本文選題：腹部 + 計算機體層攝影　； 參考：《安徽醫(yī)科大學(xué)》2014年博士論文

【摘要】：雙能量能譜CT(dual-energy spectral computed tomography,DESCT)是一項嶄新的影像技術(shù),它具有以下技術(shù)特征:去除硬化偽影;優(yōu)化圖像及圖像的對比噪聲比;進行物質(zhì)定量分析;進行能譜綜合分析。本研究應(yīng)用DESCT能譜分析軟件(gemstone spectral imaging,GSI)對壺腹周圍癌的圖象進行分析,并與手術(shù)病理結(jié)果進行對照,探討能譜CT在壺腹周圍癌的的術(shù)前診斷及手術(shù)可切除性評估中的價值。研究分為三個部分:第一部分:對腹部雙能量能譜CT成像中混合能量模式與單能量模式重建圖像的進行比較研究,探討單能量重建模式對圖像質(zhì)量的影響;第二部分,通過雙能量能譜CT的物質(zhì)定量分析技術(shù)對病變進行分析,探討CT能譜成像在鑒別壺腹周圍癌的組織起源中的價值;第三部分,應(yīng)用雙能量能譜CT對壺腹周圍癌手術(shù)可切除性進行評價,并與手術(shù)病理進行對照。第一部分目的通過比較單源雙能量CT腹部能譜成像后,混合能量重建圖像與單能量重建圖像質(zhì)量,篩選適合臨床應(yīng)用的重建模式。方法應(yīng)用能譜CT(Discovery CT750HD,GE Healthcare,USA)對40例患者行CT平掃及雙期增強掃描。分別采用混合能量模式及單能量模式重建。測量并比較肝臟、胰腺、脾臟及腹腔脂肪的CT值,分別計算各組織臟器的信噪比、對比噪聲比及背景噪聲。并對兩組圖像進行評分。結(jié)果單能量重建圖像中組織及器官的SNR、CNR均高于混合能量重建圖像,且單能量重建圖像質(zhì)量評分高于混合能量重建圖像。結(jié)論單能量重建圖像質(zhì)量優(yōu)于混合能量重建圖像,可以作為臨床常規(guī)重建方式使用。第二部分目的通過分析壺腹周圍癌雙能量能譜CT參數(shù)特征,探討CT能譜成像在判斷不同組織來源壺腹部腫瘤中的應(yīng)用價值。方法將行能譜CT檢查并經(jīng)手術(shù)或活檢病理證實的壺腹周圍88例分為三組:胰頭腺癌39例,膽總管末端腺癌22例,十二指腸乳頭腺癌27例。分別測量及比較各組間能譜參數(shù)間的差異。結(jié)果三期增強掃描中,三組之間水濃度均無統(tǒng)計學(xué)差異;碘濃度、標(biāo)準(zhǔn)化碘濃度及斜率均為膽總管末端腺癌組最大,胰頭腺癌組最小,且兩兩比較均有統(tǒng)計學(xué)差異。在十二指腸乳頭腺癌與膽總管末端腺癌組間,當(dāng)門脈期及延遲期NIC(normalized iodine concentration)分別大于0.44及0.72時,鑒別診斷的敏感性為89%、85%,特異性達73%、78%;在膽總管末端腺癌與胰腺癌組間,各測量值的診斷效能均較好,其中當(dāng)門脈期碘濃度25.50mg/m L作為閾值時,敏感度達100%,當(dāng)延遲期碘濃度16.46mg/m L作為閾值時,特異度達100%;胰腺癌與十二指腸乳頭腺癌組間,各期碘濃度值效能較好:當(dāng)門脈期碘濃度10.20mg/m L及延遲期碘值13.49mg/m L作為閾值時,鑒別診斷的敏感度達100%。結(jié)論CT能譜成像多參數(shù)聯(lián)合診斷有助于鑒別壺腹周圍癌的起源。第三部分目的:探討雙能量能譜CT在評估壺腹周圍癌手術(shù)可切除性中的價值。方法:98例壺腹周圍癌患者(后來經(jīng)臨床綜合診斷或病理證實)行DESCT三期增強掃描。原始數(shù)據(jù)采用單能重建模式,采用最佳對比噪聲比對圖像進行優(yōu)化,并應(yīng)用物質(zhì)定量分析技術(shù)及能譜綜合分析技術(shù)分析圖像。判斷腫瘤對血管、淋巴等的浸潤與否,對其進行可切除性評估,并與手術(shù)結(jié)果進行對照分析,計算DESCT預(yù)測壺腹周圍癌手術(shù)可切除的敏感性、特異性、陽性預(yù)測值及陰性預(yù)測值和準(zhǔn)確率。結(jié)果:DESCT判斷壺腹周圍癌血管侵犯的靈敏度達93.8%,特異度達98.3%,準(zhǔn)確率達96.7%;DESCT預(yù)測壺腹周圍癌可切除性靈敏度達96%,特異度達95.7%,準(zhǔn)確率達96%,陽性預(yù)測值為98.6%,陰性預(yù)測值為88%。結(jié)論:DESCT對壺腹周圍癌術(shù)前可切除性評估的敏感性、特異性和準(zhǔn)確性均較高,為壺腹周圍癌術(shù)前分期的理想的影像技術(shù)手段。
[Abstract]:Dual energy spectral CT (dual-energy spectral computed tomography, DESCT) is a new imaging technology, it has the following technical characteristics: the removal of hardening artifacts; optimizing contrast noise ratio of image and image; quantitative analysis; energy spectrum analysis. This research used DESCT spectrum analysis software (gemstone spectral imaging, GSI) on the image of periampullary carcinoma were analyzed and compared with surgical pathology results, to explore the spectrum of CT in the preoperative periampullary cancer diagnosis and surgical resectability evaluation value. Research is divided into three parts: the first part: the spectral CT imaging in mixed mode and energy single mode energy reconstruction image comparison research to explore the influence of abdominal double energy, single energy reconstruction on the image quality; the second part quantitative material by dual energy spectrum analysis of CT lesions were analyzed, Study of spectral CT imaging in differentiating tissue origin of periampullary carcinoma in value; third part, application of dual energy spectral CT of periampullary carcinoma surgical resectability was evaluated, and compared with surgical pathology. The first part through comparison of single source dual energy CT abdominal spectral imaging after reconstruction of mixed energy reconstruction the single energy image and image quality, selection of reconstruction mode suitable for clinical application. Methods using spectral CT (Discovery CT750HD, GE Healthcare, USA) of 40 patients who underwent CT plain and dual phase enhanced scanning. By using mixed mode and single mode of energy energy reconstruction. To measure and compare the liver, pancreas, spleen and abdominal cavity fat CT values were calculated for each organ of SNR, contrast noise ratio and background noise. And scores on two