本文選題：超聲檢查　切入點(diǎn)：融合成像　出處：《山東大學(xué)》2014年碩士論文　論文類型：學(xué)位論文

【摘要】：研究背景與目的 肝臟是人體內(nèi)最大的、最重要的消化腺,它承擔(dān)維持人體生命活動(dòng)的重要功能,參與機(jī)體的消化、代謝、分泌、解毒、排泄、吞噬與防御等過程。近年來,隨著科學(xué)技術(shù)水平的不斷提高,超聲醫(yī)學(xué)的成像技術(shù)和檢查方法的迅速發(fā)展,超聲以其無創(chuàng)、實(shí)時(shí)、高效、廉價(jià)等優(yōu)點(diǎn)在臨床診斷、治療中被廣泛應(yīng)用,肝臟局灶性病變的檢出率、定位和定性診斷的準(zhǔn)確性得以大大提高。肝臟局灶性病變主要包括肝囊腫、肝血管瘤、肝膿腫、肝臟局灶性結(jié)節(jié)性增生、肝臟孤立壞死結(jié)節(jié)等良性病變及肝臟原發(fā)性、繼發(fā)性惡性腫瘤。由于良惡性病變的生物學(xué)特點(diǎn)明顯不同,對人體的影響有顯著差別,因此區(qū)別良惡性病變對臨床治療方案的選擇、預(yù)后的判斷具有重大意義。 受超聲波物理學(xué)特性、超聲診斷儀性能、檢查者操作手法等因素影響,常規(guī)超聲對等回聲病灶、肝硬化背景、多次介入術(shù)后、位于膈下、被胃腸道氣體遮擋的病灶等顯示存在一定的困難。而CT不易受上述因素影響,成像質(zhì)量較高,但實(shí)時(shí)性差,檢查費(fèi)用較高,具有放射性損傷。融合成像技術(shù)成功地結(jié)合兩種成像技術(shù)的優(yōu)勢,即超聲的實(shí)時(shí)性和CT的空間分辨力,采用磁定位技術(shù)將超聲與CT圖像在空間上配對融合,實(shí)現(xiàn)二者在任意切面實(shí)時(shí)同屏顯示,不但擴(kuò)大了顯像范圍,而且還能夠?qū)Σ≡钸M(jìn)行定性診斷,具有廣闊的臨床應(yīng)用前景。 本研究應(yīng)用融合成像技術(shù)對肝臟局灶性病變進(jìn)行定位、定性診斷,以明確該技術(shù)的可行性及準(zhǔn)確性,探討其臨床應(yīng)用價(jià)值。 資料與方法 1.臨床資料收集2013年7月至2014年1月在山東大學(xué)齊魯醫(yī)院檢查發(fā)現(xiàn)肝臟局灶性病變的患者共42例,其中男24例,女18例,年齡31歲至73歲,平均(55.88±9.94)歲。其中7例有結(jié)腸癌病史,3例有腎癌病史,1例有肺癌病史, 1例有胃癌病史,1例有宮頸癌病史。 2.儀器與方法 2.1實(shí)驗(yàn)儀器超聲儀器為美國GE公司生產(chǎn)的LOGIQ E9彩色多普勒超聲診斷儀,配備有C5-1寬頻凸陣探頭,頻率為3～5MHz。融合成像系統(tǒng)由內(nèi)置于超聲診斷儀的融合成像軟件及場頻信號發(fā)生器、示蹤儀器、工具連接單元等構(gòu)成。CT使用SIEMENS16層和Philip MAX80004層螺旋CT,造影劑為優(yōu)維顯或碘海醇。 2.2研究方法選擇肝內(nèi)管道結(jié)構(gòu)及病灶均顯示清晰的增強(qiáng)CT圖像,將DICOM格式的CT圖像導(dǎo)入彩色多普勒超聲診斷儀內(nèi),采用內(nèi)部點(diǎn)配準(zhǔn)法中的點(diǎn)-面配準(zhǔn)法進(jìn)行圖像融合。圖像融合成功后,記錄融合成像所需時(shí)間、病灶的數(shù)目及聲像圖特征,并做出定性診斷。將診斷結(jié)果與綜合臨床表現(xiàn)、其他影像學(xué)檢查、實(shí)驗(yàn)室檢查、術(shù)后病理、穿刺活檢及隨訪得出的結(jié)論對比,比較融合成像技術(shù)與CT檢查技術(shù)對病灶定性診斷的準(zhǔn)確性。 3.統(tǒng)計(jì)學(xué)處理采用SPSS19.0軟件包進(jìn)行統(tǒng)計(jì)學(xué)分析,計(jì)量資料采用(x±s)表示。組間對比采用兩獨(dú)立樣本的非參數(shù)檢驗(yàn),P0.05為差異具有統(tǒng)計(jì)學(xué)意義。 結(jié)果 1.42例患者融合成像成功率為100%,融合成像所需時(shí)間為4～9min,平均(5.90±1.20)min。 2.42例患者共64個(gè)肝臟局灶性病變,其中26例患者有1個(gè)病灶,13例患者有2個(gè)病灶,4例患者有3個(gè)病灶。病灶直徑為0.29～10.05cm,平均(1.92±1.97)cm。常規(guī)超聲共顯示51個(gè)病灶,病灶檢出率為79.69%(51/64),增強(qiáng)CT共顯示63個(gè)病灶,病灶檢出率為98.43%(63/64),融合成像技術(shù)成功顯示62個(gè)病灶,病灶檢出率為96.87%(62/64),其中61個(gè)病灶與CT圖像顯示位置一致,1個(gè)病灶在CT圖像中未顯示。