發(fā)布時間：2018-03-04 00:33

  本文選題：卵巢腫瘤　切入點(diǎn)：寶石能譜CT　出處：《山東大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:通過對符合研究條件的卵巢原發(fā)良惡性腫瘤患者進(jìn)行能譜CT掃描,獲得單能量能譜曲線圖、碘含量、水含量并計(jì)算能譜曲線斜率等參數(shù),能譜CT診斷結(jié)果與病理結(jié)果對比分析,初步探討能譜CT在卵巢原發(fā)良惡性腫瘤鑒別診斷中的臨床應(yīng)用價值。方法:回顧性分析2015年5月至2016年8月進(jìn)行盆腔動脈、靜脈期能譜CT掃描的女性患者58人,年齡范圍19～64歲,將其分為兩組:良性組30例,惡性組28例。選取標(biāo)準(zhǔn):①檢查者為女性;②病變均含有實(shí)性成分;③無對比劑過敏;④具有本院或其他三級醫(yī)院病理學(xué)檢查結(jié)果。所有患者均在寶石能譜CT(Discovery CT 750 HDGE Heahhcare,Mliwaukee,美國)上進(jìn)行盆腔平掃加雙期增強(qiáng)掃描,掃描范圍至少包括髂脊到恥骨聯(lián)合下緣水平。雙期增強(qiáng)掃描均用能譜掃描模式(GemStone imaging,GSI),管電壓在80kVp、140kVp間0.5ms內(nèi)迅速切換,管電流:375mAs,轉(zhuǎn)速:0.5s/周,探測器寬:40mm,掃描展厚及層間距均:5.00mm。高壓注射器將碘海醇(300mgl/mL)通過肘靜脈注入,劑量:1.2mL/kg,流速::3.0 mL/s。動脈期圖像于注射開始后25-30s掃描得到,靜脈期圖像于注射開始后60-75s掃描得到。采用標(biāo)準(zhǔn)算法重建圖像。所有患者掃描前均簽署知情同意書。將獲得的能譜圖像拆為層厚和層間距1.25mm單能量圖像,傳入AW4.4工作站進(jìn)行能譜分析,采用能譜成像軟件(GSI Viewer)進(jìn)行單能量圖像顯示、定量數(shù)據(jù)測量。在腫瘤較多實(shí)性成分的層面放置感興趣區(qū)(ROI),RO]放置標(biāo)準(zhǔn):①選取實(shí)性成分最大層面放置相同大小的圓形或橢圓形ROI,再選取其上、下兩個層面測量,取三者平均值作為測量結(jié)果;②ROI面積為50～60mm2;③測量位置盡量在兩期相同的層面;④放置ROI時避開囊性部分、瘤體壞死、液化、鈣化及血管區(qū)。然后測算R0I40～100keV單能量下(間隔10keV)平均CT值、碘含量(ICg/L)、水含量(WCg/L)、40～100keV間能譜曲線斜率并獲得ROI能譜曲線,40～100keV間能譜曲線斜率λ=CT(40keV)-CT(100keV)/|40keV-100keV|)。將兩組分析結(jié)果對比相應(yīng)的病理結(jié)果。計(jì)量(定量)經(jīng)正態(tài)性檢驗(yàn)和方差齊性檢驗(yàn),滿足正態(tài)性的再根據(jù)方差齊性的結(jié)果采用t檢驗(yàn)或校正t檢驗(yàn),不滿足正態(tài)性的采用秩和檢驗(yàn)。計(jì)數(shù)(定性)資料的比較分析采用χ2檢驗(yàn),Kappa值用于評價影像與病理結(jié)果的一致性。所有數(shù)據(jù)均應(yīng)用SAS9.4統(tǒng)計(jì)軟件分析,P0.05為有統(tǒng)計(jì)學(xué)意義。結(jié)果:兩組病變在動脈期、靜脈期隨著單能量增大能譜曲線形態(tài)呈弧形下降型,能量越低CT值差異越大;動脈期單能量40～100keV間、靜脈期60～140keV間兩組CT值差異均有統(tǒng)計(jì)學(xué)意義(P0.05),動脈期良性組CT值大部分小于惡性組,靜脈期良性組CT值大部分大于惡性組;動脈期40～1OOkeV間能譜曲線斜率、碘含量良性組分別為(1.43±0.58)、(11.82±4.89)100g/L,惡性組分別為(2.43±0.29)、(20.77±1.90)100g/L,兩組差異均有統(tǒng)計(jì)學(xué)意義(P0.05);動脈期兩組水含量兩組分別為(1030.37± 10.56)、(1025.96±6.10)100g/L,靜脈期兩組水含量分別為(1032.34±11.44)、(1029.06±6.25)100g/L,靜脈期碘含量、能譜曲線斜率良性組分別為(17.78±5.75)100g/L、(1.98±0.65),惡性組分別為(15.85±2.02)100g/L、(2.0±0.38),差異均無統(tǒng)計(jì)學(xué)意義(P0.05);能譜CT對良性、惡性腫瘤的檢出率分別為86.67%(26/30)、85.71%(24/28),靈敏度分別為 86.67%、80.00%,特異度分別為 80.00%、86.67%,配對設(shè)計(jì)χ2檢驗(yàn)顯示,能譜CT與病理結(jié)果無統(tǒng)計(jì)學(xué)差異(χ2=30.39,P0.0001)Kappa值為0.72,一致性較高。結(jié)論及意義:能譜CT動脈期單能量40～100keV間CT值、動脈期能譜曲線斜率及動脈期碘含量良性組均小于惡性組,能譜CT診斷結(jié)果與病理結(jié)果無統(tǒng)計(jì)學(xué)差異(Kappa值為0.72),一致性較高。說明能譜CT多參數(shù)分析對卵巢良惡性腫瘤的診斷具有一定的參考價值及臨床應(yīng)用意義。
[Abstract]:Objective: to meet the conditions on the primary ovarian benign and malignant tumor spectrum CT scan were obtained, the energy spectrum curve, iodine content, water content and calculation of energy spectrum curve slope parameters compared to the spectral analysis of the CT diagnosis and pathological results, preliminary study of spectral CT in the diagnosis of primary ovarian identification of benign and malignant tumors in clinical application. Methods: a retrospective analysis from May 2015 to August 2016 for pelvic artery, venous phase spectrum CT scans of 58 female patients, age ranged from 19~64 years old, they were divided into two groups: 30 cases of benign group and malignant group 28 cases. Selection criteria: check for female; the lesions contain solid components; and without contrast agent allergy; the hospital has three hospitals or other pathological