高分辨率CT定性、定量技術(shù)評(píng)估慢性阻塞性肺疾病的臨床應(yīng)用價(jià)值
[Abstract]:The first part of the high resolution CT quantitative technique to evaluate the clinical application of chronic obstructive pulmonary disease: using the high resolution CT (High-resolution computed tomography, HRCT) volume quantitative technique to automatically measure the volume percentage of the low density region of each lobe (low attenuation areas volume percentage, LA), and the quantitative parameters Correlation study with pulmonary function test (PFT) parameters to assess the severity of pulmonary function damage in patients with chronic obstructive pulmonary disease (Chronic, obstructive pulmonary disease, COPD), and provide valuable imaging support for clinical diagnosis and treatment programs. Materials and methods: from December 2015 to 2016 In December, 83 patients with COPD were diagnosed with clinical and pulmonary function tests (all patients completed HRCT examination and pulmonary function examination within 7 days). All cases were scanned by GE 64 row Lightspeed VCT at the deep inhalation terminal. HRCT original data were transmitted to the post processing workstation GEadw4.6, and the system set the terminal CT threshold -950HU to emphysema. The following parameters were obtained by using CT after processing Parenchyma analysis software, including left lower lobe LAA%, left upper lobe LAA%, right upper lobe LAA%, right lower lobe LAA%, right pulmonary middle lobe LAA%, double lung LAA%, right lung LAA%, left lung LAA%, total emphysema volume, total lung volume. The parameters of the lung function are as follows: the first second forced expiratory volume (forced expiratory volume in one second, FEV1), the ratio of the measured value of the forced expiratory volume to the predicted value (FEV1% prediction), the forced vital capacity (forced vital capacity, FVC), the ratio of the expiratory volume, the peak expiratory flow, and the force of the expiratory flow, and the peak expiratory flow peak. Expiratory flow (forced expiratory flow at 25%of FVC exhaled, FEF25), expiratory expiratory flow of 50% vital capacity (forced expiratory flow at), expiratory exhalation of 75% vital capacity, lung carbon monoxide dispersion Usion capacity of carbon monoxide in the lung, DLCO) measured value as a percentage of expected value (DLCO%), the ratio of residual volume to total volume of lung (RV/TLC). Factor variance analysis (One-Way ANOVA), LSD test was used among groups. Kruskal-Wallis test was used to compare FEV1/FVC, FEV1% prediction value, BMI and so on. This study was analyzed by SPSS20.0 software, P0.05 thought the difference was statistically significant, P0.01 thought the difference was significant statistically. Results: 83 cases People aged 47~85, age 47~85, average age 66 years, sex are male, BMI index 13.3 ~ 28.1, smokers 71 cases, non smokers 12 cases, according to the 2017 COPD grading standard, the group cases: GOLD1 class 8 cases, GOLD2 class 33 cases, GOLD3 class 27 cases, GOLD 4 level 15 cases, left lung LAA%, right lower lobe LAA%, right lung LAA%, LAA% lung and FEV1/F. VC, FEV1, FEV1% predicted values, FEF25 and FEF50 were correlated. Two the lower lobe of the lung was also associated with PEF and FEF75. Two lower lobe LAA% and lung function limited parameters (FEV1, FEV1% predictive value, FEV1/FVC, PEF) were significantly correlated with the two lung The leaf LAA% was correlated (r=-0.473, P=0.026). Two the difference between LAA% in the lower lobe of the lung in GOLD1 and GOLD3 was statistically significant. The difference between the LAA% in the lower lobe of the left lung was statistically significant between GOLD 1 and GOLD4. Except for the middle lobe LAA% of the right lung, the difference between the other lung lobes was statistically significant between the GOLD2 level and the grade. There was a significant difference between the GOLD2 and GOLD4 levels on the right lung LAA%, and the difference between the FEV1% prediction values in the GOLD group was statistically significant. Conclusion: two the LAA% in the lower lobe of the lung has a significant correlation with the limited parameters of the pulmonary function (FEV1, FEV1% prediction, FEV1/FVC, FEF50, PEF), and there is no significant correlation with the lung function. Two the upper lobe of the lung is