本文選題：腮腺 + 體層攝影術��； 參考：《昆明醫(yī)科大學》2017年碩士論文

【摘要】：第一部分腮腺占位病變中雙源CT雙能量虛擬平掃的可行性研究[目的]探討腮腺占位病變中雙源CT雙能量虛擬平掃代替常規(guī)平掃的可行性。[資料方法]回顧性分析在我院行雙源CT檢查并經外科手術取得病理證實的腮腺病變共54例(腮腺良性占位38例,其中良性腫瘤34例,其他良性占位4例;惡性腫瘤12例;炎性病變4例)。所有患者均進行常規(guī)平掃(truenon-contrast,TNC)及雙能量增強掃描。利用Liver VNC軟件處理分別得到動脈期及靜脈期虛擬平掃(virtualnon-contrast,VNC)圖像,比較常規(guī)平掃與動靜脈期虛擬平掃圖像上顯示腮腺占位能力的一致性,分別計算兩組圖像對腮腺良、惡性腫瘤及炎性病變診斷的敏感度、特異度及準確度;常規(guī)平掃及兩組虛擬平掃正常腮腺組織、病灶區(qū)、頜下腺、胸鎖乳突肌、下頜骨平均CT值、信號噪聲比(signal-to-noiseratio,SNR)、對比噪聲比(contrast-to-noiseratio,CNR)、圖像質量評分、輻射劑量。[結果]①常規(guī)平掃及虛擬平掃均能顯示病灶,常規(guī)平掃及動脈期虛擬平掃圖像對于診斷腮腺良、惡性腫瘤、炎性病變診斷準確率一致性好(Kappa值分別為0.96、0.93、0.73);真實平掃對良性腫瘤、惡性腫瘤、炎性病變診斷的敏感度、特異度和符合率分別為 89.5%、81.7%、88.5%,70%、95.2%、90.4%,50%、97.9%、94.2%;動脈期虛擬平掃對三者診斷的敏感度、特異度和符合率分別為86.8%、85.7%、86.5%,70%、97.6%、92.3%,75%、95.8%、94.2%。②常規(guī)平掃、VNCA、VNCv主觀圖像質量評分分別為4.31±0.76、4.19±0.82、4.21±0.78,三者間差異無統(tǒng)計學意義(P0.05)。③53例腮腺占位患者平掃下頜角層面胸鎖乳突肌、頜下腺平均CT值均無統(tǒng)計學意義(P0.05),腮腺占位灶、下頜骨、正常腮腺平均CT值差異有統(tǒng)計學意義(P0.05);兩組VNC圖所有組織SNR均大于真實平掃,差異有統(tǒng)計學意義(P0.05)。三組圖CNR差異無統(tǒng)計學意義(P0.05)。④雙能量雙期掃描有效劑量低于常規(guī)三期掃描,差異有統(tǒng)計學意義(P0.05),降低輻射劑量約38.6%。[結論]腮腺占位雙源CT雙能量虛擬平掃能保證圖像質量及診斷準確性,能替代真實平掃,從而降低受檢者接受的輻射劑量。第二部分腮腺多形性腺瘤、腺淋巴瘤及腮腺惡性腫瘤的雙能量能譜分析[目的]分析腮腺多形性腺瘤、腺淋巴瘤及惡性腫瘤能譜曲線特征,探討雙源CT雙能量成像技術在三類腮腺腫瘤診斷及鑒別診斷中的應用價值。[資料與方法]收集經手術病理證實且具有完整資料的腮腺腫瘤患者共46例,52個病灶。剔除基底細胞腺瘤及轉移瘤各1例后,共44例,50個病灶,其中腮腺多形性腺瘤19例,腺淋巴瘤14例(20個病灶),惡性腫瘤11例。均行雙源CT雙能量掃描后,分別將動脈期、靜脈期100 kVp及Sn140 kVp兩組薄層圖像調入雙能量工具軟件中,選取“Mono Energetic”模式處理得到40-160kev單能譜圖像,觀察能譜曲線變化趨勢,比較腮腺多形性腺瘤、腺淋巴瘤及惡性腫瘤實質區(qū)動脈期能譜曲線斜率。[結果]腮腺多形性腺瘤、腺淋巴瘤及惡性腫瘤對比,在40-160keV范圍內,隨著單能KeV值的升高,動脈期腫瘤實質CT值逐漸遞減,且隨keV值越高,CT值降低的幅度越小,其能譜曲線在40-160keV下均呈“下降型”。動脈期腮腺腺淋巴瘤能譜曲線斜率在40KeV-160KeV范圍內均位于最上方,惡性腫瘤居中,多形性腺瘤位于最下方,三組間在40-160KeVCT值差異有統(tǒng)計學意義(P0.05);腮腺多形性腺瘤、腺淋巴瘤及惡性腫瘤實質區(qū)動脈期能譜曲線斜率分別為1.22±0.99、2.36±1.02,1.55±0.83三組間差異具均有統(tǒng)計學意義(P0.05),兩兩比較示腮腺多形性腺瘤及腺淋巴瘤間差異具有統(tǒng)計學差異(P0.05),而惡性腫瘤與多形性腺瘤及腺淋巴瘤間斜率存在部分重疊,差異無統(tǒng)計學差異。去除不同性質腮腺腫瘤之間重疊部分,我們初步得出,動脈期腮腺腫瘤實質區(qū)能譜曲線斜率(K)的范圍如下:若1.68K≥0.82,可能是多形性腺瘤;若2.87≥K2.0,可能是腺淋巴瘤。[結論]雙源CT動脈期能譜分析對腮腺多形性腺瘤、腺淋巴瘤及惡性腫瘤影像鑒別診斷有一定的參考價值。第三部分雙能量CT碘濃度及形態(tài)學分析在腮腺多形性腺瘤、腺淋巴瘤及惡性腫瘤診斷中的價值[目的]探討雙源CT雙能量掃描所獲碘圖碘濃度及常規(guī)形態(tài)學方法對腮腺多形性腺瘤、腺淋巴瘤、惡性腫瘤診斷及鑒別診斷價值。[資料與方法]臨床資料及掃描方法同第二部分。①分析及記錄腮腺三類腮腺腫瘤常規(guī)形態(tài)學特點(包括部位、象限、形態(tài)、邊界、有無囊變、有無腫大淋巴結),分組為腮腺多形性腺瘤組、腺淋巴瘤組、惡性腫瘤組,進行x~2檢驗及Logistic回歸區(qū)分主要征象及次要征象。②將動、靜脈期100 kVp及Sn140 kVp兩組薄層圖像調入雙能量工具軟件中,利用后處理軟件“Liver VNC”,分別測量腮腺多形性腺瘤、腺淋巴瘤及惡性腫瘤實性部分的動、靜脈兩期的碘濃度(iodineconcentration,IC)及標準化碘濃度(normalizedconcentration,NIC),計算動靜脈期碘值差值(ICD=靜脈期碘濃度-動脈期碘濃度)。采用方差分析,以P0.05為差異具有統(tǒng)計學意義;比較三組之間的差異,并對其敏感度、特異度及受試者工作特性曲線(ROC)進行分析。[結果]腮腺多形性腺瘤組、腺淋巴瘤組與惡性腫瘤組動脈期碘濃度、標準化碘濃度分別為0.93±0.79mg/ml、1.94±0.74mg/ml、1.33±0.72mg/ml 及0.09±0.09、0.23±0.11、0.17±0.11,其差異具有統(tǒng)計學意義(F值分別為8.755、8.648,P均0.05)。進一步進行兩兩之間對比,腮腺多形性腺瘤組與腺淋巴瘤組之間碘濃度及標準化碘濃度差異具有統(tǒng)計學意義(P0.05),而惡性腫瘤組與多形性腺瘤組、腺淋巴瘤組間差異不具有統(tǒng)計學意義(P0.05)。靜脈期與動脈期碘濃度差值分別為0.83±0.52mg/ml、0.72±0.93mg/ml及0.45 ±0.77mg/ml,其差異具有統(tǒng)計學意義(F=21.352,P=0.000),兩兩之間對比,腺淋巴瘤與多形性腺瘤、惡性腫瘤靜脈-動脈碘濃度差值之間差異具有統(tǒng)計學意義(P0.05),而多形性腺瘤與惡性腫瘤動靜脈期碘濃度差值之間差異不具有統(tǒng)計學意義(P0.05)。利用靜脈期碘值診斷多形性腺瘤時,敏感度為63.2%,特異度為72.7%,AUC(ROC曲線下面積)為0.671;利用動脈期碘值診斷腺淋巴瘤時,敏感度為90%,特異度為68.7%,AUC為0.795,動脈期標準化碘濃度診斷腺淋巴瘤時,敏感度為95%,特異度為65.6%,AUC為0.798;而利用碘濃度診斷惡性腫瘤的敏感性及特異性均不高。對腮腺腫瘤發(fā)生部位、象限、形態(tài)、邊界、有無囊變、有無腫大淋巴結等形態(tài)指標進行多因素回歸分析,發(fā)現(xiàn)腮腺深淺葉均受累、邊界不清、形態(tài)不規(guī)則、有腫大淋巴結為診斷腮腺惡性腫瘤有價值的形態(tài)學指標。[結論]能譜CT碘值在腮腺多形性腺瘤、腺淋巴瘤及惡性腫瘤間的鑒別有一定價值,但惡性腫瘤與多形性腺瘤及腺淋巴瘤間碘濃度存在部分重疊,結合常規(guī)形態(tài)學特點,有助于正確診斷及鑒別三類腫瘤性病變,其敏感性及特異度較高。
