發(fā)布時(shí)間：2018-04-11 07:40

  本文選題：體層攝影術(shù) + X線(xiàn)計(jì)算機(jī)　； 參考：《泰山醫(yī)學(xué)院》2013年碩士論文

【摘要】：目的 本研究旨在利用通過(guò)雙源CT（Somatom Definition flash DSCT）對(duì)臨床擬診為阻塞性黃疸的病患行雙能量掃描，探討雙源CT雙能量虛擬平掃技術(shù)（VNC）在阻塞性黃疸病因診斷中的價(jià)值。 研究方法 選擇自2012年4月-2012年10月來(lái)我院檢查的30例經(jīng)臨床診斷為阻塞性黃疸患者，其中男性16例,女性14例,年齡34~75歲,平均57.9歲，口服對(duì)比劑前先行常規(guī)腹部平掃（CNC），然后口服陽(yáng)性對(duì)比劑500ml，再用雙能量掃描模式動(dòng)脈期強(qiáng)化掃描，最后行常規(guī)門(mén)靜脈期強(qiáng)化掃描，之后采用肝臟虛擬平掃后處理軟件Liver VNC，經(jīng)參數(shù)調(diào)整，對(duì)雙能量強(qiáng)化圖像進(jìn)行處理，得到VNC圖像，以常規(guī)平掃圖像為金標(biāo)準(zhǔn)比較VNC圖像在病灶檢出中的準(zhǔn)確性，并利用t檢驗(yàn)對(duì)比分析圖像信噪比（SNR），用軼和檢驗(yàn)分析患者不同掃描方式接受的總輻射劑量容積CT劑量指數(shù)（CTDIvol）值和劑量長(zhǎng)度乘積（DLP）值有無(wú)統(tǒng)計(jì)學(xué)差異。 結(jié)果 以常規(guī)平掃圖像為標(biāo)準(zhǔn)，VNC圖像病灶檢出率100%，其中膽囊結(jié)石6例，膽總管結(jié)石5例，膽管腫瘤11例，壺腹部腫瘤3例，胰腺腫瘤5例，VNC組圖像瘤可見(jiàn)度、診斷接受度低于CNC組，差異無(wú)明顯統(tǒng)計(jì)學(xué)意義（P0.05），圖像CT值及信噪比差異無(wú)明顯統(tǒng)計(jì)學(xué)意義， VNC圖像質(zhì)量略有下降，但能滿(mǎn)足診斷要求，在結(jié)石和腫瘤等病變檢出中無(wú)明顯差異,在劑量統(tǒng)計(jì)分析中虛擬組較常規(guī)組低，具有明顯統(tǒng)計(jì)學(xué)差異（P=0.0020.05）。 結(jié)論 在阻塞性黃疸患者的CT病因診斷時(shí)，虛擬平掃技術(shù)能夠有效減少輻射劑量，且不影響結(jié)石和腫瘤等病變的檢出，使其取代常規(guī)平掃成為可能。 意義 黃疸(jaundice)是指由于血漿內(nèi)膽紅素濃度升高所導(dǎo)致的皮膚、結(jié)膜和粘膜出現(xiàn)的橙黃色改變，是一種臨床常見(jiàn)的征象，其中阻塞性黃疸不僅對(duì)肝臟的形態(tài)和功能有很大影響，對(duì)除了肝臟之外的臟器也有巨大的影響，例如心血管、腎臟、胃腸道、胰腺等。雖然良性病因常占大多數(shù)，為膽石癥、膽管炎癥、寄生蟲(chóng)病、膽管憩室、先天性膽管異常、急性或慢性胰腺炎、手術(shù)后膽管狹窄、膽總管周?chē)M織粘連等，但是惡性阻塞性黃疸往往起病隱匿，病因復(fù)雜，，既可為原發(fā)于肝、膽、胰腺等部位的惡性腫瘤如膽管癌、膽囊癌、胰頭癌、肝細(xì)胞癌、壺腹周?chē)┑�，也可以為其他部位的惡性腫瘤轉(zhuǎn)移而來(lái)侵犯膽道，而且預(yù)后較差，因此早期診斷對(duì)其臨床治療方案的制定有重大意義。在當(dāng)前的臨床工作中，阻塞性黃疸患者受檢方法主要有B超、CT、MRCP、ERCP等，但B超診斷準(zhǔn)確率較低，MRCP無(wú)法對(duì)病變周?chē)芮闆r做出評(píng)價(jià)，ERCP檢查存在創(chuàng)傷性和風(fēng)險(xiǎn)性，可能發(fā)生并發(fā)癥，CT掃描速度快,且可以獲得任意平面的重建圖像,對(duì)膽總管下段小病變的顯示極為有利，對(duì)膽系疾患的診斷更具有獨(dú)特的優(yōu)越性，而且當(dāng)前對(duì)阻黃患者過(guò)度檢查、盲目檢查時(shí)有發(fā)生，不但浪費(fèi)了患者的時(shí)間，加重了患者的負(fù)擔(dān)，而且增加了患者接受的輻射劑量，虛擬平掃技術(shù)的應(yīng)用使阻塞性黃疸的檢查狀況有了較大改善，虛擬平掃技術(shù)的應(yīng)用不但可以節(jié)省掃描時(shí)間，減少了患者接受的輻射劑量，且可以為臨床提供足夠的診斷信息，為治療方案的制定提供足夠的幫助。
[Abstract]:objective
The purpose of this study is to explore the value of dual source CT dual energy virtual flat scan (VNC) in etiological diagnosis of obstructive jaundice by dual energy scanning through dual source CT (Somatom Definition flash DSCT).
research method
Select 30 cases from April 2012 -2012 year in October in our hospital diagnosed by clinical examination of patients with obstructive jaundice, of which 16 were male, 14 were female, aged 34~75 years old, average 57.9 years old, oral contrast agent before routine abdominal plain (CNC), and positive oral contrast agent 500ml, with dual energy scan mode arterial phase enhancement scan, and then routine venous phase enhanced scan of the liver, after using the virtual scan postprocessing software Liver VNC, the parameter adjustment of dual energy image enhancement, VNC images are obtained by conventional unenhanced image standard accuracy of VNC images in the detection of lesions in gold, and the use of T comparative analysis of test image signal-to-noise ratio (SNR) index, the total radiation dose volume CT dose received by different scanning methods and test analysis of patients with Yi (CTDIvol) and dose length product (DLP) value has no statistical difference.
Result
