(shù)及灌注TDC曲線最大斜率法的應(yīng)用對于孤立性肺結(jié)節(jié)良惡性的診斷價值。分析各個灌注值BF、PF、PI、TPF及灌注TDC曲線中左心房達峰時間前后出現(xiàn)的最大斜率對于鑒別良惡性孤立性肺結(jié)節(jié)的意義,為早期診斷、治療、評估SPN提供依據(jù)。方法分析我院經(jīng)CT平掃發(fā)現(xiàn)孤立性肺結(jié)節(jié)患者51例,均行320排雙入口肺部灌注掃描,全部病例經(jīng)病理證實,其中惡性結(jié)節(jié)35例,良性結(jié)節(jié)16例。所有掃描均選用東芝Aquilion One 320排CT Lung Perfusion掃描程序進行容積掃描,運用雙入口體部灌注軟件對數(shù)據(jù)進行采集與處理,通過軟件運算獲得良、惡性結(jié)節(jié)的肺動脈血流量(PF)、支氣管動脈血流量(BF)及灌注指數(shù)(PI),并計算出總體灌注量(TPF)及分析病灶時間-密度曲線(TDC)在左心房達峰時間(LA-TTP)前后出現(xiàn)兩段上升支曲線的斜率變化情況,分別獲取的良、惡性SPN的灌注參數(shù)及LA-TTP前后SPN上升支曲線的斜率值。利用SPSS統(tǒng)計學(xué)軟件對數(shù)據(jù)進行分析,以P0.05視為數(shù)據(jù)之間差異具有統(tǒng)計學(xué)意義。結(jié)果1.灌注參數(shù):惡性、良性SPN的支氣管動脈血流量(BF)比較有統(tǒng)計學(xué)差異(P0.01);惡性、良性SPN的灌注指數(shù)(PI)比較有統(tǒng)計學(xué)差異(P0.01)。其中,將良性組SPN分為炎性組SPN及結(jié)核球組SPN,分別對惡性組、炎性組、結(jié)核球組SPN的各灌注參數(shù)之間進行相互比較,惡性組SPN的BF值分別與炎性組BF值、結(jié)核球組BF值比較,存在有統(tǒng)計學(xué)差異(P0.01、P0.01);炎性組SPN的PF值分別與惡性組PF值、結(jié)核球組PF值比較,存在統(tǒng)計學(xué)差異(P0.01、P0.01);惡性組PI值、炎性組PI值、結(jié)核球組PI值進行相互比較,均有統(tǒng)計學(xué)差異(惡性組、炎性組比較P0.01,惡性組、結(jié)核球組比較P0.05,炎性組、結(jié)核球組比較P0.01);結(jié)核球組SPN的TPF值分別與惡性組TPF值及炎性組TPF值比較,存在統(tǒng)計學(xué)差異(P0.01、P0.05)。2.達峰時間比較:惡性、良性SPN的TDC曲線中肺動脈達峰時間(PA-TTP)、左心房達峰時間(LA-TTP)、主動脈達峰時間(A-TTP)、SPN達峰時間(SPN-TTP)進行比較,無統(tǒng)計學(xué)差異(P0.05)。3.最大斜率比較:惡性、良性組SPN的TDC曲線中,LA-TTP前出現(xiàn)的上升曲線的最大斜率、LA-TTP后出現(xiàn)的上升曲線的最大斜率、SPN的TDC曲線總體斜率,組間比較分別有統(tǒng)計學(xué)差異(P0.05、P0.01、P0.01)。在惡性組中LA-TTP前、后上升曲線的最大斜率比較有統(tǒng)計學(xué)差異(P0.01),稱之為主動脈型曲線,惡性TDC曲線共計35例均為此類曲線;在良性組中LA-TTP前、后上升曲線的最大斜率比較有統(tǒng)計學(xué)差異(P0.01),稱之為肺動脈型曲線,其中11例炎性SPN曲線呈典型的肺動脈型曲線,5例結(jié)核球SPN曲線呈上升緩慢的低平曲線,稱為結(jié)核球型曲線。4.通過ROC曲線分析所得,灌注指數(shù)PI值的ROC曲線下面積最大,為0.952(P0.01),BF、PF 及 TPF 的 ROC 曲線下面積分別為 0.084、0.570、0.332,當PI取值47.85%,診斷惡性SPN的敏感度及特異度最高分別為87.50%、91.40%。5.應(yīng)用Spearman相關(guān)分析所得,惡性組SPN的直徑與PI值的相關(guān)性最大,相關(guān)系數(shù)為-0.701(P0.01),與BF、PF、TPF值的相關(guān)系數(shù)均沒有PI值的相關(guān)系數(shù)高。6.各惡性病理分型的灌注值比較:進行腺癌、鱗癌、小細胞肺癌的各個灌注參數(shù)之間比較,無統(tǒng)計學(xué)差異(P0.05)。結(jié)論首過雙入口 CT灌注技術(shù)所得到的灌注參數(shù)及病灶TDC曲線最大斜率法的應(yīng)用可以對孤立性肺結(jié)節(jié)的血流供應(yīng)情況及良惡性鑒別提供有力參考。
[Abstract]:Objective to investigate the application of 320 slice CT first pass perfusion technique and double entrance perfusion TDC curve of maximum slope method for the value of benign and malignant solitary pulmonary nodule diagnosis. Analysis of the various perfusion values of BF, PF, PI, TPF and TDC perfusion curve of left atrium reached the maximum slope of the peak time occurred before and after for identification of benign and malignant solitary pulmonary nodules significance for early diagnosis, treatment, provide the basis for the assessment of SPN. Methods: analysis of our hospital by CT scan found 51 cases of patients with solitary pulmonary nodules, underwent 320 slice dual entrance lung perfusion scan, all cases were confirmed by pathology, including 35 cases of malignant nodules, 16 cases of benign nodules. All scans are used for Toshiba Aquilion One CT Lung volume scanning of 320 slice Perfusion scanner, data acquisition and processing by using double entrance body perfusion software. Through the software operation was good, pulmonary blood flow of malignant nodules (PF), bronchial artery Blood flow (BF) and perfusion index (PI), and calculate the total perfusion (TPF) and analysis of time density curve (TDC) lesions in the left atrium peak time (LA-TTP) before and after the change of slope of the ascending branch curve two, respectively, obtained good, slope before and after the perfusion parameters and LA-TTP of malignant SPN SPN rising branch curve value. The data were analyzed by SPSS statistical software, using P0.05 as the statistically significant differences between the 1. data. Results: malignant bronchial artery perfusion parameters, blood flow in benign SPN (BF) were statistically significant difference (P0.01); malignant, benign SPN perfusion index (PI) compared with statistical difference (P0.01). Among them, the SPN group is divided into benign inflammatory group SPN and group SPN respectively for tuberculosis, malignant group, inflammatory group, the perfusion parameters between tuberculoma group SPN comparison, the SPN of malignant group BF respectively and inflammatory group BF, tuberculoma 緇凚F鍊兼瘮杈，

本文編號：1578286