groups of image. In the image reconstruction of the tissues and organs of single energy SNR, CNR are higher than the mixed energy The reconstructed image and the reconstructed image quality score was higher than that of single energy mixed energy images are reconstructed. The reconstructed image quality is better than the single energy conclusion mixed energy reconstruction images can be used as a routine clinical reconstruction. In the second part, through the spectral CT parameters of periampullary carcinoma double energy analysis, investigate the CT spectral imaging diagnostic value on different tissue sources ampullary tumors. Methods for spectrum around CT examination and confirmed by surgery or biopsy of 88 cases were divided into three groups: 39 cases of pancreatic adenocarcinoma, 22 cases of distal common bile duct carcinoma, 27 cases of duodenal adenocarcinoma. The nipples were measured and compared between different spectral parameters results. Three phase enhanced scan, between the three groups were no significant difference between the concentration of water; iodine concentration, normalized iodine concentration and slope were the highest at the end of common bile duct adenocarcinoma, pancreatic adenocarcinoma and 22 comparison group minimum. There were significant differences. In papillary adenocarcinoma of the duodenum and distal common bile duct adenocarcinoma group, and venous phase and delayed phase NIC (normalized iodine concentration) were greater than 0.44 and 0.72, the diagnostic sensitivity was 89%, specificity was 85%, 73%, 78%; end of adenocarcinoma and pancreatic cancer group in the end of common bile duct between the diagnostic efficacy of the measured values are good, which when the pulse period 25.50mg/m L iodine concentration as a threshold, the sensitivity was 100%, when the delay time of 16.46mg/m L as the iodine concentration threshold, the specificity reached 100%; pancreatic carcinoma and papillary adenocarcinoma of the duodenum between groups, the concentration of iodine value better performance when the door pulse 10.20mg/m L and the concentrations of iodine during delayed phase iodine 13.49mg/m L as threshold, differential diagnosis sensitivity was 100%. conclusion CT spectral imaging diagnosis with multipleparameters origin is helpful in the differential diagnosis of periampullary carcinoma. The third part objective: To investigate the dual energy spectral CT in Evaluation of surgical resectability of periampullary carcinoma in value. Methods: 98 cases of patients with periampullary carcinoma (later by clinical diagnosis and pathology) three phase enhanced DESCT scanning. The original data can be reconstructed by single mode, the optimal contrast noise ratio of image is optimized, and the application of quantitative analysis technology and image analysis spectrum. Comprehensive analysis technology to determine the tumor vascular invasion and lymph, such as whether the assessment of resectability, and compared with surgical results, calculate the sensitivity of DESCT in predicting surgical resectable ampullary carcinoma, specificity, positive predictive value and negative predictive value and accuracy. Results: the sensitivity of DESCT judgment the vascular invasion of periampullary carcinoma was 93.8%, specificity was 98.3%, accuracy was 96.7%; DESCT prediction sensitivity of 96% resected periampullary carcinoma, a specificity of 95.7%, positive predictive accuracy rate of 96%. The value is 98.6%, and the negative predictive value is 88%.. Conclusion: DESCT is highly sensitive, specific and accurate in evaluating the preoperative resectability of periampullary carcinoma. It is an ideal imaging technique for preoperative staging of periampullary carcinoma.

【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2014
【分類號】：R735.0;R730.44

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