本文選題：體層攝影術(shù) + X線計(jì)算機(jī)��； 參考：《鄭州大學(xué)》2017年碩士論文

【摘要】：第一部分能譜CT單能量成像聯(lián)合迭代重建技術(shù)優(yōu)化卵巢動脈顯示的臨床價值目的:探討能譜CT單能量成像聯(lián)合自適應(yīng)統(tǒng)計(jì)迭代重建(ASIR)技術(shù)在優(yōu)化卵巢動脈圖像質(zhì)量中的臨床價值。材料與方法:本研究經(jīng)我院倫理委員會許可;所有患者在檢查前均提供知情同意書。前瞻性的收集2015年8月至2016年12月臨床懷疑盆腔占位并在鄭州大學(xué)第一附屬醫(yī)院行全腹部雙期增強(qiáng)掃描的女性患者,最終將顯示卵巢動脈的64例(對照組和試驗(yàn)組各32例)女性患者納入本研究,年齡20~82歲,平均年齡51.30歲。對照組采用120 k Vp管電壓常規(guī)掃描,聯(lián)合40%ASIR重建圖像;試驗(yàn)組采用能譜(GSI)掃描,原始數(shù)據(jù)選取40~70 ke V單能量水平圖像(以5 ke V為間隔),共7個單能量水平,分別聯(lián)合30~60%ASIR(以10%為間隔)進(jìn)行重建,共獲得35亞組圖像。測量圖像動脈期卵巢動脈及同層同側(cè)的腰大肌內(nèi)的CT值及同層同側(cè)背部皮下脂肪內(nèi)CT值的標(biāo)準(zhǔn)差(SD),計(jì)算卵巢動脈的對比噪聲比(CNR)和信噪比(SNR),采用單因素方差分析比較試驗(yàn)組各亞組圖像客觀評價指標(biāo)(CT、SNR、CNR),組內(nèi)兩兩比較采用LSD法;采用獨(dú)立樣本t檢驗(yàn)比較兩組圖像客觀評價指標(biāo)及年齡、有效輻射劑量。由兩名放射科醫(yī)師采用5分評分制法對兩組圖像動脈期的圖像質(zhì)量進(jìn)行主觀評價,采用Mann-Whitney U檢驗(yàn)比較,一致性采用Kappa檢驗(yàn)。結(jié)果:對照組和試驗(yàn)組的年齡(歲)(對照組53.78±14.15,試驗(yàn)組48.81±17.29,)及ED(m Sv)(對照組9.80±1.51,試驗(yàn)組10.84±3.55)差異均無統(tǒng)計(jì)學(xué)意義(P均0.05);隨著單能量水平的逐漸升高,卵巢動脈的CT值逐漸降低;卵巢動脈的CNR值及SNR值在40ke V單能量水平聯(lián)合60%ASIR(26.12±7.92、30.45±8.13)時均最高,與對照組(13.29±5.44、18.67±5.61)比較差異均有統(tǒng)計(jì)學(xué)意義(P0.05);試驗(yàn)組主觀評分在40ke V單能量水平聯(lián)合50%ASIR時最高(4.18±0.63),與40ke V單能量水平聯(lián)合60%ASIR(4.12±0.64)比較差異無統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論:能譜CT單能量成像聯(lián)合迭代重建技術(shù)既不增加輻射劑量,且在40ke V單能量水平聯(lián)合60%ASIR可明顯提高卵巢動脈的圖像質(zhì)量,對臨床診斷和治療提供幫助。第二部分能譜CT成像在鑒別卵巢腫瘤良惡性中的價值目的:探討能譜CT成像定量分析在鑒別卵巢腫瘤良惡性中的應(yīng)用價值。材料與方法:本研究經(jīng)我院倫理委員會許可;所有患者在檢查前均提供知情同意書。前瞻性的收集2015年8月至2016年12月臨床懷疑盆腔占位并在鄭州大學(xué)第一附屬醫(yī)院行盆腔或腹盆腔增強(qiáng)掃描的女性患者,最終將病理結(jié)果證實(shí)為卵巢腫瘤的98例患者納入本研究,年齡12~84歲,平均45.01歲。根據(jù)囊實(shí)性成分的不同將其分為兩組,第一組為囊性成分為主的卵巢腫瘤,共64例,其中良性卵巢腫瘤和惡性卵巢腫瘤各32例;第二組為實(shí)性成分為主的卵巢腫瘤,共34例,其中良性卵巢腫瘤11例,惡性卵巢腫瘤23例。所有患者在Discover GSI CT機(jī)行常規(guī)平掃和能譜雙期增強(qiáng)掃描。圖像重建選用原始數(shù)據(jù)聯(lián)合40%自適應(yīng)統(tǒng)計(jì)迭代重建(ASIR)。在后處理站上,分別測量兩組圖像動靜脈兩期卵巢病灶囊性成分或?qū)嵭猿煞值腃T值、碘水濃度(IC)、水碘濃度(WC)、鈣水濃度(CC)、病灶同側(cè)同層髂動脈的碘水濃度及病灶的能譜曲線,并計(jì)算病灶處的標(biāo)準(zhǔn)化碘濃度(NIC)和能譜曲線的斜率,即標(biāo)準(zhǔn)化碘濃度=病灶的碘濃度/同層髂動脈碘濃度,斜率=(HU40ke V-HU100ke V)/60。采用獨(dú)立樣本t檢驗(yàn)對良惡性卵巢腫瘤參數(shù)進(jìn)行統(tǒng)計(jì)學(xué)比較,并繪制ROC曲線評估相應(yīng)參數(shù)的診斷效能。結(jié)果:惡性卵巢腫瘤的年齡(49.33±13.57)較良性卵巢腫瘤(39.49±14.18)大,且差異有統(tǒng)計(jì)學(xué)意義(P0.01)。以囊性成分為主的惡性卵巢腫瘤碘水濃度、鈣水濃度、標(biāo)準(zhǔn)化碘濃度、能譜曲線斜率在動脈期分別為3.63±1.70(100μg/cm3)、5.21±2.47(mg/cm3)、0.05±0.02、0.43±0.20,靜脈期分別為3.81±1.62(100μg/cm3)、5.44±2.25(mg/cm3)、0.04±0.01、0.45±0.19;良性卵巢腫瘤碘水濃度、鈣水濃度、標(biāo)準(zhǔn)化碘濃度、能譜曲線斜率在動脈期分別為2.08±0.84(100μg/cm3)、2.92±1.25(mg/cm3)、0.03±0.02、0.25±0.10,靜脈期分別為2.58±1.22(100μg/cm3)、3.66±1.80(mg/cm3)、0.03±0.01、0.31±0.14;且差異有統(tǒng)計(jì)學(xué)意義(P均0.01);各參數(shù)的特異度在動脈期均較靜脈期高,其靈敏度在靜脈期均較動脈期高。以實(shí)性成分為主的惡性卵巢腫瘤碘水濃度、標(biāo)準(zhǔn)化碘濃度、能譜曲線斜率在靜脈期分別為14.50±6.44(100μg/cm3)、0.33±0.12、1.72±0.77,良性卵巢腫瘤碘水濃度、標(biāo)準(zhǔn)化碘濃度、能譜曲線斜率在靜脈期分別為8.86±4.04(100μg/cm3)、0.22±0.13、1.05±0.48,其差異有統(tǒng)計(jì)學(xué)意義(P均=0.01);標(biāo)準(zhǔn)化碘濃度的AUC最大。結(jié)論:良惡性卵巢腫瘤的能譜CT參數(shù)有顯著差異。能譜CT成像可以為卵巢腫瘤良惡性的鑒別診斷提供更多的信息,具有一定的臨床應(yīng)用價值。
