本文關(guān)鍵詞： 雙源 CT 虛擬平掃 肺部病變 雙源CT 碘圖 肺部病變 雙源CT 能譜分析 肺部病變　出處：《山西醫(yī)科大學(xué)》2013年碩士論文　論文類型：學(xué)位論文

【摘要】：目的：探討第二代雙源CT虛擬平掃圖像在肺部占位性病變診斷中的應(yīng)用研究。 方法：回顧性分析2012年4月-2012年10月在本院行胸部平掃及增強掃描58例肺部占位性病變的病例。所有病例均利用德國西門子第二代雙源CT（SOMATOM Definition Flash）進行檢查，首先采用單源模式對患者進行胸部平掃（管電壓120kV，參考電流210mAs），然后經(jīng)肘靜脈注入碘海醇，總量為1ml/kg，流速3.0ml/s，行胸部雙能增強掃描（A球管管電壓100kV，參考管電流200mAs；B球管管電壓140kV，參考管電流170mAs），掃描時開啟CARE Dose4D技術(shù)。利用Liver VNC模式得到虛擬平掃圖像。比較虛擬平掃圖像與常規(guī)平掃圖像質(zhì)量評分、噪聲、病灶平均CT值及輻射劑量。結(jié)果：虛擬平掃圖像與常規(guī)平掃圖像質(zhì)量評分分別為（4.620.52）、（4.710.46）分，兩者無顯著差異t=2.319，P0.05；虛擬平掃圖像和常規(guī)平掃圖像噪聲分別為（8.101.16）、（7.301.06）HU，虛擬平掃噪聲略高于常規(guī)平掃t=5.246，P0.05；虛擬平掃圖像與常規(guī)平掃圖像顯示病變CT值分別為（32.658.09）、(27.947.16）HU，t=-8.154，P0.05；且兩組CT值有很好的一致性（r=0.840，P0.05）。虛擬平掃與常規(guī)平掃的有效劑量分別為（5.180.96）、（5.551.18）mSv，虛擬平掃有效劑量低于常規(guī)平掃t=4.005，P0.05。 結(jié)論：虛擬平掃圖像對肺部病變顯示良好，可滿足診斷要求，有代替胸部常規(guī)平掃的潛在價值。 目的：探討第二代雙源CT碘圖在肺部占位性病變良惡性鑒別診斷中的應(yīng)用研究。 方法：回顧性分析2012年4月-2012年10月在本院行胸部平掃及增強掃描58例肺部占位性病變的病例，并經(jīng)病理證實。掃描方式及條件同前。應(yīng)用LiverVNC模式得到碘圖。觀察良惡性病變碘圖偽彩色分布的情況。測量碘圖中病灶的CT值，常規(guī)平掃及增強時期病灶的CT值。比較碘圖CT值與強化CT值以及以20HU為閾值，碘圖CT值與強化CT值對病灶良惡性鑒別診斷的準確度。結(jié)果：肺部不同性質(zhì)病變的碘圖偽彩色分布不同。8例結(jié)節(jié)狀良性病變碘圖顯示病灶未見明顯偽彩色覆蓋，10例炎性病變碘圖顯示病灶明顯覆蓋偽彩色且顏色鮮亮。35例惡性病灶碘圖顯示病灶偽彩色覆蓋方式多樣，其中10例病灶偽彩色覆蓋明顯，呈花斑狀覆蓋，15例病灶偽彩色覆蓋不均，病灶內(nèi)的壞死灶顯示偽彩色覆蓋缺損。惡性病變的碘圖CT值與強化CT值分別為（25.854.62）、（22.43.89）HU，t=-8.022，P0.05；兩組CT值具有很好的一致性（r=0.839，P0.05）；良性病變的碘圖CT值與強化CT差值分別為（21.9210.8）（21.0810.9）HU，t=-1.129，P＞0.05；兩組CT值具有很好的一致性（r=0.947，P＞0.05）。以凈增值≥20HU為診斷惡性病變閾值，碘圖CT值與強化CT值判斷良惡性的靈敏度、特異度、準確度分別為（85.7%，65.2%，77.6%）；（80%，60.9%，72.4%）。 結(jié)論：雙能量碘圖將病灶血供分布情況直接可視化，并定量表達病灶的強化程度，判斷病灶良惡性的靈敏度高，反映病變血供的能力更加直接、敏感。 目的：探討第二代雙源CT多組能譜衍生序列在肺部占位性病變中的應(yīng)用研究。 方法：回顧性分析2012年4月-2012年10月在本院行胸部平掃及增強掃描58例肺部占位性病變的病例，并經(jīng)病理證實。掃描方式及條件同前。選擇MonoEnergetic程序處理得到60kev、80kev、100kev、120kev單能譜圖像；經(jīng)OptimalContrast程序處理得到非線性融合圖像，并測量多種衍生序列中病灶CT值，病灶強化差值，，信噪比和噪聲，觀察不同性質(zhì)肺部病變在不同kev下的曲線走行趨勢。 結(jié)果：多組單能譜圖像間所測得的肺部病變強化CT差值以及噪聲差異均有統(tǒng)計學(xué)意義（P0.05），其中肺部病變強化CT差值最大的序列是單能譜60kev為（35.6215.94）HU，（P0.05）。