not significantly correlated. It is pertinence. Therefore, it is suggested that different pulmonary lobectomy LAA% can evaluate the damage location and serious damage of lung function in COPD patients, and provide the relevant basis for the clinical formulation of different treatment schemes. The second part of high resolution CT image is used by computer post-processing technique to determine the subtype of emphysema. An automatic identification of reduplicated, unbiased, and more accurate emphysema subtypes to deeply understand the different morphologic and pathological changes of emphysema, thus providing a new idea for clinicians to develop individualized treatment schemes for COPD patients. Materials and methods: GE64 row LightspeedVCT at the end of deep inhalation for the whole lung 6 cases (typical cases of emphysema) (2 cases of emphysema) and 6 cases of normal group were collected, and the reconstructed data were introduced into ITK-SNAP software, and then different colors representing different emphysema subtypes and normal lung tissues were used for image tagging: normal lung tissue (Normaltissue, NT) used red label, lobule. Centrilobular Emphysema (CLE) used green tagging, full lobular emphysema (Panlobular Emphysema, PLE) using blue tagging, paranatal emphysema (Paraseptal Emphysema, PSE) using yellow for tagging. 1000 unoverlapped abnormal ROI (Region of) at the end of all the cases were randomly selected. Interest), each abnormal ROI has a corresponding label (label): including CLE, PLE, PSE, and collect 1000 unoverlapped normal lung tissues (Normaltissue, NT) ROI. in a total of 6000 non overlapping normal groups (Normaltissue, NT) ROI., and take 1000 non overlapping normal tissues (NT) in the ROI. case group from 6000 abnormal lungs in each type of emphysema. The subtype (CLE, PSE, PLE) randomly selected 1000 ROI, a total of 3000, and 1000 ROI of the normal group as a training sample (training samples), and then trained the classifier that could automatically identify the emphysema subtype. Then the 3000 remaining ROI and 1000 normal tissue ROI were left in the case group, and each type of emphysema subtype (CLE, PSE, PLE) and positive was in each class. NT (NT) was randomly selected as a test sample (test samples). Using a computer to process Intensity (INT), Rotation invariant Local Binary Patterns (RILBPs), three methods were used to automatically identify the various emphysema subtypes. The test results were compared with the artificial annotation results and the classification accuracy was calculated. The above tests were tested. The experiment was repeated 5 times and the average value of 5 classification accuracy was used as the final classification accuracy. Results: the classification accuracy of the subtype of emphysema was automatically identified by three methods of computer post-processing INT, RILBPs and INT+RILBPs, respectively: only CLE, PLE, PSE, three emphysema subtypes were tested, the accuracy INT method was 88.28%, RILBPs method was 86.46%, I. NT+RILBPs method 94.62%; among the three methods, the classification accuracy of the lobular central emphysema (CLE) was the highest. The classification accuracy decreased after adding the normal tissue (NT), the INT method was 72.09%, the RILBPs method was 67.34%, and the INT+RILBPs method 84.29%. had the highest classification accuracy except for the total lobular emphysema (PLE) in the INT method, and the other two methods were all. The classification precision of CLE is the highest. This shows that INT+RILBPs has the highest classification precision, and the classification precision of CLE is higher in emphysema subtype. Conclusion: computer after processing INT, RILBPs, INT+RILBPs three methods to compare and analyze the classification accuracy of emphysema subtype by computer, the precision of INT+RILBPs method is obviously higher than that of other two. The INT+RILBPs method only extracts CLE, PLE, and PSE three emphysema subtypes, which is significantly higher than the classification precision.INT+RILBPs after adding normal lung tissue. This method can provide diagnostic basis for the automatic identification of emphysema subtype.
【學(xué)位授予單位】:浙江大學(xué)
【學(xué)位級(jí)別】:碩士
【學(xué)位授予年份】:2017
【分類號(hào)】:R563.9;R816.41
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