[Abstract]:The feasibility study of double source CT double energy virtual plain scan in parotid space occupying lesions [Objective] to explore the feasibility of double source CT double energy virtual scan in parotid space occupying lesion instead of routine plain scan. [data method] Retrospective analysis of 54 cases of parotid disease confirmed by double source CT examination in our hospital and pathologically confirmed by surgery (Sai Xianliang There were 38 cases of sexual occupying, including 34 cases of benign tumor, 4 cases of other benign space occupying sites, 12 cases of malignant tumor and 4 cases of inflammatory disease. All patients were performed routine plain scan (truenon-contrast, TNC) and double energy enhanced scan. The images of virtualnon-contrast (VNC) of arterial and venous phase (virtualnon-contrast, VNC) were obtained by Liver VNC software, and the normal level was compared. The sensitivity, specificity and accuracy of the two groups of images on parotid benign, malignant and inflammatory lesions were calculated respectively. The average CT value of the lesion area, the submandibular gland, the sternocleidomastoid muscle and the mandible, and the signal noise of the two groups of normal plain scan and the normal plain scan were calculated respectively. Signal-to-noiseratio (SNR), contrast noise ratio (contrast-to-noiseratio, CNR), image quality score, radiation dose. [result] 1. Routine plain scan and virtual plain scan were all able to show the focus. The accuracy of diagnosis of benign parotid, malignant and inflammatory lesions was consistent with routine plain scan and arterial phase (Kappa value, respectively). 0.96,0.93,0.73); the sensitivity, specificity and coincidence rate of true plain scan for benign tumor, malignant tumor, and inflammatory disease were 89.5%, 81.7%, 88.5%, 70%, 95.2%, 90.4%, 50%, 97.9%, 94.2%. The sensitivity, specificity and coincidence rate of virtual plain scan to the three were 86.8%, 85.7%, 86.5%, 70% The subjective image quality score of the routine plain scan, VNCA and VNCv was 4.31 + 0.76,4.19 + 0.82,4.21 + 0.78 respectively, and there was no significant difference between the three groups (P0.05). (3) 53 cases of parotid gland occupying patients had no statistical significance (P0.05), the average CT value of the submandibular gland was not statistically significant (P0.05), the parotid gland space, the mandible, and the normal parotid gland average CT value difference. The difference was statistically significant (P0.05); the SNR of all tissues in the two group of VNC was greater than that of the true plain scan (P0.05). There was no statistical significance (P0.05) in the difference of CNR in the three group diagram. (4) the effective dose of double energy biphasic scan was lower than that of the conventional three phase scan, and the difference was statistically significant (P0.05), and the radiation dose reduced about 38.6%.