In conventional unenhanced image as the standard, the VNC images of the lesion detection rate of 100%, including 6 cases of cholecystolithiasis, 5 cases of common bile duct stones, bile duct tumor in 11 cases, 3 cases of ampullary carcinoma, 5 cases of pancreatic cancer, VNC images of tumor visibility, diagnosis of acceptance is lower than the CNC group, the difference was not statistically significant (P0.05) the value of CT, the image signal-to-noise ratio and the difference was not statistically significant, the image quality of VNC decreased slightly, but to meet the diagnostic requirements, no significant difference in the detection of calculus and tumor lesions, at the doses of statistical analysis in virtual group lower than the conventional group, with significant statistical difference (P=0.0020.05).
conclusion
In the diagnosis of CT in patients with obstructive jaundice, virtual scanning technology can effectively reduce the radiation dose, and does not affect the detection of stones and tumors, making it possible to replace conventional plain scan.
Significance
Jaundice (jaundice) refers to the bilirubin concentration in plasma increased in the skin, conjunctiva and mucosa appeared orange color change, is a common clinical signs of obstructive jaundice, which not only on the morphology and function of the liver has great influence, also have a huge impact on the outside, in addition to the liver organs such as cardiovascular. Kidney, gastrointestinal tract, pancreas. Although benign etiology is often the majority for cholelithiasis, bile duct inflammation, parasitic disease, biliary diverticulum, congenital bile duct abnormalities, acute or chronic pancreatitis, biliary stricture after surgery, common bile duct tissue adhesion, but malignant obstructive jaundice is often insidious onset, complex causes, can for the primary liver, gallbladder, bile duct cancer such as malignant gallbladder carcinoma, pancreas, pancreatic carcinoma, hepatocellular carcinoma and periampullary carcinoma, can also invade other parts of the biliary tract for malignant tumor metastasis, and The prognosis is poor, therefore making early diagnosis of the clinical treatment scheme is of great significance in clinical work. The current in the patients with obstructive jaundice. Methods include ultrasound, CT, MRCP, ERCP and so on, but the accuracy rate of ultrasound diagnosis is low, MRCP will not be able to do the evaluation of peripheral vascular disease, ERCP examination traumatic and the risk of possible complications, CT scanning speed, the reconstructed image can be obtained and arbitrary, for common bile duct lesions showed extremely beneficial for diagnosing biliary diseases has unique advantages, and when the patients with obstructive jaundice excessive examination, blind checks have occurred not only a waste of time, patients, increased the burden on patients, but also increase the radiation dose of patients, application of virtual scan technology to check the status of obstructive jaundice has greatly improved, not only the application of virtual scan technology It can save scanning time, reduce the radiation dose of patients, and provide enough information for clinical diagnosis, so as to provide enough help for the formulation of treatment plan.

【學(xué)位授予單位】：泰山醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2013
【分類(lèi)號(hào)】：R816.5;R575

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