本文選題：雙能　切入點：體層攝影術(shù)　出處：《鄭州大學(xué)》2014年博士論文

【摘要】：胃癌是消化道常見惡性腫瘤,占每年新發(fā)癌癥人數(shù)的8%。胃癌的預(yù)后和TNM分期及分化程度密切相關(guān)。多排螺旋CT(multi-detector row CT,MDCT)成像已廣泛的應(yīng)用于胃癌的術(shù)前TNM分期及分化程度的診斷,但是仍有一些問題需要解決。雙源雙能量CT已應(yīng)用于臨床,它的優(yōu)勢在于一次掃描可以同時獲得高能量圖像、低能量圖像及混合能量圖像。還可得到各水平的單能量圖像及最佳單能量圖像。我們可以根據(jù)診斷的需要,選擇不同的圖像。能得到虛擬平掃圖像。虛擬平掃圖像因能夠避免常規(guī)平掃,可減少輻射劑量,尤其是對需要長期隨訪的患者。本文研究目的是評價雙源雙能量CT技術(shù)是否能優(yōu)化圖像質(zhì)量,提高TNM分期及分化程度診斷的準(zhǔn)確性,以及虛擬平掃圖像在降低輻射劑量可行性的評估。 第一部分胃癌雙能量圖像的優(yōu)化選擇及其在術(shù)前分期中的應(yīng)用 目的： 探討雙源雙能量CT圖像優(yōu)化選擇后的圖像質(zhì)量,及其在胃癌術(shù)前分期中的臨床應(yīng)用。 材料和方法： 收集我院2011年12月至2013年2月期間懷疑胃癌行腹部雙源雙能量增強掃描的患者55例。其中男41例,女14例,年齡23-81歲,平均年齡59.38歲。均經(jīng)手術(shù)或胃鏡病理證實。其中行手術(shù)的患者43例,其中男31例,女12例,年齡23～78歲,平均年齡59.05歲。測量100kV、120kV及70keV各能量下胃癌病灶、淋巴結(jié)的CT值、噪聲、對比噪聲比(signal-to-noise ratio,SNR)。比較各kV能量及70keV圖像間圖像質(zhì)量,優(yōu)化選擇最佳的圖像。并評估優(yōu)化后圖像的胃癌術(shù)前TNM分期,和120kV圖像相對比。 結(jié)果： 1.胃癌病灶動脈期100kV、120kV、70keV圖像質(zhì)量評價：100kV和70keV圖像強化程度明顯高于120kV。100kV和70keV圖像的CT值(87.28±23.91；84.86+21.59)明顯高于120kV的的CT值(73.08±17.49)(P0.001)。120kV和70keV的圖像噪聲(16.67±4.44；17.50±3.48)明顯低于100kV(23.80±6.53)的圖像噪聲(P0.01)。120kV和70keV的SNR(4.58±1.32；4.97±1.44)明顯高于100kV(3.844±1.29)(P0.01),70keV的CT值較120kV的的CT值增加了約16%,但是SNR是相仿的。 2.胃癌病灶靜脈期100kV、120kV、70keV圖像質(zhì)量評價。100kV和70keV圖像強化程度明顯高于120kV。100kV和70keV圖像的CT值(102.10±21.06；101.33士18.68)明顯高于120kV的的CT值(83.70±15.37)(P0.001)。120kV和70keV的圖像噪聲(18.16±5.25；18.37±5.31)明顯低于100kV(25.53±7.93)的圖像噪聲(P0.01)。70keV的SNR(5.93±2.00)明顯高于120和100kV的SNR(5.01±1.91；4.43±2.03)(P0.01),70keV的CT值較120kV的的CT值增加了約21%,但是SNR較120kV的高。 3.70keV和120kV胃癌患者T分期總的符合率分別為83.7%、72.1%。