本文選題：CT灌注成像 + 受試者工作特征曲線��； 參考：《福建醫(yī)科大學》2012年碩士論文

【摘要】：目的：研究CT灌注成像在肺癌、肺炎及結核鑒別診斷中的價值。 材料和方法：分析35例經(jīng)病理證實的肺癌、結核及肺炎患者的CT灌注掃描資料，其中肺癌22例，結核7例，肺炎6例，所有患者均用Siemens SOMATOMsensation64層螺旋CT進行CT灌注掃描(對比劑總量50ml,注射速率4～6ml/s)，采用隨機syngo Body PCT軟件中的Lung tumor項對病灶進行分析，分別獲得時間-密度曲線（TDC），血流量（BF）、血容量（BV）、毛細血管通透性（PMB）3個灌注參數(shù)，對各灌注參數(shù)進行相關性分析。 結果：(1)肺癌、肺炎及結核的TDC形態(tài)各不相同。肺癌的TDC分為A、B、C、D四型，其中以C型為主（36%），表現(xiàn)為曲線逐漸上升達峰值后，幾乎沒有降支，持續(xù)在較高水平；結核的TDC分為A、B、C三型，其中以A型為主（42%），，表現(xiàn)為曲線上升及下降緩慢，整個曲線較低平，增強幅度小于10HU左右；炎癥的TDC分為A、B二型，其中以A型為主（67%），表現(xiàn)與肺癌時間-密度曲線的C型類似，但增強幅度明顯高于肺癌。(2)結果顯示肺癌、肺炎與結核之間的BV無統(tǒng)計學意義（P0.05）。肺癌、肺炎與結核之間的PMB、BF有統(tǒng)計學意義(P0.05)，肺癌的BF、PMB值均高于肺炎與結核,其中肺炎與結核的BF、PMB無統(tǒng)計學意義(P0.05)。(3)選擇Youden指數(shù)最大值作為灌注參數(shù)診斷的最佳臨界點。鑒別診斷肺癌與結核時，PMB值的ROC曲線的AUC為0.812，閾值為16.36，敏感性77.3%，特異性100%， BF值的ROC曲線的AUC為0.838，閾值為11.30，敏感性72.7%，特異性100%。鑒別診斷肺癌與炎癥時，PMB值的ROC曲線的AUC為0.833，閾值為13.99，敏感性81.8%，特異性100%， BF值的ROC曲線的AUC為0.826，閾值為14.82，敏感性68.2%，特異性100%。 結論：64層螺旋CT灌注成像的時間-密度曲線及灌注參數(shù)能夠客觀評價肺部病變的血流學動力學狀況，綜合分析有助于肺癌、肺炎及結核的鑒別診斷。
[Abstract]:Objective: to study the value of CT perfusion imaging in differential diagnosis of lung cancer, pneumonia and tuberculosis. Materials and methods: Ct perfusion scan data of 35 patients with lung cancer, tuberculosis and pneumonia, including 22 cases of lung cancer, 7 cases of tuberculosis and 6 cases of pneumonia, were analyzed. All the patients were performed CT perfusion scanning (total volume of contrast medium 50 ml, injection rate 4~6ml/s) with Siemens SOMATOMsensation64 slice spiral CT. Lung item in random syngo body PCT software was used to analyze the lesions. Three perfusion parameters including time-density curve (TDC), blood flow (BF), blood volume (BV) and capillary permeability (PMB) were obtained. Results: (1) the morphology of TDC was different in lung cancer, pneumonia and tuberculosis. The TDC of lung cancer was divided into four types: type C (36%), showing that there was almost no descending branch after the curve reached the peak value, and the TDC of tuberculosis was classified into three types. Among them, type A (42%) showed a slow ascending and descending curve, the whole curve was relatively low and the enhancement amplitude was less than 10HU, the inflammatory TDC was divided into two types: type A (67%), which was similar to type C of the time-density curve of lung cancer. But the enhancement range was significantly higher than that of lung cancer. (2) the results showed that there was no significant difference in BV between lung cancer, pneumonia and tuberculosis (P0.05). In lung cancer, pneumonia and tuberculosis, there was significant difference in PMBMB between lung cancer, pneumonia and tuberculosis (P0.05), and the BFF-PMB value of lung cancer was higher than that of pneumonia and tuberculosis. There was no significant difference between lung cancer and tuberculosis (P0.05). (3), and the maximum value of Youden index was chosen as the best critical point for the diagnosis of perfusion parameters. The ROC curve of PMB was 0.812, the threshold was 16.36, the sensitivity was 77.3, the specificity was 100, the ROC curve of BF was 0.838, the threshold was 11.30, the sensitivity was 72.7, and the specificity was 100. The ROC curve of PMB in differential diagnosis of lung cancer and inflammation was 0.833, the threshold was 13.99, the sensitivity was 81.8, the specificity was 100, the ROC curve of BF was 0.826, the threshold was 14.82, the sensitivity was 68.2 and the specificity was 100. Conclusion the time-density curve and perfusion parameters of 64-slice spiral CT perfusion imaging can objectively evaluate the hemodynamic status of pulmonary lesions, and comprehensive analysis is helpful to the differential diagnosis of lung cancer, pneumonia and tuberculosis.
【學位授予單位】：福建醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2012
【分類號】：R816.41

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