[Conclusion] parotid occupying double Source CT dual energy virtual scan can ensure image quality and diagnostic accuracy, and can replace true plain scan, thus reducing the radiation dose accepted by the subjects. Second partial parotid pleomorphic adenomas, adenomas and parotid malignancies are analyzed by dual energy spectrum analysis [Objective] to analyze the spectral curves of pleomorphic adenomas, adenomas and malignant tumors of the parotid gland. Characteristics, the application value of dual source CT dual energy imaging technique in the diagnosis and differential diagnosis of three types of parotid tumors. [data and methods] 46 cases of parotid tumors confirmed by operation and pathology were collected and 52 lesions were found in 1 cases of basal cell adenoma and metastasis, including 44 cases and 50 lesions, including parotid pleomorphic. 19 cases of adenoma, 14 cases of adenoma lymphoma (20 focus) and 11 cases of malignant tumor. After double source CT double energy scanning, the thin layer images of the arterial phase, the venous phase 100 kVp and the Sn140 kVp two were transferred to the dual energy tool software, and the "Mono Energetic" mode was selected to obtain the 40-160kev single energy spectrum image, and the variation trend of the energy spectrum curve was observed and the gills were compared. Adenoma of adenoma, adenoma, and the arterial phase in the parenchyma of the tumor were slope. [results] the parotid pleomorphic adenoma, adenoma and malignant tumor were compared. In the range of 40-160keV, the CT value of the arterial phase decreased gradually with the increase of the KeV value of the single energy, and the lower the CT value decreased with the higher the keV value, the energy spectrum curve In the 40-160keV, the slope of the parotid gland lymphoma was located at the top of the 40KeV-160KeV range, the malignant tumor was middle, and the pleomorphic adenoma was located at the bottom. The difference between the three groups was statistically significant (P0.05); the parotid gland multiform adenoma, adenoma and the malignant tumor parenchyma artery The difference of the slope of the period energy spectrum curve was 1.22 + 0.99,2.36 + 1.02,1.55 + 0.83 respectively (P0.05). 22 compared with the parotid pleomorphic adenoma and adenoma (P0.05), but there was a partial overlap between the malignant tumor and the pleomorphic adenoma and adenoma, and there was no statistical difference. In order to remove the overlapping parts of different parotid tumors, we preliminarily conclude that the range of K is as follows: if 1.68K > 0.82, it may be a pleomorphic adenoma; if 2.87 or more K2.0, it may be adenoma. [Conclusion] the dual source CT arterial phase can be analyzed for parotid pleomorphic adenoma, adenoma and malignant swelling The value of third partial CT iodine concentration and morphological analysis in the diagnosis of parotid pleomorphic adenoma, adenoma and malignant tumor. [Objective] to explore the iodine concentration of double source CT double energy scan and the conventional morphological method for parotid pleomorphic adenoma, adenoma and malignant tumor. Diagnostic and differential diagnostic value. [data and methods] clinical data and scanning methods are the same as second parts. (1) analysis and record the conventional morphological features of parotid gland tumors (including location, quadrant, shape, boundary, cyst, lymph node), parotid pleomorphic adenoma group, adenoma group, malignant tumor group, x~2 Test and Logistic regression were used to distinguish the main signs and secondary signs. 