70keV和120kV圖像T1符合率分別為88.4%、95.3%,T2-3符合率分別為81.4%、90.7%,T4a符合率分別為83.7%、88.3%,T4b胃癌符合率分別為95.3%、95.3%,兩種圖像在胃癌浸潤深度中差別沒有統(tǒng)計學(xué)意義(P=0.25)。 4.120kV胃癌患者N分期總的符合率為62.8%,70keV提高到74.4%(P0.05)。70keV和120kV圖像NO符合率分別為86.0%、86.0%,N1符合率分別為86.0%、76.7%,N2符合率分別為83.7%、81%,N3胃癌符合率分別為93.0%、88.4%。結(jié)論： 雙能量CT成像70keV單能圖像較120kV不僅提高了胃癌病灶的CT值,圖像質(zhì)量。并且提高了胃癌N分期的符合率(P＜0.05)。 第二部分雙能量CT虛擬平掃技術(shù)在胃癌診斷中的價值 目的： 本文研究的目的主要是定性、定量評價胃癌雙能量掃描中虛擬平掃的圖像質(zhì)量及對胃癌術(shù)前評價的診斷價值。評估在胃癌患者中虛擬平掃能減少的輻射劑量問題。 材料和方法： 收集我院2011年12月至2013年2月期間懷疑胃癌行腹部雙源雙能量增強掃描的患者55例。其中男41例,女14例,年齡23～81歲,平均年齡59.38歲。均經(jīng)手術(shù)或胃鏡病理證實。利用雙能技術(shù)可以得到動脈期及靜脈期兩組圖像產(chǎn)生的虛擬平掃圖像(virtual non-enhanced,VNE),分別稱為VNEA (VNE images derived from the arterial phases, VNEA)、VNEP (VNE images derived from the portal venous phases,VNEP)。測量常規(guī)平掃(true non-enhanced, TNE)、VNEP、VNEA三組圖像胃癌病灶、淋巴結(jié)的CT值、噪聲、SNR。主觀評價三組圖像的解剖細(xì)節(jié)、噪聲、偽影及是否能滿足診斷。記錄三期掃描的容積CT劑量指數(shù)(volme CT dose index,CTDIvol)值。比較雙能三期(常規(guī)平掃、動脈期、門脈期)、及雙期(動脈期、門脈期)的容積CT劑量指數(shù)劑量來計算輻射劑量降低的百分比。 30例患者于半年內(nèi)進(jìn)行了復(fù)查。其中和首次檢查同在第二代雙源的患者15例。記錄治療后單源模式掃描的CTDIvol值。 結(jié)果： 1.常規(guī)平掃和虛擬平掃圖像胃癌病灶的CT值、最大厚度差異沒有統(tǒng)計學(xué)意義(P0.05)。但是常規(guī)平掃的噪聲高于虛擬平掃,SNR低于虛擬平掃圖像(P0.05)。兩組虛擬平掃圖像間腫瘤的CT值、最大厚度、噪聲及SNR沒有差別(P0.05)。 TNE、VNE圖像腫大淋巴結(jié)的直徑相仿(P0.05)。TNE較VNEP的CT值高(P0.05)。常規(guī)平掃的噪聲高于虛擬平掃,SNR低于虛擬平掃圖像(P0.05)。VNEA、VNEp兩組虛擬圖像不論腫大淋巴結(jié)的大小、CT值、噪聲及SNR差異均沒有統(tǒng)計學(xué)意義(P0.05)。 2.TNE、VNEA、VNEP三組圖像中,在解剖細(xì)節(jié)顯示方面,兩兩比較,TNE較VNEP解剖細(xì)節(jié)顯示清晰(P0.05),TNE、VNEA間相仿(P0.05)。虛擬平掃較的噪聲、界面?zhèn)斡暗脑u分高于常規(guī)平掃(P0.05)。兩組虛擬平掃圖像間解剖細(xì)節(jié)的顯示、噪聲級界面?zhèn)斡霸u分沒有差異(P0.05)。三組圖像均能滿足診斷需求(P0.05)。 3.22例結(jié)石、鈣化中,4例在VNE圖像中沒有顯示,1例在VNEP中沒有顯影,VNEA中吸收明顯。