本文關(guān)鍵詞： 肺腫瘤 體層攝影術(shù) X線計(jì)算機(jī) 灌注成像　出處：《青島大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:采用東芝320排容積CT對(duì)40例經(jīng)病理證實(shí)的肺癌進(jìn)行容積灌注掃描后行雙入口灌注圖像后處理分析,通過雙入口CT灌注成像技術(shù)對(duì)肺腺癌和肺鱗癌血供特征的評(píng)價(jià),探討東芝320排容積CT雙入口灌注成像技術(shù)用于區(qū)分肺癌體循環(huán)血供和肺循環(huán)血供的可行性及肺腺癌和肺鱗癌血供特征的差異,以期為臨床介入治療提供指導(dǎo)。研究方法:收集2015.05月至2016.09月青島大學(xué)附屬醫(yī)院收治的經(jīng)手術(shù)或CT引導(dǎo)下穿刺活檢或纖維支氣管鏡檢查得到病理證實(shí)的40例原發(fā)性肺癌患者,行胸部容積CT灌注掃描后行雙入口灌注圖像后處理分析,沿腫瘤邊緣繪制感興趣區(qū)并盡量避開肉眼可見的壞死鈣化及脂肪成分,由2名高年資醫(yī)師單獨(dú)測(cè)量記錄肺部癌性腫塊的支氣管動(dòng)脈灌注血流量(BF)、肺動(dòng)脈灌注血流量(PF)、肺動(dòng)脈灌注指數(shù)[PI;PI=PF/(PF+BF)]及腫塊體積,將肺癌分為中央型肺癌和周圍型肺癌。采用組內(nèi)相關(guān)系數(shù)(ICC)分析觀察者間一致性。觀察病灶的時(shí)間密度曲線(time density curves,TCD)形態(tài)。采用兩獨(dú)立樣本t檢驗(yàn)比較肺腺癌和肺鱗癌、中央型和周圍型肺癌各灌注值之間的差異。采用Spearman相關(guān)分析評(píng)估各灌注參數(shù)與腫瘤體積的相關(guān)性。以P0.05為差異具有統(tǒng)計(jì)學(xué)意義。結(jié)果:1.2名醫(yī)師測(cè)量病灶的PF、BF、PI的一致性良好,ICC分別為0.97、0.93、0.91。2.37例病灶的TCD曲線在肺循環(huán)和體循環(huán)共兩個(gè)上升斜率,且前者斜率小于后者斜率。3例病灶的TCD曲線有多個(gè)上升斜率,曲線整體呈上升型。3.40例肺癌患者的平均PF為[(54.26±21.07)ml/(min·100 ml)],BF為(64.41±22.06)ml/(min·100 ml),PI為(43.38±16.07)%,其中肺腺癌23例、肺鱗癌17例,腺癌的PF為[(51.56±22.19)ml/(min·100 ml)],BF為[(66.09±18.08)ml/(min·100 ml)],PI為(38.80±14.88)%,肺鱗癌的平均PF為[(57.90±21.12)ml/(min·100 ml)],平均BF為[(62.13±26.96)ml/(min·100 ml)],PI為(49.58±15.95)%,肺腺癌PI小于肺鱗癌(t=-2.196,P0.05)。肺腺癌與肺鱗癌的BF與PF均無統(tǒng)計(jì)學(xué)差異(P0.05,t分別為-0.911,0.556)。4.周圍型肺癌17例,中央型肺癌23例。周圍型肺癌PF為[(47.57±24.31)ml/(min·100ml)],BF為[(65.84±19.12)ml/(min·100 ml)],PI為(48.15±7.14)%,中央型肺癌[(53.80±20.03)ml/(min·100 ml)],BF為(60.84±18.30)ml/(min·100 ml),PI為(43.20±5.74)%,周圍型肺癌的PI高于中央型肺癌(t=-2.305,P0.05)。中央型肺癌和周圍型肺癌之間PF與BF的差異均無統(tǒng)計(jì)學(xué)意義(P均0.05,t分別為0.842,-0.851)。5.腫瘤體積4.19~75.29 cm3,PI與腫瘤體積呈負(fù)相關(guān)(r=-0.39,P=0.01),PF、BF與腫瘤體積無明顯線性相關(guān)(P=0.88、0.21)。結(jié)論:肺癌主要由體循環(huán)供血。雙入口CT灌注技術(shù)可重復(fù)性良好,該技術(shù)可用于區(qū)分肺癌的肺循環(huán)血供和體循環(huán)血供;肺腺癌和肺鱗癌的PI有差異,其灌注參數(shù)PI值與腫瘤的大小及位置有關(guān)。意義:探究雙入口CT灌注用于肺癌灌注研究的可行性及不同類型肺癌血供是否有差異,以期為臨床預(yù)判和介入治療提供指導(dǎo)。
[Abstract]:Objective: to evaluate the blood supply characteristics of lung adenocarcinoma and squamous cell carcinoma (SCC) by Dual-Inlet Perfusion Imaging (DTI) and Dual-Inlet Perfusion Imaging (DTI) in 40 patients with pathologically proved lung cancer by Toshiba 320 slice volume CT. To explore the feasibility of using Toshiba 320 row volume CT dual portal perfusion imaging to distinguish the blood supply of lung cancer from that of lung cancer, and to explore the difference of blood supply characteristics between lung adenocarcinoma and lung squamous cell carcinoma. Methods: 40 cases of primary lung cancer confirmed by operation or CT guided biopsy or fiberoptic bronchoscopy were collected from Qingdao University affiliated Hospital from May, 2015 to September, 2016. The chest volume CT perfusion scan was performed after double portal perfusion image postprocessing analysis. The region of interest was drawn along the edge of the tumor and the necrotic calcification and fat components were avoided as far as possible. The bronchial artery perfusion blood flow (BFFN), pulmonary artery perfusion blood flow (PAF), pulmonary artery perfusion index (PII-PIP / PF BFV) and mass volume were measured separately by two senior physicians in lung carcinomatous masses. Lung cancer was divided into central lung cancer and peripheral lung cancer. The consistency between observers was analyzed by intragroup correlation coefficient (ICCs). The time density density curve (TCD) was observed. Two independent samples t test were used to compare lung adenocarcinoma and lung squamous cell carcinoma. Spearman correlation analysis was used to evaluate the correlation between perfusion parameters and tumor volume. The TCD curves of the well-induced lesions were 0.970.93 and 0.91.2.37, respectively, with two ascending slopes of pulmonary circulation and systemic circulation. The slope of the former was smaller than that of the latter, and the TCD curve of the former was smaller than the latter. 3. 40 patients with lung cancer had an average PF of 54.26 鹵21.07ml / min 路100ml] BF = 64.41 鹵22.06ml / min 路100ml Pi = 43.38 鹵16.07ml / min, including 23 cases of lung adenocarcinoma and 17 cases of lung squamous cell carcinoma. The PF of adenocarcinoma was [51.56 鹵22.19ml / r / min 路100ml] BF = [66.09 鹵18.08ml / min 路100ml] Pi was 38.80 鹵14.88m / min, the mean PF of squamous cell carcinoma was [57.90 鹵21.12ml / min 路100ml], the mean BF was [62.13 鹵26.96ml / min 路100ml] and that of adenocarcinoma of lung was 49.58 鹵15.95ml / min, respectively. The BF and PF of lung adenocarcinoma and lung squamous cell carcinoma were 0.9-110.556.40.17 cases respectively. Central lung cancer (PF = 47.57 鹵24.31ml / min 路100ml)] BF = [65.84 鹵19.12ml / min 路100ml] Pi = 48.15 鹵7.14m, central lung cancer (53.80 鹵20.03ml / min 路100ml)] BF = 60.84 鹵18.30ml / min 路100ml). The Pi of peripheral lung cancer was 43.20 鹵5.74ml / min. The Pi of peripheral lung cancer was higher than that of central type lung cancer (P < 0.05). There was no significant difference between central lung cancer and peripheral lung cancer (PF = 43.84 鹵18.30ml / min 路100ml). The Pi of peripheral lung cancer was higher than that of central lung cancer (P < 0.05). There was no significant difference in PF and BF between central lung cancer and peripheral lung cancer. The correlation between tumor volume and tumor volume was negative correlation between Pi and tumor volume. There was no significant linear correlation between PFBF and tumor volume. Conclusion: lung cancer is mainly supplied by systemic circulation. The double portal CT perfusion technique has good reproducibility. This technique can be used to distinguish pulmonary circulation blood supply from systemic circulation blood supply in lung cancer, and there are differences in Pi between lung adenocarcinoma and lung squamous cell carcinoma. The Pi value of perfusion parameters is related to the size and location of tumor. Significance: to explore the feasibility of dual-portal CT perfusion in lung cancer perfusion study and whether there are differences in blood supply of different types of lung cancer in order to provide guidance for clinical prejudgment and interventional therapy.
【學(xué)位授予單位】：青島大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R734.2;R730.44

