本文選題：寶石CT能譜成像 + 透明細(xì)胞型腎細(xì)胞癌��； 參考：《山西醫(yī)科大學(xué)》2014年碩士論文

【摘要】：目的： 通過對(duì)透明細(xì)胞型腎細(xì)胞癌(Clear cell renal cell carcinoma, CCRCC)和腎血管平滑肌脂肪瘤(Renal angiomyolipoma, RAML)行能譜CT成像,將其數(shù)據(jù)進(jìn)行后處理分析并與臨床病理資料相對(duì)比,探討能譜CT成像對(duì)于透明細(xì)胞型腎細(xì)胞癌惡性度分級(jí)以及與血管平滑肌脂肪瘤的鑒別診斷價(jià)值。 方法： 收集2012年10月至2014年1月經(jīng)手術(shù)或穿刺病理證實(shí)的44例透明細(xì)胞型腎細(xì)胞癌和27例血管平滑肌脂肪瘤患者,均行能譜成像模式二期增強(qiáng)掃描并完成圖像重建,在動(dòng)脈期、靜脈期單能譜圖像上獲得腎臟病灶及腹主動(dòng)脈不同keV下的CT值,計(jì)算不同keV下病灶與腹主動(dòng)脈CT比值(標(biāo)準(zhǔn)CT值)；利用單能量圖像的能譜分析功能獲得以碘和水為基物質(zhì)的碘基圖和水基圖、以脂肪和水為基物質(zhì)對(duì)的脂肪圖和水基圖,并測(cè)量病灶與腹主動(dòng)脈相應(yīng)的碘含量、水含量和脂肪含量,計(jì)算病灶與腹主動(dòng)脈比值。并對(duì)所獲得數(shù)據(jù)進(jìn)行統(tǒng)計(jì)學(xué)分析。 結(jié)果： 1、從年齡構(gòu)成、性別及腫瘤的發(fā)生部位(左側(cè)或右側(cè))不能區(qū)分透明細(xì)胞型腎細(xì)胞癌各分級(jí),P0.05。 2、透明細(xì)胞型腎細(xì)胞癌的惡性度分級(jí)在有無靜脈瘤栓的差別有統(tǒng)計(jì)學(xué)意義,P0.05。(兩兩比較)：2級(jí)與3級(jí)、2級(jí)與4級(jí)在有無靜脈瘤栓的差別有統(tǒng)計(jì)學(xué)意義,2級(jí)有靜脈瘤栓的比例低于3級(jí)、4級(jí)。 3、keV在40-100時(shí)透明細(xì)胞型腎細(xì)胞癌各級(jí)的動(dòng)脈期單能量平均值的差別有統(tǒng)計(jì)學(xué)意義,P0.05；在110-140keV時(shí)無統(tǒng)計(jì)學(xué)意義,P0.05。 4、keV在40-140時(shí)透明細(xì)胞型腎細(xì)胞癌分級(jí)的靜脈期單能量平均值的差別無統(tǒng)計(jì)學(xué)意義,P0.05。 5、RAML和透明細(xì)胞型腎細(xì)胞癌在發(fā)病部位的差別無統(tǒng)計(jì)學(xué)意義,P0.05。 6、動(dòng)脈期標(biāo)準(zhǔn)碘濃度、動(dòng)脈期標(biāo)準(zhǔn)脂濃度在透明細(xì)胞型腎細(xì)胞癌不同分級(jí)的差別有統(tǒng)計(jì)學(xué)意義,P0.05。 7、動(dòng)脈期標(biāo)準(zhǔn)碘濃度、靜脈期標(biāo)準(zhǔn)碘濃度、動(dòng)脈期水濃度、動(dòng)脈期標(biāo)準(zhǔn)脂濃度、靜脈期標(biāo)準(zhǔn)值濃度在透明細(xì)胞型腎細(xì)胞癌和血管平滑肌脂肪瘤的差別有統(tǒng)計(jì)學(xué)意義,P0.05。透明細(xì)胞型腎細(xì)胞癌各指標(biāo)濃度高于血管平滑肌脂肪瘤。 結(jié)論： 寶石能譜成像檢查對(duì)透明細(xì)胞型腎細(xì)胞癌和血管平滑肌脂肪瘤的鑒別診斷及對(duì)透明細(xì)胞型腎細(xì)胞癌惡性度分級(jí)具有一定的價(jià)值。透明細(xì)胞型腎細(xì)胞癌中2級(jí)出現(xiàn)靜脈瘤栓的幾率明顯低于3級(jí)和4級(jí)；在40-100keV時(shí),GSI動(dòng)脈期單能量平均值、動(dòng)脈期標(biāo)準(zhǔn)碘濃度、動(dòng)脈期標(biāo)準(zhǔn)脂濃度可區(qū)分透明細(xì)胞型腎細(xì)胞癌各分級(jí)；動(dòng)脈期標(biāo)準(zhǔn)碘濃度、靜脈期標(biāo)準(zhǔn)碘濃度、動(dòng)脈期水濃度、動(dòng)脈期標(biāo)準(zhǔn)脂濃度、靜脈期標(biāo)準(zhǔn)值濃度在透明細(xì)胞型腎細(xì)胞癌和血管平滑肌脂肪瘤的差別有統(tǒng)計(jì)學(xué)意義。
[Abstract]:Objective: Clear cell renal cell carcinoma, CCRCC) and Renal angiomyolipoma (RAMLL) of clear renal cell carcinoma (RCC) were examined by energy dispersive computed tomography (EDS). The data were analyzed by post-processing and compared with the clinicopathological data. To evaluate the diagnostic value of energy dispersive CT in the grade of malignancy of clear cell renal cell carcinoma and its differential diagnosis with angiomyolipoma. Methods: From October 2012 to January 2014, 44 cases of clear cell renal cell carcinoma and 27 cases of angiomyolipoma confirmed by operation or puncture pathology were collected. The CT values of renal lesions and abdominal aorta under different keV were obtained on single energy spectrum images of venous phase. The ratio of focus to abdominal aorta under different keV (standard CT value) was calculated. The iodine and water based images were obtained by using the