本文選題：食管胃接合處 + 腫瘤��； 參考：《山東中醫(yī)藥大學(xué)》2017年碩士論文

【摘要】：目的:探討能譜CT成像在食管胃結(jié)合部鱗癌與腺癌鑒別診斷中的應(yīng)用價(jià)值。方法:回顧性分析我院經(jīng)病理證實(shí)并行能譜CT增強(qiáng)掃描的食管胃結(jié)合部占位患者45例,鱗癌20例、腺癌25例。利用能譜后處理分析軟件分別測(cè)量?jī)山M動(dòng)脈期及靜脈期腫塊內(nèi)同一感興趣區(qū)的碘濃度(IC)、水濃度(WC)、有效原子序數(shù)(Eff-Z)及能譜曲線斜率(λHU);在滿(mǎn)足正態(tài)分布條件下采用獨(dú)立樣本t檢驗(yàn)比較鱗癌組與腺癌組各能譜參數(shù)有無(wú)差異;對(duì)差異有統(tǒng)計(jì)學(xué)意義的參數(shù)進(jìn)一步繪制ROC曲線,利用曲線下面積(AUC)衡量其各自的鑒別診斷效能并選擇最佳診斷閾值。結(jié)果:動(dòng)脈期IC、Eff-Z和λHU的平均值,腺癌分別為(1.75±0.40)mg/mL、8.65±0.22、3.33±0.74,鱗癌相應(yīng)參數(shù)分別為(1.40±0.35)mg/mL、8.50±0.20及2.71±0.66,腺癌均大于鱗癌,差異有統(tǒng)計(jì)學(xué)意義(t值分別為-2.833、-2.879、-2.678,P值均0.05);靜脈期IC、Eff-Z和λHU的平均值,腺癌分別為(2.17±0.23)mg/mL、8.87±0.11、4.10±0.44,鱗癌相應(yīng)參數(shù)分別為(1.67±0.20)mg/mL、8.60±0.11及3.19±0.41,腺癌均大于鱗癌,差異也均有統(tǒng)計(jì)學(xué)意義(t值分別為-6.963、-7.218、-6.521,P均0.05)。而動(dòng)脈期WC的平均值,腺癌和鱗癌分別為(1016.04±7.80)mg/mL和(1020.40±10.43)mg/mL;靜脈期WC的平均值,腺癌和鱗癌分別為(1019.94±6.51)mg/mL和(1020.23±10.09)mg/mL,差異均無(wú)統(tǒng)計(jì)學(xué)意義(t值分別為1.435和0.104,P均0.05)。對(duì)動(dòng)脈期及靜脈期IC、Eff-Z和λHU行ROC曲線分析顯示靜脈期IC、Eff-Z和λHU具有較高的診斷效能,尤其是靜脈期Eff-Z,AUC為0.97,以8.72為閾值,其鑒別鱗癌與腺癌的敏感度和特異度分別為88.9%、94.7%。結(jié)論:能譜CT多參數(shù)定量分析對(duì)食管胃結(jié)合部鱗癌與腺癌的鑒別診斷具有價(jià)值。
[Abstract]:Objective: to evaluate the value of energy dispersive CT in differential diagnosis of esophageal and gastric squamous cell carcinoma and adenocarcinoma.Methods: 45 patients with esophageal and gastric junction, 20 with squamous cell carcinoma and 25 with adenocarcinoma were retrospectively analyzed.Using the software of energy spectrum post-processing analysis, the iodine concentration of the same area of interest in the two groups of arterial and venous tumors were measured, and the slope of the energy spectrum curve (位 HUU) and the effective atomic number (Eff-Z) were measured under the condition of satisfying the normal distribution of the tumor by using the iodide concentration, the water concentration, the effective atomic number and the slope of the energy spectrum curve.T test was used to compare the difference of energy spectrum parameters between squamous cell carcinoma group and adenocarcinoma group.The ROC curve was further drawn for the parameters with statistical significance. The area under the curve was used to evaluate their differential diagnostic effectiveness and select the best diagnostic threshold.Results: the mean values of ICEff-Z and 位 Hu in arterial stage were 1.75 鹵0.40 mg / mL, 8.65 鹵0.22 mg / mL, 3.33 鹵0.74, respectively, and the corresponding parameters of squamous cell carcinoma were 1.40 鹵0.35 mg / mL, 8.50 鹵0.20 and 2.71 鹵0.66, respectively. The mean values of ICEff-Z and 位 Hu were higher in adenocarcinoma than in squamous cell carcinoma (P = -2.83 3, -2.879- 2.678, P = 0.05, respectively).The corresponding parameters of squamous cell carcinoma were 1.67 鹵0.20 mg / mL, 8.60 鹵0.11 and 3.19 鹵0.41, respectively. The difference between adenocarcinoma and squamous cell carcinoma was statistically significant (-6.963- 7.218- 6.521, P < 0.05).The mean values of WC in arterial phase, adenocarcinoma and squamous cell carcinoma were 1016.04 鹵7.80)mg/mL and 1020.40 鹵10.43 mg / mL, respectively, while the mean values of WC in venous phase, adenocarcinoma and squamous cell carcinoma were 1019.94 鹵6.51)mg/mL and 1020.23 鹵10.09 mg / mL, respectively. The difference was not statistically significant (t = 1.435 and 0.104g / mL, respectively).The ROC curve analysis of ICEff-Z and 位 Hu in arterial phase and venous phase showed that ICEff-Z and 位 Hu had high diagnostic efficacy, especially in venous phase, Eff-Z and 位 Hu were 0.97. The sensitivity and specificity of Eff-Z and 位 Hu in differentiating squamous cell carcinoma from adenocarcinoma were 88.994. 77.The sensitivity and specificity of Eff-Z and 位 Hu were 88.994.Conclusion: multiparameter quantitative analysis of energy dispersive CT is valuable in the differential diagnosis of esophageal and gastric squamous cell carcinoma and adenocarcinoma.
【學(xué)位授予單位】：山東中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R735;R730.44

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