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 高壘;楊青;胡亞彬;張亮;任佳男;;雙入口CT灌注評(píng)價(jià)肺腺癌和肺鱗癌血供特征[J];中國醫(yī)學(xué)影像技術(shù);2017年03期

2 方進(jìn);毛家驥;梁敏杰;鄧達(dá)標(biāo);胡鈺;鄒亞妮;李紅林;蔡湘怡;周全;;320排動(dòng)態(tài)容積CT對(duì)正常人肺實(shí)質(zhì)不同區(qū)域灌注定量研究[J];臨床放射學(xué)雜志;2016年10期

3 朱曉龍;劉慶嘯;紀(jì)蒙蒙;李傳貴;崔書君;朱月香;;640層容積CT雙入口灌注成像在肺結(jié)核早期治療效果評(píng)價(jià)中的作用[J];山東醫(yī)藥;2016年25期

4 劉慧;林江;陸秀良;顧君英;姚家美;;320排容積CT雙血供灌注評(píng)估肺占位性病變的良惡性及與微血管密度的相關(guān)性[J];復(fù)旦學(xué)報(bào)(醫(yī)學(xué)版);2016年03期

5 李娜;袁立華;;64層CT灌注孤立性肺結(jié)節(jié)的診斷技術(shù)及臨床價(jià)值分析[J];中國CT和MRI雜志;2015年07期

6 馬澤鵬;敖國昆;袁小東;李利佳;田梅;萬廣志;;肺癌雙循環(huán)血供CT灌注的初步研究[J];臨床放射學(xué)雜志;2015年02期

7 馮坤鵬;閆美玲;李艷輝;黎庶;初金剛;徐克;;雙入口CT灌注技術(shù)評(píng)價(jià)周圍型肺癌血供特性[J];中國醫(yī)學(xué)影像技術(shù);2014年10期

8 王虹壬;葉兆祥;;CT灌注成像評(píng)價(jià)非小細(xì)胞肺癌抗血管生成治療[J];中國腫瘤臨床;2014年19期

9 姚靈;郭曉山;張千里;;CT灌注成像技術(shù)分析原發(fā)性肺癌的血供模式[J];中國醫(yī)學(xué)影像學(xué)雜志;2014年08期

10 孫瓊芳;涂蓉;張業(yè)雨;李勝達(dá);王圣恩;史華莉;尤曉光;伍保忠;;CT灌注成像對(duì)肺癌的診斷研究[J];海南醫(yī)學(xué);2014年16期

，

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