[Abstract]:The first part can be used to optimize the clinical value of ovarian artery display by CT single energy imaging combined with iterative reconstruction technique: To explore the clinical value of CT single energy imaging combined with adaptive statistical iterative reconstruction (ASIR) technique in optimizing the quality of the ovarian artery image. An informed consent form was provided before the examination. A prospective collection of female patients who were clinically suspected of pelvic occupying from August 2015 to December 2016 at the First Affiliated Hospital of Zhengzhou University and underwent a full abdominal double phase enhanced scan will eventually show 64 cases of ovarian arteries (32 cases in the control group and the experimental group), aged 20~82 years old, flat. The control group was 51.30 years old. The control group used the 120 K Vp tube voltage routine scan and the combined 40%ASIR reconstruction image. The test group used the energy spectrum (GSI) scan, the original data selected the 40~70 Ke V single energy level image (5 Ke V interval), a total of 7 single energy levels, respectively combined 30~60%ASIR (10% interval) for reconstruction, a total of 35 subgroups of images were obtained. The standard deviation (SD) of the CT value and the CT value of the subcutaneous fat in the same layer on the same side of the same layer of the arterial phase of the arterial phase and the same side of the same layer (SD) was used to calculate the contrast noise ratio (CNR) and the signal-to-noise ratio (SNR) of the ovarian artery. The objective evaluation indexes (CT, SNR, CNR) were compared by the single factor analysis of variance (CT, SNR, CNR) in the experimental group, and 22 in the group were compared to LSD. Methods: the independent sample t test was used to compare the objective evaluation indexes of the two groups of images and the age and effective radiation dose. The image quality of the two groups of images was evaluated by two radiologists using the 5 score score system, and the consistency was compared with the Kappa test. The results were as follows: the age of the control group and the test group (years old). (53.78 + 14.15, 48.81 + 17.29 in the control group, 48.81 + 17.29 in the test group) and ED (m Sv) (9.80 + 1.51 in the control group), there was no significant difference (P 0.05). As the level of single energy increased, the CT value of the ovarian artery decreased gradually; the CNR value and SNR value of the ovarian artery were in 40ke V single energy level combined 60%ASIR (26.12 + 7.92,30.45 + 8.13. It was the highest, compared with the control group (13.29 + 5.44,18.67 + 5.61), the difference was statistically significant (P0.05); the subjective score of the test group was highest at 40ke V single energy level (4.18 + 0.63), and 60%ASIR (4.12 + 0.64) combined with 40ke V single energy level was not statistically significant (P0.05). Conclusion: the spectrum CT single energy imaging combined superposition. The reconstructive technique does not increase the dose of radiation, and the 40ke V single energy level combined with 60%ASIR can obviously improve the image quality of the ovarian artery and provide help for the clinical diagnosis and treatment. The second part can be used to identify the value of CT imaging in the differentiation of benign and malignant ovarian tumors: the quantitative analysis of the spectral CT imaging is used to identify the benign and malignant ovarian tumors. Application value. Materials and methods: This study was licensed by the ethics committee of our hospital; all patients provided informed consent before the examination. A prospective collection of women who suspected pelvic space occupying from August 2015 to December 2016 and underwent pelvic or pelvic enhanced scan at the First Affiliated Hospital of Zhengzhou University eventually resulted in the pathological results. 