Moidal非線性融合圖像病變組織、肌肉軟組織、降主動脈信噪比分別為（4.291.03）、（4.211.41）、（15.070.93）HU，線性融合圖像分別為（3.210.72）、（2.830.99）、（12.224.05）HU，兩者差異有統(tǒng)計學(xué)意義（P0.05）。Moidal非線性融合圖像與線性融合圖像病變CT差值分別是（25.8712.64）、（22.2910.19）HU。非線性融合圖像顯示質(zhì)量均優(yōu)于線性融合圖像（P0.05）。不同性質(zhì)肺部病變在不同kev下的曲線走行趨勢對診斷有一定幫助。 結(jié)論：雙能量掃描模式經(jīng)后處理可得到多組能譜衍生序列圖像，這些序列的綜合應(yīng)用可以為肺部病變良惡性的鑒別提供新的診斷信息。
[Abstract]:Objective: To explore the application of the second generation of dual source CT virtual plain scan in the diagnosis of pulmonary space occupying lesions.
Methods: a retrospective analysis of 58 cases of lung scan and occupying lesion cases in April 2012 -2012 year in October in our hospital for chest. All cases were using the German SIEMENS second generation dual source CT (SOMATOM Definition Flash) were examined using single source model to patients with chest scan (tube voltage 120kV, reference current 210mAs), then through elbow vein injection of iohexol, total 1ml/kg, velocity 3.0ml/s, dual energy scan chest (A tube voltage 100kV, tube current reference 200mAs; B tube voltage 140kV, tube current reference 170mAs), scanning CARE Dose4D technology opens. Get virtual unenhanced image using Liver VNC model. Comparison of virtual unenhanced images and conventional CT image quality score, noise, mean CT value of the lesions and radiation dose. Results: the virtual unenhanced images and conventional CT image quality scores were (4.620.52), (4.710. 46), had no significant difference between t=2.319 and P0.05; virtual unenhanced images and conventional unenhanced image noise respectively (8.101.16), HU (7.301.06), virtual scan noise is slightly higher than that of conventional plain t=5.246, P0.05; virtual unenhanced images and conventional unenhanced images showed lesions of CT = (32.658.09) (27.947.16), HU, t=-8.154, P0.05; and the two groups of CT values are in good agreement (r=0.840, P0.05). The virtual unenhanced effective dose and conventional plain respectively (5.180.96), (5.551.18) mSv, the effective dose is lower than that of the conventional virtual unenhanced scan t= 4.005, P0.05.