results. All patients were in the gemstone CT (Discovery CT 750 HDGE Heahhcare, Mliwaukee, America) on the pelvic plain and Dual phase enhanced scanning, the scanning range includes at least the iliac crest to the lower edge of pubic symphysis. Dual phase enhanced scan with spectrum scan mode (GemStone imaging, GSI), tube voltage in 80kVp, 140kVp 0.5ms quickly switch tube current: 375mAs speed: 0.5s/ weeks, detector width: 40mm, scanning exhibition the thickness and spacing of layers are: 5.00mm. high pressure syringe will iohexol (300mgl/mL) through elbow vein injection dose: 1.2mL/kg, flow rate: 3 mL/s. arterial phase images in 25-30s scanning after injection, intravenous injection in the image after the start of 60-75s scan. The standard algorithm for image reconstruction. All patients were scanned before signed informed consent will be obtained. Energy spectrum image split with layer thickness of 1.25mm single energy image was transferred to AW4.4 workstation, energy spectrum analysis, using spectral imaging software (GSI Viewer) single energy image display, quantitative data in swollen measurements. The tumor more solid component level placement of region of interest (ROI), RO] put standard: round or oval ROI the solid component placed the largest level of the same size, then select it, under the two level measurement, the three is taken as the average value of the measurement results; the ROI area is 50 ~ 60mm2; 3 to measure the position of the same level as far as possible in the two periods; avoid the cystic part of the placement of ROI, tumor necrosis, liquefaction, calcification and vascular area. Then measure the R0I40 ~ 100keV single energy (10keV interval) the average value of CT, the content of iodine (ICg/L), water content (WCg/L), 40 ~ 100keV spectrum curve the slope and ROI spectrum curve, 40 ~ 100keV, energy spectrum curve slope of lambda =CT (40keV) -CT (100keV) /|40keV-100keV|). The pathological results of two group analysis results are compared. The corresponding measurement (Quantitative) by the test of normality and homogeneity of variance test, to satisfy the normality again according to variance the results of the T test or calibration t test, Wilcoxon test does not meet the normality. Count (Qualitative) data analysis using 2 test, Kappa value for consistency evaluation of imaging and pathological results. All data are used SAS9.4 statistical analysis software, P0.05 was considered statistically significant. Results: two groups of lesions in the arterial phase, venous phase with single energy increases energy spectrum curve shape curved down type, the lower the energy difference of the CT value is higher; the arterial phase single energy 40 ~ 100keV, 60 ~ 140keV in venous phase two groups were statistically significant differences in CT values (P0.05), arterial CT value is less than most of malignant and benign group group, benign group venous phase CT value greater than the malignant group; arterial phase 40 ~ 1OOkeV spectrum curve slope, iodine content in benign group respectively (1.43 + 0.58), (11.82 + 4.89) 100g/L, malignant group were (2.43 + 0.29), (20.77 + 1.90) 100g/L, there were two groups the difference 鎰忎箟(P0.05);鍔ㄨ剦鏈熶袱緇勬按鍚噺涓ょ粍鍒嗗埆涓，

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