本文選題：乳腺 + 能譜CT��； 參考：《蘭州大學(xué)》2017年碩士論文

【摘要】：第一部分正常乳腺的能譜特征目的:初步探討正常乳腺的能譜CT特征。方法:收集因胸部其它病變行常規(guī)胸部寶石能譜CT平掃及雙期增強掃描的正常乳腺15例,應(yīng)用能譜CT后處理及分析軟件進行分析測量,分別獲得平掃及動、靜脈期顯示正常乳腺腺體最佳CNR的平均單能量水平(ke V),正常腺體40ke V~140ke V下的平均CT值(HU),以及特征性能譜曲線并計算40ke V~70ke V水平下的曲線斜率;測量正常乳腺腺體動、靜脈期的碘(水)濃度(mg/cc)及相對碘濃度。采用?x±s及95%可信區(qū)間進行統(tǒng)計學(xué)描述,平掃及動、靜脈期曲線斜率間的比較采用單因素方差分析。結(jié)果:平掃及動、靜脈期顯示正常乳腺腺體最佳CNR的平均單能量水平分別為65.55±0.82ke V,65.70±0.80ke V,65.80±0.69ke V;95%可信區(qū)間分別為(65.2,65.95)ke V,(65.35,66.05)ke V,(65.50,66.10)ke V。動、靜脈期不同單能量下CT值較平掃略高,且靜脈期更高。正常腺體平掃、動脈期及靜脈期的特征性能譜曲線在40ke V~70ke V水平下的平均曲線斜率分別為:0.46±0.07,0.45±0.05,0.52±0.08,三者間無統(tǒng)計學(xué)差異(P0.05)。正常乳腺腺體增強后動、靜脈期平均碘(水)濃度分別為:1.42±0.30mg/cc,2.10±0.40mg/cc;95%可信區(qū)間分別為(1.13,1.72)mg/cc,(1.63,2.62)mg/cc。正常乳腺腺體動、靜脈期平均相對碘濃度分別為:0.02±0.003,0.06±0.005;95%可信區(qū)間分別為(0.01,0.03),(0.05,0.08)。結(jié)論:正常乳腺腺體能譜CT平掃及增強具有一定特征性,可以為后續(xù)相關(guān)研究提供一定理論依據(jù)。第二部分乳腺癌的能譜特征目的:探討乳腺癌的能譜特征,評價能譜CT在乳腺癌診斷方面的應(yīng)用價值。方法:回顧性分析12例經(jīng)手術(shù)病理證實的乳腺癌患者的能譜CT資料,其中10例為浸潤性導(dǎo)管癌,余2例分別為浸潤性小葉癌、浸潤性乳頭狀癌。所有患者術(shù)前行能譜CT雙期增強掃描,在后處理軟件上分別測量動、靜脈期乳腺癌病灶及對側(cè)正常乳腺腺體40ke V~140ke V水平下的平均CT值(HU)及40ke V~70ke V水平下的曲線斜率、碘(水)濃度(mg/cc)、相對碘濃度。隨機納入行胸部常規(guī)CT雙期增強掃描的女性患者12例作為對照組,分別記錄能譜CT及常規(guī)CT掃描模式的輻射劑量參數(shù),包括CT容積劑量指數(shù)(CTDIvol),劑量長度乘積(DLP),有效輻射劑量(ED)。掃描采用兩獨立樣本t檢驗比較乳腺癌與正常腺體間能譜參數(shù)的差異及胸部常規(guī)CT雙期增強掃描與能譜CT掃描間輻射劑量的差異。結(jié)果:乳腺癌動、靜脈期40ke V~140ke V水平下的平均CT值及能譜曲線斜率、碘(水)濃度、相對碘濃度均較正常乳腺腺體高,兩者差異具有統(tǒng)計學(xué)意義(P0.05);能譜CT胸部雙期增強掃描的平均輻射劑量明顯低于常規(guī)CT,兩者差異具有統(tǒng)計學(xué)意義(P0.05)。結(jié)論:乳腺癌能譜參數(shù)具有一定特征性,且能譜CT胸部雙期增強掃描的輻射劑量明顯低于常規(guī)CT,因此,能譜CT在診斷乳腺癌方面具有一定的應(yīng)用價值。第三部分乳腺癌轉(zhuǎn)移性淋巴結(jié)的能譜特征目的:初步探討能譜CT在評價乳腺癌轉(zhuǎn)移性淋巴結(jié)方面的應(yīng)用價值。方法:回顧性分析經(jīng)手術(shù)病理證實的乳腺癌12例,其中6例伴有淋巴結(jié)轉(zhuǎn)移,5例為同側(cè)腋窩淋巴結(jié)受累,1例為胸肌間淋巴結(jié)受累。對6例轉(zhuǎn)移性淋巴結(jié)及原發(fā)病灶進行能譜特征分析,繪制其動、靜脈期能譜曲線,直方圖及散點圖并分析其特點,初步探索能譜CT在診斷乳腺癌轉(zhuǎn)移性淋巴結(jié)方面的應(yīng)用。結(jié)果:對6例轉(zhuǎn)移性淋巴結(jié)進行能譜特征分析發(fā)現(xiàn),轉(zhuǎn)移性淋巴結(jié)的能譜曲線形態(tài)、直方圖及散點圖分布與原發(fā)病灶相似或基本一致,且靜脈期符合程度較動脈期更高。結(jié)論:轉(zhuǎn)移性淋巴結(jié)與原發(fā)病灶能譜曲線、直方圖及散點圖的一致性在診斷乳腺癌轉(zhuǎn)移性淋巴結(jié)方面具有一定的應(yīng)用價值,尤其是靜脈期可靠性更加,因此能譜CT在乳腺癌術(shù)前分期方面具有一定的指導(dǎo)作用。
[Abstract]:The first part of the normal breast energy spectrum characteristics Objective: to preliminarily discuss the characteristics of the normal mammary spectrum CT. Methods: 15 cases of normal breast were collected by CT plain scan and double phase contrast enhancement scan because of other thoracic lesions. The energy spectrum CT post-processing and analysis software were used for analysis and measurement. The average single energy level (Ke V) of the best CNR of normal mammary glands, the average CT value (HU) under the normal gland 40ke V~140ke V, the characteristic spectrum and the curve slope at the 40ke V~70ke V level, and the measurement of normal mammary gland movement, iodine (water) concentration (mg/cc) and relative iodine concentration in the venous phase of the mammary glands, are used for statistics and 95% confidence intervals. A single factor variance analysis was used in the comparison of the curve slope of the venous phase. Results: the average single energy level of the best CNR in the normal mammary glands was 65.55 + 0.82ke V, 65.70 + 0.80ke V and 65.80 + 0.69ke V, respectively, and the 95% trusted regions were 65.2,65.95 Ke V, (65.35,66.05) ke. Ke V. movement, the CT value of different single energy in venous phase was higher than that of plain scan, and the venous phase was higher. The average curve of normal glandular scan, arterial and venous phase curves at 40ke V~70ke V level were 0.46 + 0.07,0.45 + 0.05,0.52 + 0.08 respectively, and there was no statistical difference (P0.05) between the three. The average iodine (water) concentration of pulse period was 1.42 + 0.30mg/cc, 2.10 + 0.40mg/cc, 95% confidence interval was (1.13,1.72) mg/cc, (1.63,2.62) mg/cc. normal mammary gland movement, the average relative iodine concentration in venous phase was 0.02 + 0.003,0.06 + 0.005, 95% confidence interval was (0.01,0.03), (0.05,0.08). Conclusion: normal breast gland can be used for plain