Conclusion: the virtual scan images are good for the pulmonary lesions, which can meet the diagnostic requirements and have the potential value of replacing the routine plain scan of the chest.
Objective: To study the application of second generation double source CT iodide map in the differential diagnosis of pulmonary occupying venereal disease.
Methods: a retrospective analysis of 58 cases of lung scan and occupying lesion cases in April 2012 -2012 year in October in our hospital for chest, and confirmed by pathology. Scanning mode and conditions. With application of LiverVNC model to get iodine map. Observation of benign and malignant lesions of the iodine image pseudo color distribution situation. Focus measurement of iodine map CT values in the conventional plain and enhanced CT. The lesions value during the comparison of iodine maps CT value and CT value and strengthen the 20HU threshold, iodine graph of CT and enhanced CT value in differential diagnosis of benign and malignant lesions. Results: the accuracy of iodine iodine Maps map pseudo color distribution of.8 cases of benign nodules lung lesions of different lesions showed no obvious pseudo color cover, 10 cases of inflammatory lesions showed obvious lesions iodine pseudo color and bright color covering.35 cases of malignant lesions showed lesions of iodine pseudo color covering diverse ways, among them 10 cases were pseudo color coating The cover was a piebald cover, 15 cases were pseudo color uneven coverage, necrotic foci showed pseudo color coverage defect. Figure CT iodine value and malignant lesions enhanced CT respectively (25.854.62), (22.43.89) HU, t=-8.022, P0.05; the two group CT value has a good consistency (r=0.839, P0.05); iodine figure CT benign lesions and enhanced CT value difference respectively (21.9210.8) (21.0810.9) HU, t=-1.129, P > 0.05; two group CT value has a good consistency (r=0.947, P > 0.05). The net value added more than 20HU for the diagnosis of malignant lesions threshold, iodine maps the value of CT and CT to strengthen the value judgement of benign and malignant sensitivity, specificity and accuracy were (85.7%, 65.2%, 77.6%); (80%, 60.9%, 72.4%).
Conclusion: dual energy iodine map can directly visualize the distribution of blood supply, and quantitatively express the degree of enhancement of lesions. It is highly sensitive and sensitive to identify benign and malignant lesions. It is more direct and sensitive to reflect the blood supply of lesions.
Objective: To investigate the application of the second generation CT multi group energy spectrum derived sequence in the lung space occupying lesions.
Methods: a retrospective analysis of 58 cases of lung scan and occupying lesion cases in April 2012 -2012 year in October in our hospital for chest, and confirmed by pathology. Scanning mode and conditions as before. Select the MonoEnergetic program to get the 60keV, 80kev, 100keV, 120kev single spectral image; nonlinear fusion by OptimalContrast program. The image and measure various derived sequence lesions were enhanced CT value difference, SNR and noise, the observed curve of lung lesions on different keV under the running trend.
Results: a series of single spectral image of lung lesions measured by enhanced CT and the difference between the noise differences were statistically significant (P0.05), the pulmonary lesions enhanced CT sequence is the maximum difference between the single energy spectrum 60keV (35.6215.94) HU, (P0.05).Moidal nonlinear image fusion disease tissue, muscle and soft tissue, drop aortic signal-to-noise ratio (4.291.03), respectively (4.211.41), HU (15.070.93), linear image fusion respectively (3.210.72), (2.830.99), HU (12.224.05), the difference was statistically significant (P0.05).Moidal nonlinear image fusion and linear image fusion lesions CT difference (25.8712.64), respectively (22.2910.19) HU. nonlinear fusion image quality was better than that of linear image fusion (P0.05). Different curve lung lesions under different keV running trend is helpful to the diagnosis.
Conclusion: the dual energy scanning mode can get multiple sets of energy spectrum derived sequence images after post-processing. The comprehensive application of these sequences can provide new diagnostic information for identification of benign and malignant lung lesions.

【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2013
【分類號】：R816.41

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