1例在VNEA中沒有顯影,在VNEp中重度吸收。3例在VNE圖像中均變小。 4.胃癌檢出及周圍侵犯的比較：對病灶檢出情況及周圍的侵犯的顯示,TNE、VNEA、VNEp三組圖像結(jié)果近似(P0.05)。有2例TNE、VNEA、VNEp三組圖像均沒有發(fā)現(xiàn)病變,1例TNE中發(fā)現(xiàn),2組VNE圖像中沒有檢出病灶,VNEA中1例沒有檢出處漿膜侵犯,VNEp中2例沒有檢出漿膜侵犯,三組圖像中對鄰近胰腺、肝臟的侵犯均檢出,對肝臟轉(zhuǎn)移檢測的情況相同,在腫大淋巴結(jié)中,TNE檢測出47例,有1例VNEA檢測出,VNEP沒有檢測出,2例VNEP檢測出,VNEA沒有檢測出,5例二者都沒有檢測出。 5.雙能量掃描模式,虛擬平掃圖像可代替常規(guī)平掃,如果去掉平掃的輻射劑量,可減少32.41%的輻射劑量。結(jié)論： 胃癌患者術(shù)前分期掃描虛擬平掃圖像具有替代常規(guī)平掃的潛在能力,從而可以降低32.41%的輻射劑量。 第三部分雙能量CT碘濃度及能譜曲線在胃癌病理分級中的應(yīng)用 目的： 判斷雙能量CT技術(shù)的碘含量及能譜曲線與胃癌病理分級間的關(guān)系。 材料和方法： 收集我院2011年12月至2013年2月期間懷疑胃癌行腹部雙源雙能量增強掃描的患者55例。其中男41例,女14例,年齡23-81歲,平均年齡59.38歲。均經(jīng)手術(shù)或胃鏡病理證實。測量平掃、動脈期和靜脈期胃癌病灶的CT值、碘值及同層主動脈碘值。測量腫大淋巴結(jié)動靜脈雙期的碘值,計算標(biāo)準(zhǔn)化碘濃度(normalized iodine concentration,NIC)=病灶內(nèi)測得的碘值／同層面腹主動脈測得。的碘值。計算胃癌病灶動脈期、靜脈期強化的程度。動脈期強化程度CTA為動脈期CT值-平掃的CT值；靜脈期強化程度CTP為靜脈期CT值-平掃的CT值。CTPA為靜脈期腫瘤的CT值-動脈期腫瘤的CT值。 將雙能量數(shù)據(jù)傳入Dual-Ene(?)gy軟件的"Monoenergetic”程序進(jìn)行觀察分析�？梢缘玫�40kev-190kev任意kev條件下感興趣區(qū)的CT值。測量胃癌病灶、腫大淋巴結(jié)單能量條件下的CT值,每隔10kev保存記錄一次。 結(jié)果： 1.不同分化程度胃癌的平掃、動脈期、靜脈期CT值及CTA、CTP差異沒有統(tǒng)計學(xué)意義(P均大于0.05)。 2.不同分化程度胃癌的CTPA、靜脈期的標(biāo)準(zhǔn)化碘值差異有統(tǒng)計學(xué)意義(P0.05)。 3.不同性質(zhì)的淋巴結(jié)動脈期、靜脈期標(biāo)準(zhǔn)化碘值差異均有統(tǒng)計學(xué)意義(P0.05)。 4.不同分化程度胃癌的能譜曲線,動脈期曲線走形是重疊的。靜脈期,低分化胃癌的曲線位于中高分化胃癌的上方,keV越低,走形越陡,差別越明顯；隨著keV增高,走形平緩,差異減小。 5.靜脈期低分化胃癌的能譜衰減曲線斜率大于中分化胃癌。動脈期斜率無統(tǒng)計學(xué)意義。 結(jié)論： 雙能CT技術(shù)的標(biāo)準(zhǔn)化碘濃度定量測定及能譜曲線和胃癌的病理分化程度是相關(guān)的。
[Abstract]:Multi - detector row CT ( MDCT ) imaging has been widely used in the diagnosis of preoperative TNM staging and differentiation of gastric cancer .