常規(guī)超聲與融合成像技術(shù)病灶檢出率的差異具有統(tǒng)計(jì)學(xué)意義(P0.05),增強(qiáng)CT與融合成像技術(shù)病灶檢出率的差異不具有統(tǒng)計(jì)學(xué)意義(P0.05)。 3.64個(gè)肝臟局灶性病變,CT明確診斷38個(gè)病灶,明確診斷率為58.46%(38/64),包括17個(gè)肝血管瘤病灶(包括融合成像技術(shù)未能顯示的2個(gè)病灶),1個(gè)肝臟假脂瘤病灶,8個(gè)肝細(xì)胞肝癌病灶,12個(gè)轉(zhuǎn)移性肝癌病灶。其余26個(gè)病灶未能做出明確診斷。融合成像技術(shù)明確診斷病灶59個(gè)病灶,‘明確診斷率為92.18%(59/64),其中36個(gè)病灶與CT診斷結(jié)果一致,另外還包括9個(gè)肝血管瘤病灶,1個(gè)肝臟孤立壞死結(jié)節(jié)病灶,5個(gè)肝細(xì)胞肝癌病灶,8個(gè)轉(zhuǎn)移性肝癌病灶。增強(qiáng)CT與融合成像技術(shù)的明確診斷率的差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。4.與最終臨床診斷結(jié)果對比,CT檢查技術(shù)診斷準(zhǔn)確率為59.38%(38/64),包括17個(gè)肝血管瘤病灶,1個(gè)肝臟假脂瘤病灶,8個(gè)肝細(xì)胞肝癌病灶,11個(gè)轉(zhuǎn)移性肝癌病灶。融合成像技術(shù)診斷準(zhǔn)確率為89.06%(57/64),包括26個(gè)肝血管瘤病灶,1個(gè)肝臟孤立壞死結(jié)節(jié)病灶,1個(gè)肝臟假脂瘤病灶,11個(gè)肝細(xì)胞肝癌病灶,22個(gè)轉(zhuǎn)移性肝癌病灶。增強(qiáng)CT與融合成像技術(shù)的診斷準(zhǔn)確率的差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。 結(jié)論 融合成像技術(shù)操作簡便,安全無創(chuàng),對于肝臟局灶性病變的檢出、定位、定性診斷開辟了一條新的途徑,展現(xiàn)出廣闊的臨床應(yīng)用前景。
[Abstract]:Research background and purpose
The liver is the body's largest, the most important digestive gland, its important function to undertake the maintenance of human life activities, involved in digestion, metabolism, excretion, secretion, detoxification, phagocytosis and defense process. In recent years, with the improvement of science and technology, the rapid development of imaging technology and inspection method of ultrasonic medicine the ultrasound with its non-invasive, real-time, efficient, cheap and other advantages is widely used in clinical diagnosis, treatment, detection rate of focal liver lesions, and the positioning accuracy can be greatly improved. The qualitative diagnosis of focal liver lesions mainly include liver cyst, liver hemangioma, liver abscess, hepatic focal nodular hyperplasia, solitary necrotic nodule of liver benign lesions such as liver and primary and secondary malignant tumor. The biological characteristics of benign and malignant lesions were significantly different. There was a significant difference between the effects on the human body, so the difference between benign and malignant lesions It is of great significance to the choice of the clinical treatment plan and the judgement of the prognosis.