2. TLC images of the 100 kVp and Sn140 kVp two groups were transferred into the two energy tools software, and the postprocessing software "Liver VNC" was used to measure the activity of the parotid pleomorphic adenoma, adenoma and malignant tumor, and the iodine concentration of the two phases of the vein (iodineconcent Ration, IC) and standardized iodine concentration (normalizedconcentration, NIC) were used to calculate the difference of iodized iodine value (iodine concentration in the venous phase - arterial phase iodine concentration in the venous phase of ICD=). The variance analysis was used to analyze the difference between the three groups, and to compare the differences between the two groups, and to analyze the sensitivity, specificity and the working characteristic curve of the subjects (ROC). Results: the iodine concentration in the parotid pleomorphic adenoma group, the adenoma group and the malignant tumor group was 0.93 + 0.79mg/ml, 1.94 + 0.74mg/ml, 1.33 + 0.72mg/ml and 0.09 + 0.09,0.23 + 0.11,0.17 + 0.11 respectively. The difference was statistically significant (F value was 8.755,8.648, P 0.05). Further comparison was carried out between 22, gills. The difference of iodine concentration and standard iodine concentration between the adenoma group and the adenoma group was statistically significant (P0.05), but the difference between the malignant tumor group and the pleomorphic adenoma group and the adenoma group was not statistically significant (P0.05). The difference between the venous and arterial phase iodine concentration was 0.83 + 0.52mg/ml, 0.72 + 0.93mg/ml and 0.45 + 0.77mg/, respectively. Ml, the difference was statistically significant (F=21.352, P=0.000), the difference between adenoma and pleomorphic adenoma, and the difference of iodide concentration between the venous artery and artery of malignant tumor was statistically significant (P0.05), but there was no statistical significance (P0.05) between the difference of iodine concentration between the pleomorphic adenoma and the malignant tumor (P0.05). The sensitivity was 63.2%, the specificity was 72.7%, the AUC (the area under ROC curve) was 0.671, and the sensitivity was 90%, the specificity was 68.7%, and the AUC was 0.795. The sensitivity was 95%, the specificity was 65.6% and the AUC was 0.798, while the iodized iodine value of the arterial phase was 0.798; and iodine was used for iodine. The sensitivity and specificity of concentration diagnosis of malignant tumor were not high. The multiple regression analysis on the location of parotid tumor, quadrant, shape, boundary, no cystic change, or no swelling lymph node, found that the parotid glands were all affected, the boundary was not clear, the shape was irregular, and the lymph nodes were valuable for the diagnosis of parotid malignant tumor. [Conclusion] [Conclusion] the CT iodized value has a certain value in the differentiation of parotid pleomorphic adenoma, adenoma and malignant tumor. However, there are some overlaps in the iodine concentration between malignant tumors and pleomorphic adenomas and adenomas. Combined with the conventional morphological characteristics, it is helpful for Yu Zheng to diagnose and identify three types of tumor, and its sensitivity and specificity. The degree is high.

【學位授予單位】：昆明醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R739.8;R730.44

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