The Optimal Selection of Dual Energy Image in the First Part of Gastric Cancer and Its Application in Preoperative Staging

Purpose :

Objective To investigate the image quality of dual - source dual - energy CT image optimization and its clinical application in preoperative staging of gastric cancer .

Materials and methods :

Fifty - five patients were collected from our hospital between December 2011 and February 2013 . Among them , 41 males and 14 females , aged 23 - 81 years , mean age of 59.38 years , were confirmed by operation or endoscopy . Among them , 31 males , 12 females , aged 23 - 78 years , mean age of 59.05 years , measured the lesions of gastric cancer , CT value , noise and contrast - to - noise ratio ( SNR ) of lymph nodes at 100kV , 120kV and 70keV . The best image quality was selected by comparing the image quality between each kV energy and 70keV images . The preoperative TNM staging and the relative ratio of 120kV images were evaluated .

Results :

1 . The image quality of 100 kV , 120kV and 70keV images in the arterial phase of gastric cancer was evaluated : the enhancement degree of 100kV and 70keV images was obviously higher than that of 120kV , 100kV and 70keV images ( 87.28 鹵 23.91 ;
84.86 + 21.59 ) significantly higher than 120kV ( 73.08 鹵 17.49 ) ( P0.001 ) . 120kV and 70keV image noise ( 16.67 鹵 4.44 ;
17.50 鹵 3.48 ) significantly lower than 100kV ( 23.80 鹵 6.53 ) image noise ( P0.01 ) . SNR of 120kV and 70keV ( 4.58 鹵 1.32 ) ;
4 . 97 鹵 1 . 44 ) was significantly higher than that of 100 kV ( 3 . 844 鹵 1 . 29 ) ( P0.01 ) . CT value of 70 keV increased by about 16 % than that of 120kV , but SNR was similar .

2 . The image quality of 100 kV , 120kV and 70keV images was evaluated in 100 kV , 120 kV and 70 keV images , and the enhancement of 100 kV and 70 keV images was significantly higher than that of 120kV . 100kV and 70keV images ( 101.10 鹵 21.06 ) .
101.33 鹵 18.68 ) significantly higher than 120kV ( 83.70 鹵 15.37 ) ( P0.001 ) . 120kV and 70keV image noise ( 18.16 鹵 5.25 ;
The SNR ( 5.93 鹵 2.00 ) of the 70keV SNR ( 5.93 鹵 2.00 ) was significantly higher than that of 120 and 100kV ( 5.01 鹵 1.91 ) , which was significantly lower than that of 100kV ( 25.53 鹵 7.93 ) .
4.43 鹵 2.03 ) ( P0.01 ) , the CT value of 70keV increased by about 21 % compared with that of 120kV , but SNR was higher than 120kV .

The coincidence rate of T staging in patients with 3.70keV and 120kV gastric cancer was 83.7 % , 72.1 % , 70keV and 120kV , respectively 88.4 % , 95.3 % , T4a coincidence rate 81.4 % , 90.7 % , T4a coincidence rate 83.7 % , 88.3 % , T4b gastric cancer coincidence rate was 95.3 % and 95.3 % , respectively . There was no significant difference between the two images in the depth of invasion of gastric cancer ( P = 0.25 ) .

The coincidence rate of N staging of patients with 120kV gastric cancer was 62.8 % , 70keV increased to 74.4 % ( P0.05 ) . The coincidence rates of NO in 70keV and 120kV were 86.0 % , 86.0 % , N1 coincidence rate was 86.0 % , 76.7 % , N2 coincidence rate was 83.7 % , 86.4 % , respectively . Conclusion :

Dual - energy CT imaging 70 keV single - energy image 120 kV not only improved the CT value and image quality of gastric cancer lesions , but also improved the coincidence rate of N staging of gastric cancer ( P & lt ; 0.05 ) .

Value of the second partial double - energy CT virtual plain scanning technique in the diagnosis of gastric cancer

Purpose :

The purpose of this study is to qualitatively and quantitatively evaluate the image quality of virtual plain scan in gastric cancer dual energy scan and the diagnostic value of preoperative evaluation of gastric cancer .

