本文選題：能譜CT + 碘基圖像　； 參考：《石河子大學(xué)》2017年碩士論文

【摘要】：目的:探討能譜CT對(duì)原發(fā)性肝癌(Primary Hepatic Carcinoma,PHC)經(jīng)導(dǎo)管動(dòng)脈化療栓塞術(shù)(Transcatheter Arterial Chemoembolization,TACE)治療后早期療效評(píng)估應(yīng)用價(jià)值的準(zhǔn)確性與常規(guī)CT的對(duì)比。材料與方法:1.收集2015年11月至2016年11月就診于新疆石河子大學(xué)醫(yī)學(xué)院第一附屬醫(yī)院被確診為原發(fā)性肝癌并準(zhǔn)備再次行TACE治療的患者39例,所有患者均簽署知情同意書(shū)同意進(jìn)行TACE治療,并且術(shù)前1~3天均進(jìn)行能譜CT及常規(guī)CT檢查,然后又經(jīng)數(shù)字減影血管造影(Digital subtraction angiography,DSA)復(fù)查證實(shí);男性35例(89.7%),女性4例(10.3%),年齡42~79歲,平均(55.4±11.1)歲。2.掃描設(shè)備采用美國(guó)GE公司生產(chǎn)的Discovery HD 750 CT掃描儀及GSI Liver掃描序列。3.將采集到的常規(guī)CT圖像(即混合能量圖像)及能譜CT圖像傳至GE adw4.6工作站,并重建出1.25mm層厚平掃及3期(動(dòng)脈期、門(mén)脈期、延遲期)碘基圖像;在每一時(shí)相栓塞瘤體不同的層面圖像上選定5個(gè)感興趣區(qū)(region of interest,ROI),瘤區(qū)選擇ROI時(shí)應(yīng)盡量包括整個(gè)病變區(qū)域,非瘤區(qū)(瘤周正常肝實(shí)質(zhì)區(qū))選取ROI時(shí)應(yīng)盡量避開(kāi)血管、膽道、偽影處。然后分別測(cè)量各期瘤區(qū)、非瘤區(qū)碘基圖像上碘濃度含量,及常規(guī)CT圖像上CT值;瘤區(qū)碘濃度含量即IC病灶為3期增強(qiáng)掃描病灶測(cè)量的碘濃度含量—平掃病灶測(cè)量的碘濃度含量,非瘤區(qū)碘濃度含量即IC肝臟為各期周?chē)８谓M織的碘濃度含量。4.采用SPSS 17.0統(tǒng)計(jì)軟件進(jìn)行分析,所用統(tǒng)計(jì)方法為診斷試驗(yàn),通過(guò)能譜CT及常規(guī)CT與金標(biāo)準(zhǔn)DSA的比較,得到真陽(yáng)性、假陽(yáng)性、真陰性、假陰性的例數(shù),分別計(jì)算兩種方法的靈敏度、特異度、漏診率、誤診率、診斷指數(shù),繪制ROC曲線,通過(guò)曲線下面積來(lái)比較二者的檢驗(yàn)效能。結(jié)果:1.39例PHC患者均獲得較滿意的常規(guī)CT、能譜CT及DSA圖像。2.能譜CT判斷結(jié)果分析:以DSA作為“金標(biāo)準(zhǔn)”,能譜CT判斷是否有腫瘤殘留或復(fù)發(fā)的靈敏度為96.77%,特異度為100.0%,誤診率為0.0%,漏診率為3.23%,診斷指數(shù)為196.77%。3.常規(guī)CT判斷結(jié)果分析:以DSA作為“金標(biāo)準(zhǔn)”,常規(guī)CT判斷是否有腫瘤殘留或復(fù)發(fā)的靈敏度為67.74%,特異度為100.0%,誤診率為0.0%,漏診率為32.26%,診斷指數(shù)為167.74%。4.繪制ROC曲線顯示,能譜CT的曲線下面積為0.984,常規(guī)CT的曲線下面積為0.839。結(jié)論:1.能譜CT碘基圖的碘含量變化對(duì)檢出肝內(nèi)病灶的敏感性較高,對(duì)評(píng)價(jià)TACE術(shù)后療效具有重要參考價(jià)值。2.能譜CT及常規(guī)CT和DSA相比,二者均可通過(guò)判斷是否有腫瘤殘留或復(fù)發(fā)來(lái)對(duì)TACE治療原發(fā)性肝癌的療效進(jìn)行評(píng)估,但能譜CT的評(píng)估準(zhǔn)確性較常規(guī)CT高。3.能譜CT的多參數(shù)成像對(duì)TACE治療原發(fā)性肝癌療效的評(píng)估及指導(dǎo)再次介入手術(shù)的時(shí)機(jī)選擇可以提供更詳細(xì)、更準(zhǔn)確、更全面的影像資料,是一種更為可靠的評(píng)估方法;對(duì)臨床醫(yī)生在后續(xù)治療方案的制定及判斷預(yù)后也有一定的指導(dǎo)作用。
[Abstract]:Objective: to evaluate the value of energy dispersive CT (EDS) in evaluating the early efficacy of transcatheter arterial chemoembolization (TACE) for primary Hepatic carcinoma (PHC) and to compare with conventional CT in evaluating the early efficacy of transcatheter arterial chemoembolization (TACE). Materials and methods: 1. From November 2015 to November 2016, 39 patients who were diagnosed with primary liver cancer at the first affiliated Hospital of Medical College of Shihezi University of Xinjiang and were ready to receive TACE treatment again were collected. All the patients signed informed consent to TACE treatment. EDS and conventional CT were performed on 1 day and 3 days before operation, and then were confirmed by digital subtraction angiography (DSA). 