本文選題：能譜CT + 喉及下咽鱗癌�。� 參考：《北京協(xié)和醫(yī)學(xué)院》2016年博士論文

【摘要】：第一部分：不同病理級(jí)別喉及下咽鱗癌的能譜參數(shù)研究目的：探討不同病理級(jí)別喉及下咽鱗狀細(xì)胞癌(laryngeal and hypopharyngeal squamous cell carcinoma, LHSCC)能譜參數(shù)的差異,為判斷LHSCC預(yù)后、指導(dǎo)臨床治療提供幫助。材料與方法：回顧性分析2014年1月至2015年3月經(jīng)病理證實(shí)LHSCC患者61例,所有患者治療前均行DECT掃描,掃描后數(shù)據(jù)在GE AW4.6工作站用GSI Volume Viewer軟件進(jìn)行分析,獲取病變部位的碘基物質(zhì)濃度(iodine concentration of lesion, IC-L)、水基物質(zhì)濃度(water concentration of lesion, WC-L)、頸動(dòng)脈竇碘基物質(zhì)濃度(iodine concentration of carotid sinus,IC-C)、頸動(dòng)脈竇水基物質(zhì)濃度(water concentration of carotid sinus, WC-C)并計(jì)算標(biāo)化碘基物質(zhì)濃度(standardized IC, sIC)、標(biāo)化水基物質(zhì)濃度(standardized WC. sWC)、能譜曲線斜率(slope of spectral Hu curve, λHU)值。按照細(xì)胞分化程度的不同將所有患者分為高分化組、中分化組和低分化組,比較不同組間sIC、sWC、λHU、T分期及N分期構(gòu)成比、淋巴結(jié)轉(zhuǎn)移發(fā)生率的差異。結(jié)果：高、中、低分化組sIC、λHU分別為[(30.56±7.98)×10-2、(24.06±9.21)×10-2、(18.64±5.26)×10-2,F=5.75]、[(3.O1±1.38)、(2.50±0.82)、(2.01±0.77),F=3.96],差異均有統(tǒng)計(jì)學(xué)意義(P0.05)；最小顯著差法(least significance difference test, LSD-t)進(jìn)一步兩兩比較顯示低分化組與高分化組λHU差異有統(tǒng)計(jì)學(xué)意義(P0.05),低、中分化組和中、高分化組λHU差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)；三組兩兩比較sIC值差異均有統(tǒng)計(jì)學(xué)意義(P0.05),高、中、低分化組sWC值差異無(wú)統(tǒng)計(jì)學(xué)意義(H=0.01,P0.05)；高、中、低分化組T分期構(gòu)成比差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)；高、中、低分化組N分期構(gòu)成比差異有統(tǒng)計(jì)學(xué)意義(P0.05)；高、中、低分化組淋巴結(jié)轉(zhuǎn)移發(fā)生率差異有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論：不同分化LHSCC的λHU、sIC值有一定差異;低分化LHSCC更易發(fā)生淋巴結(jié)轉(zhuǎn)移；能譜參數(shù)對(duì)判斷LHSCC預(yù)后可能有一定幫助。第二部分：能譜CT診斷喉及下咽鱗癌淋巴結(jié)轉(zhuǎn)移的臨床價(jià)值目的：探討能譜CT (dual-energy CT, DECT)診斷喉及下咽鱗癌(laryngeal and hypopharyngeal squamous cell carcinoma, LHSCC)淋巴結(jié)轉(zhuǎn)移的價(jià)值,同時(shí)確定能譜參數(shù)及形態(tài)學(xué)指標(biāo)對(duì)LHSCC轉(zhuǎn)移性淋巴結(jié)的診斷閾值。材料與方法：回顧性收集經(jīng)手術(shù)病理證實(shí)的LHSCC患者60例,所有患者均在術(shù)前2周內(nèi)行DECT檢查,1名具有10年以上的頭頸部腫瘤放射醫(yī)師參照病理結(jié)果,在軸位圖像上選擇代表性轉(zhuǎn)移與非轉(zhuǎn)移淋巴結(jié),測(cè)量淋巴結(jié)的長(zhǎng)徑(L)、短徑(S)、病灶碘基物質(zhì)濃度(iodine concentration of lesion, IC-L),病灶水基物質(zhì)濃度(water concentration of lesion, WC-L),右側(cè)頸動(dòng)脈竇碘基物質(zhì)濃度(iodine concentration of carotid sinus, IC-C),右側(cè)頸動(dòng)脈水基物質(zhì)濃度(water concentration of carotid sinus, WC-C)。計(jì)算S/L、標(biāo)化碘基物質(zhì)濃度(standardized IC, sIC)=IC-C/IC-L,標(biāo)化水基物質(zhì)濃度(standardized WC, sWC)=WC-L/(WC-C),能譜曲線斜率(slope of spectral Hu curve, λHU),比較轉(zhuǎn)移與非轉(zhuǎn)移淋巴結(jié)形態(tài)學(xué)指標(biāo)及能譜參數(shù)值的差異。將有統(tǒng)計(jì)學(xué)差異的形態(tài)學(xué)參數(shù)、能譜參數(shù)帶入logistic回歸方程產(chǎn)生預(yù)測(cè)淋巴結(jié)轉(zhuǎn)移的新變量(new variable, NV),對(duì)S、λHU、NV進(jìn)行受試者工作特征曲線(receiver operating characteristic curve, ROC)分析,并比較其診斷能力。結(jié)果：轉(zhuǎn)移淋巴結(jié)的S顯著大于非轉(zhuǎn)移淋巴結(jié)(t=3.86,P0.05)：轉(zhuǎn)移淋巴結(jié)的L、S/L大于非轉(zhuǎn)移淋巴結(jié),但差異無(wú)統(tǒng)計(jì)學(xué)意義(t=0.38,1.74,P0.05)；轉(zhuǎn)移淋巴結(jié)的XHU顯著大于非轉(zhuǎn)移淋巴結(jié)(t=3.97,P0.05)；轉(zhuǎn)移淋巴結(jié)的sWC、sIC大于非轉(zhuǎn)移淋巴結(jié),但差異無(wú)統(tǒng)計(jì)學(xué)意義(Z=-1.45,-1.85,P0.05)。