Materials and methods :

Fifty - five patients were collected from our hospital between December 2011 and February 2013 . Among them , 41 males and 14 females , aged 23 - 81 years , mean age of 59.38 years , were confirmed by operation or pathology . Virtual non - enhanced , VNE images produced by both arterial and venous phases were obtained by dual - energy technique , respectively , and VNEP ( VNE images derived from the portal venous phases , VNEP ) . The volume CT dose index ( CTDIvol ) values of three groups of images , such as normal plain scan ( true non - enhanced , TNE ) , VNEP and Vnea , were measured . The volume CT dose index ( CTDIvol ) of three groups of images was recorded .

Thirty patients were re - examined in half a year , and 15 patients with second - generation dual - source were examined for the first time and CTDIvol values were recorded for single - source mode scans after treatment .

Results :

1 . There was no significant difference in the CT value and the maximum thickness difference between conventional plain scan and virtual plain scan images ( P0.05 ) , but the noise of conventional plain scan was higher than that of the virtual plain scan ( P0.05 ) . There was no difference in the CT value , the maximum thickness , the noise and SNR between the two groups of virtual plain scan images ( P0.05 ) .

Compared with VNEP ( P0.05 ) , TNE and VNE were higher than those of VNEP ( P0.05 ) . The noise of conventional plain scan was higher than that of virtual plain scan ( P0.05 ) .

2 . In three groups of images of TNE , Vnea and VNEP , the anatomical details of TNE and VNEP showed clear ( P0.05 ) , TNE and Vnea were similar ( P0.05 ) .

3 . In 22 cases of stone and calcification , 4 cases did not show in the VNE image , 1 case did not develop in VNEP , 1 case did not develop in Vnea , moderate to severe absorption in VNEp . 3 cases were smaller in VNE image .

4 . Comparison of detection and peripheral invasion of gastric cancer : There were no lesions in the three groups of TNE , Vnea and VNEp ( P0.05 ) . There were 2 cases of TNE , Vnea and VNEp . There were no lesions in the two groups .

5 . Dual - energy scanning mode , the virtual plain scan image can replace the conventional plain scan , and if the radiation dose of the plain scan is removed , the radiation dose of 32.41 % can be reduced . Conclusion :

The preoperative staging scan of the virtual plain scan image has the potential to replace the conventional plain scan , thereby reducing the radiation dose of 32.41 % .

Application of the third partial double - energy CT iodine concentration and energy spectrum curve in the pathological grade of gastric cancer

Purpose :

The relationship between iodine content , energy spectrum curve and pathological grade of gastric cancer was determined .

Materials and methods :

In this study , 55 patients were collected from our hospital between December 2011 and February 2013 . Among them , 41 male , 14 female , aged 23 - 81 years , mean age 59.38 years , were confirmed by operation or pathology .
The CT value of CT value - plain scan in venous phase is CTPA . CTPA is the CT value of venous phase tumor - CT value of arterial phase tumor .

The CT value of the region of interest can be measured with the single energy condition of 40 keV to 190 keV . The CT value of the lesion of gastric cancer and the single energy condition of the lymph node of the enlarged lymph node is measured , and the record is saved every 10 keV .

Results :

1 . There was no significant difference between CT value and CT value of different degrees of differentiation ( P > 0.05 ) .

2 . There was significant difference in the standardized iodine value between CTPA and venous phase in different degrees of differentiation ( P0.05 ) .

3 . There was significant difference in the standardized iodine value between lymph node arterial phase and venous phase in different properties ( P0.05 ) .

4 . The curve of energy spectrum of gastric cancer with different differentiation degree and the shape of arterial phase were overlapped . The curve of venous phase and low differentiation gastric cancer was located above the middle and high differentiated gastric cancer . The lower the keV , the steeper the shape , the more obvious the difference .
With the increase of keV , the shape is gentle and the difference is reduced .

5 . The slope of energy spectrum attenuation curve of venous phase low differentiation gastric cancer was larger than that in middle - differentiated gastric cancer . There was no statistical significance in the slope of arterial phase .

Conclusion :

The quantitative determination of standardized iodine concentration in dual - energy CT and the degree of pathological differentiation of gastric cancer were correlated .

【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2014
【分類號】：R735.2;R730.44

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