energy spectrum analysis function of single energy images, and the fat and water base maps with fat and water as base substances were obtained. The corresponding iodine content, water content and fat content were measured and the ratio of focus to abdominal aorta was calculated. And the obtained data were statistically analyzed. Results: 1. According to age composition, sex and location of tumor (left or right), the grade of clear cell renal cell carcinoma could not be distinguished (P 0.05). 2. The grade of malignancy of clear cell renal cell carcinoma was significantly different in the presence or absence of venous thrombus (P 0.05). The difference between grade 2 and grade 3, grade 2 and grade 4 in the presence of venous thrombus was statistically significant, and the proportion of grade 2 and grade 2 with venous thrombus was lower than that of grade 3 or grade 4. 3There was significant difference in the mean value of single energy between 40 and 100 in all stages of clear cell renal cell carcinoma (P0.05), but there was no significant difference in P0.05in 110-140keV. (4) there was no significant difference in the mean value of single energy in venous phase between 40 and 140 in clear cell renal cell carcinoma grade (P 0.05). There was no significant difference between RAML and clear cell renal cell carcinoma (RCC). 6. Standard iodine concentration in arterial phase and standard lipid concentration in arterial phase were significantly different in different grades of clear cell renal cell carcinoma (P0.05). 7. The difference of standard iodine concentration in arterial phase, water concentration in arterial phase, standard lipid concentration in arterial phase and venous phase in clear cell renal cell carcinoma and angiomyolipoma was statistically significant (P 0.05). The index concentration of clear cell renal cell carcinoma was higher than that of angiomyolipoma. Conclusion: Gem EDS is valuable in the differential diagnosis of clear cell renal cell carcinoma and angiomyolipoma and in the grade of malignancy of clear cell renal cell carcinoma. In clear cell renal cell carcinoma, the incidence of venous thrombus in grade 2 was significantly lower than that in grade 3 and grade 4, and the mean value of single energy in arterial phase and the standard iodine concentration in arterial phase were significantly lower than those in grade 3 and grade 4 in 40-100keV. The grade of clear cell renal cell carcinoma can be distinguished by standard lipid concentration in arterial phase, standard iodine concentration in arterial phase, water concentration in arterial phase, and standard lipid concentration in arterial phase. There was significant difference in venous phase standard concentration between clear cell renal cell carcinoma and angiomyolipoma.
【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R737.11

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