scanning of CT. And the enhancement has certain characteristics, can provide a certain theoretical basis for follow-up related research. Second part of the spectrum characteristics of breast cancer: To explore the spectrum characteristics of breast cancer and evaluate the application value of CT in the diagnosis of breast cancer. Methods: retrospective analysis of 12 cases of breast cancer confirmed by operation and pathology of the spectrum CT data, 10 cases were infiltrative ductal carcinoma, and the other 2 were invasive lobular carcinoma and invasive papillary carcinoma. All the patients underwent CT double phase enhanced scan before operation. In the post-processing software, the lesions of breast cancer and the average CT value (HU) and 40ke V~70ke V level under the 40ke V~140ke V level of the contralateral normal mammary gland were measured respectively. The slope, iodine (mg/cc) concentration (water) concentration and relative iodine concentration were randomly included in 12 female patients with routine chest CT double phase enhanced scan as the control group. The radiation dose parameters of the energy spectrum CT and the conventional CT scanning mode were recorded, including the CT volume dose index (CTDIvol), the dose length product (DLP), the effective radiation dose (ED). The scanning was two independent. Sample t test compared the difference of energy spectrum parameters between breast cancer and normal gland and the difference of radiation dose between routine chest CT double phase enhanced scan and energy spectrum CT scan. Results: the average CT value and the slope of energy spectrum curve, iodine (water) concentration and relative iodine concentration were higher than normal mammary glands in breast cancer movement, 40ke V~140ke V level in the venous phase, and the relative iodine concentration was higher than that of normal mammary gland. The difference had statistical significance (P0.05); the average radiation dose of the dual phase enhanced scan of the CT chest was significantly lower than that of the conventional CT, and the difference was statistically significant (P0.05). Conclusion: the spectral parameters of breast cancer were characteristic, and the radiant dose of the dual phase enhanced scan of the chest CT was significantly lower than that of the conventional CT, so the energy spectrum CT was diagnosed in the mammary gland. Third part of the energy spectrum of metastatic lymph nodes in breast cancer: a preliminary study of the value of CT in the evaluation of metastatic lymph nodes of breast cancer. Methods: retrospective analysis of 12 cases of breast cancer confirmed by surgery and pathology, including 6 cases with lymph node metastasis and 5 cases of the ipsilateral axillary lymph nodes. 1 cases were involved in the inter pectoral lymph node involvement in 1 cases. 6 cases of metastatic lymph nodes and primary foci were analyzed, the energy spectrum curve of the venous phase, the histogram and scatter plot were plotted and the characteristics were analyzed. The application of energy spectrum CT in the diagnosis of metastatic lymph nodes of breast cancer was preliminarily explored. Results: the spectrum of metastatic lymph nodes in 6 cases was characterized. The characteristic analysis showed that the distribution of the energy spectrum curve of the metastatic lymph nodes, the distribution of histogram and scatter plot was similar or basically consistent with the primary focus, and the conformity of the venous phase was higher than that of the arterial phase. Conclusion: the characteristics of the metastatic lymph node and the primary focus energy spectrum curve, the histogram and the scatter plot are in the diagnosis of the metastatic lymph nodes of the breast cancer. Certain application value, especially in the venous phase, is more reliable, so the energy spectrum CT has a certain guiding role in preoperative staging of breast cancer.
【學(xué)位授予單位】：蘭州大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R737.9;R730.44

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