98 cases of ovarian tumors were included in this study, aged 12~84 years old, with an average of 45.01 years of age. They were divided into two groups according to the different cystic components. The first group was the ovarian tumor of the cystic component, of which 64 cases were benign ovarian tumors and 32 malignant ovarian tumors, and the second groups were mainly ovarian tumors, with 34 cases. 11 cases of benign ovarian tumors and 23 cases of malignant ovarian tumors. All patients were performed routine plain scan and biphasic enhanced scan on Discover GSI CT. The image reconstruction selected original data combined with 40% adaptive statistical iterative reconstruction (ASIR). At the post treatment station, the two groups were measured as the cystic components or real components of the two phases of the ovarian focus. The CT value, iodine concentration (IC), iodine concentration (WC), calcium water concentration (CC), the iodine concentration of the iliac artery on the same side of the same side of the lesion and the spectrum curve of the focus, and the calculation of the standard iodine concentration (NIC) and the slope of the energy spectrum curve at the lesion, that is, the iodine concentration of the lesion = the concentration of iodine in the lesion / the iodine concentration of the iliac artery in the same layer, and the slope = (HU40ke V-HU100ke V) /60. adoption An independent sample t test was used to compare the parameters of benign and malignant ovarian tumors, and the ROC curve was drawn to evaluate the diagnostic efficiency of the corresponding parameters. Results: the age of malignant ovarian tumors (49.33 + 13.57) was larger than that of benign ovarian tumors (39.49 + 14.18), and the difference was statistically significant (P0.01). Calcium water concentration and standardized iodine concentration were 3.63 + 1.70 (100 g/cm3), 5.21 + 2.47 (mg/cm3), 0.05 + 0.02,0.43 + 0.20, respectively, 3.81 + 1.62 (100 u g/cm3), 5.44 + 2.25 (mg/cm3) and 0.04 + 0.01,0.45, respectively, and iodine concentration of benign ovarian tumors, calcium concentration, standard iodine concentration, spectrum curve slope The arterial phase was 2.08 + 0.84 (100 mu g/cm3), 2.92 + 1.25 (mg/cm3) and 0.03 + 0.02,0.25 + 0.10 respectively. The venous phase was 2.58 + 1.22 (100 u g/cm3), 3.66 + 1.80 (mg/cm3) and 0.03 + 0.01,0.31 +; and the difference was statistically significant (P). The specificity of the parameters was higher in the arterial phase than in the venous phase, and the sensitivity was higher in the venous phase than in the arterial phase. The iodine water concentration of the malignant ovarian tumor and the standard iodine concentration were 14.50 + 6.44 (100 g/cm3) and 0.33 + 0.12,1.72 + 0.77 respectively, and the iodine concentration of benign ovarian tumors and the standard iodine concentration were 8.86 + 4.04 (100 u g/cm3) and 0.22 + 0.13,1.05 + 0.48 respectively in the venous phase, respectively. The difference is statistically significant (P =0.01), and the AUC of standardized iodine concentration is the largest. Conclusion: the CT parameters of the benign and malignant ovarian tumors are significantly different. The energy spectrum CT imaging can provide more information for the differential diagnosis of benign and malignant ovarian tumors, and has a certain clinical value.
【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R737.31;R730.44

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