35 cases of male and 4 cases of female were confirmed by digital subtraction angiography (35 cases) and 10.3% (mean age: 55.4 鹵11.1) years old (mean, 55.4 鹵11.1) years. The scanning equipment uses Discovery HD 750 CT scanner and GSI Liver scan sequence produced by GE Company in USA. The conventional CT images (mixed energy images) and energy dispersive CT images were transferred to GE adw4.6 workstation, and then the 1.25mm slice thick plain scan and 3 phases (arterial phase, portal phase, delayed phase) were reconstructed. Five regions of interest were selected on different plane images of each transient embolization tumor. The tumor area should include the whole lesion area when selecting ROI, and the non-tumor area (normal hepatic parenchyma around the tumor) should avoid blood vessels and bile duct as far as possible. The artifact. Then the iodine concentration in each stage of tumor area and non-tumor area was measured respectively, and the CT value on conventional CT image was also measured, and the iodine concentration in the tumor area was measured by phase 3 enhancement scan and the iodine concentration measured by plain scan. The iodine concentration in the non-tumor area is the iodine concentration of the normal liver tissue around each phase of IC liver. The statistical software SPSS 17.0 was used to analyze. The statistical method was diagnostic test. By comparing the spectral CT and conventional CT with gold standard DSA, the cases of true positive, false positive, true negative and false negative were obtained, and the sensitivity of the two methods were calculated respectively. Specificity, missed diagnosis rate, misdiagnosis rate, diagnostic index, ROC curve were drawn. Results 1.39 patients with PHC obtained satisfactory routine CTS, EDS CT and DSA images. Analysis of the results of energy dispersive CT: with DSA as the "gold standard", the sensitivity, specificity, misdiagnosis rate, missed diagnosis rate and diagnostic index were 96.777.77, 100.0, 0.010, 3.23g and 196.77.3respectively. Analysis of the results of conventional CT: with DSA as the "gold standard", the sensitivity of conventional CT in judging whether there was tumor residue or recurrence was 67.74, the specificity was 100.00.The misdiagnosis rate was 0.00.The missed diagnosis rate was 32.26, and the diagnostic index was 167.74.4. The area under the curve of energy dispersive CT is 0.984, and that of conventional CT is 0.839. Conclusion 1. The changes of iodine content in EDS were highly sensitive to the detection of intrahepatic lesions, which had important reference value for evaluating the curative effect of TACE. Compared with conventional CT and DSA, energy dispersive CT and conventional CT can be used to evaluate the efficacy of TACE in the treatment of primary liver cancer by judging whether there is tumor residue or recurrence, but the accuracy of EDS is higher than that of conventional CT. Multiparameter imaging of energy dispersive CT can provide more detailed, accurate and comprehensive imaging data for evaluating the efficacy of TACE in the treatment of primary liver cancer and guiding the timing of re-interventional surgery. It is a more reliable evaluation method. It is also helpful for clinicians to make treatment plan and judge prognosis.
【學(xué)位授予單位】：石河子大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R735.7

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