S、λHU、NV預(yù)測(cè)LHSCC發(fā)生淋巴結(jié)轉(zhuǎn)移的曲線下面積(area under the curve, AUC)分別為0.77、0.77、0.87(P0.05),NV預(yù)測(cè)LHSCC發(fā)生淋巴結(jié)轉(zhuǎn)移的AUC最大,與S、λHU曲線下面積比較差異有統(tǒng)計(jì)學(xué)意義(P0.05), S、λHU的AUC差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。以NV0.46作為診斷閾值判斷LHSCC淋巴結(jié)轉(zhuǎn)移的靈敏度,特異度分別為90.91%、74.04%。結(jié)論：能譜參數(shù)診斷喉及下咽鱗癌淋巴結(jié)轉(zhuǎn)移的能力與形態(tài)學(xué)參數(shù)相近,兩者結(jié)合可以顯著提高診斷的靈敏度和特異度。第三部分：能譜參數(shù)預(yù)測(cè)局部晚期喉及下咽鱗癌治療療效的探索性研究目的：探討能譜CT(dual-energy CT, DECT)在預(yù)測(cè)局部晚期喉及下咽鱗癌(laryngeal and hypopharyngeal squamous cell carcinoma, LHSCC)放療(伴或不伴化療)療效中的作用,為臨床早期判斷LHSCC治療療效提供依據(jù)。材料與方法：前瞻性分析本院2014年1月到2015年12月原發(fā)局部晚期LHSCC患者41例,所有患者治療前均行DECT掃描,治療結(jié)束3個(gè)月后按其治療效果將患者分為完全緩解(complete remission, CR)和非完全緩解(non-complete remission, NCR)組,比較兩組間T分期構(gòu)成比、治療方式,標(biāo)化碘基物質(zhì)濃度(standardized iodine concentration, sIC)、標(biāo)化水基物質(zhì)濃度(standardized water concentration, sWC).能譜曲線斜率(slope of the spectral HU curve, λHU),有效原子序數(shù)(effective atomic number, Zeff)的差異,并對(duì)兩組間有統(tǒng)計(jì)學(xué)差異的能譜參數(shù)預(yù)測(cè)喉及下咽鱗癌的治療療效進(jìn)行受試者工作特征曲線(receiver operating characteristic curve, ROC)分析,確定預(yù)測(cè)治療療效CR的最佳閾值。結(jié)果：19(46.3%)名患者被納入CR組,22(53.7%)名患者被納入NCR組。CR組與非CR組T分期構(gòu)成比、治療方式差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。CR組λHU、 sIC、Zeff分別為1.96±0.52、0.21±0.05、8.51±0.20,NCR組λHU、SIC、Zeff分別為2.72±0.64、0.30±±0.10、8.71±0.29,兩組比較差異有統(tǒng)計(jì)學(xué)意義(t=-4.13,.4.20,-2.44,P0.05)。對(duì)μHU、sIC及Zeff預(yù)測(cè)局部晚期LHSCC治療療效CR的診斷價(jià)值進(jìn)行受試者工作特征曲線(receiver operating characteristic curve, ROC)分析,λHU、sIC、Zeff值預(yù)測(cè)治療療效CR的曲線下面積(area under curve, AUC)分別為0.83、0.85、0.70；AUC之間差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)；以sIC值≤0.21、λHU≤2.37、Zeff≤ 8.55作為診斷閾值預(yù)測(cè)局部晚期LHSCC治療療效CR的靈敏度、特異度、陽(yáng)性預(yù)測(cè)值、陰性預(yù)測(cè)值分別為84.21%、90.91%、88.9%、87.0%；84.21%、72.73%、72.7%、84.2%：68.42%、77.27%、72.2%、73.9%。結(jié)論：能譜參數(shù)對(duì)于預(yù)測(cè)局部晚期LHSCC治療療效有一定作用,可能有助于局部晚期LHSCC患者治療方式的選擇。
[Abstract]:The first part: the spectral parameters of objective pharyngeal squamous cell carcinoma of different pathological grade of larynx and lower: To investigate the pathological grades of laryngeal and hypopharyngeal squamous cell carcinoma (laryngeal and hypopharyngeal squamous cell carcinoma, LHSCC) the difference spectrum parameters, for evaluating the prognosis of LHSCC, to help guide the clinical treatment. Materials and methods: a retrospective analysis from January 2014 to 2015 3 pathologically confirmed 61 cases of LHSCC patients, all patients underwent DECT scan, scan data in GE AW4.6 workstation with GSI Volume Viewer software analysis, obtain the lesion concentration of iodine based material (iodine concentration of lesion, IC-L), the concentration of a substance (water concentration of - lesion, WC-L) carotid sinus, iodine based material concentration (iodine concentration of carotid sinus, IC-C), carotid sinus (water concentration of aqueous concentration of carotid sinus, WC -C)騫惰綆楁爣鍖栫鍩虹墿璐ㄦ祿搴，

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