By ultrasonic physics characteristics, ultrasonic diagnostic instrument performance, effect examination practices and other factors, the conventional ultrasonic echo equivalence lesion, cirrhosis, multiple times after PCI, located under the diaphragm, the gastrointestinal tract gas occlusion lesions showed that there are some difficulties. But CT is not affected by the above factors, high imaging quality, but the real-time inspection cost is higher, with radiation injury. Imaging techniques successfully combined the two imaging technology, namely real-time ultrasound and CT spatial resolution, using the magnetic positioning technology with ultrasonic CT image matching in space fusion, the two section in real time with the screen display. Not only to expand the range of imaging, but also can make a qualitative diagnosis of the lesions, has broad clinical application prospect.
In this study, we applied the fusion imaging technology to locate the liver focal lesions and make qualitative diagnosis, so as to clarify the feasibility and accuracy of the technology, and to explore its clinical application value.
Information and methods
Focal liver lesions were found in 42 cases of 1. clinical data collected from July 2013 to January 2014 in Qilu Hospital of Shandong University, including 24 male cases, 18 female patients, aged 31 to 73 years old, the average (55.88 + 9.94) years old. There were 7 cases with colon cancer, 3 cases of renal cell carcinoma and 1 cases of history. History of lung cancer,
1 cases had a history of gastric cancer and 1 had a history of cervical cancer.
2. instruments and methods
2.1 experimental instrument ultrasonic instrument was produced by American GE company LOGIQ E9 color Doppler ultrasonic diagnostic apparatus, equipped with a C5-1 broadband convex array probe, frequency of 3 ~ 5MHz. fusion imaging system by fusion imaging software and built-in audio signal generator, the ultrasonic diagnostic instrument tracing instrument, tool connecting unit composed of.CT and Philip use the SIEMENS16 layer. MAX80004 slice CT, contrast agent Ultravist or iohexol.
2.2 research methods of pipeline structure and lesions showed enhanced clear CT images, DICOM format image into CT color Doppler ultrasonic diagnostic apparatus, using the internal point registration method of point surface registration method for image fusion. Image fusion is successful, as the time required for integration into the record, number and specific map features of lesions, and make qualitative diagnosis. The diagnostic results and clinical manifestations, laboratory examination, other imaging examination, postoperative pathology, biopsy and follow-up comparison conclusion, comparing the fusion imaging and CT technology on the accuracy of qualitative diagnosis of the lesions.
3. statistical processing was carried out by SPSS19.0 software package, and the data were expressed by (x + s). Compared with two independent samples, P0.05 was statistically significant.
Result
The successful rate of fusion imaging in 1.42 patients was 100%, and the time required for fusion imaging was 4 ~ 9min, with an average of (5.90 + 1.20) min.
2.42 patients with 64 focal liver lesions, including 26 patients with 1 lesions, 13 patients with 2 lesions, 4 patients with 3 lesions. The lesion diameter was 0.29 ~ 10.05cm, the average (1.92 + 1.97) cm. ultrasound showed a total of 51 lesions, the lesion detection rate was 79.69% (51/64), enhanced CT a total of 63 lesions, the lesion detection rate was 98.43% (63/64), fusion imaging technology showed 62 lesions, the lesion detection rate was 96.87% (62/64), of which 61 lesions and CT images showed the same location, 1 lesions did not appear in the CT image. The difference was statistically significant conventional ultrasound imaging and fusion lesion detection rate (P0.05), enhance the difference between CT and fusion imaging lesions detection rate was not statistically significant (P0.05).
3.64 focal liver lesions, CT diagnosed 38 lesions, the diagnosis rate was 58.46% (38/64), including 17 hepatic hemangiomas (including fusion imaging failed to display of 2 lesions), 1 liver pseudolipoma lesions, 8 lesions of hepatocellular carcinoma, 12 metastatic liver lesions. The remaining 26 lesions failed to make a clear diagnosis. Fusion imaging technique in diagnosis of lesions in 59 lesions, "the diagnosis rate was 92.18% (59/64), of which 36 lesions and CT diagnosis results, also including 9 hepatic hemangiomas, 1 hepatic isolated section 5 bad knot lesions of hepatocellular carcinoma the lesion, 8 metastatic liver lesions. The differences of CT and enhance the fusion imaging diagnosis rate was statistically significant (P0.05) compared to.4. with the final clinical diagnosis results, the diagnostic accuracy of CT examination was 59.38% (38/64), including 17 hepatic hemangiomas, 1 hepatic false 鑴傜槫鐥呯伓,8涓倽緇嗚優(yōu)鑲濈檶鐥呯伓,11涓漿縐繪，

本文編號：1619473