發(fā)布時(shí)間：2018-06-22 23:13

  本文選題：非小細(xì)胞肺癌 + CT灌注成像��； 參考：《遵義醫(yī)學(xué)院》2017年碩士論文

【摘要】：目的:研究非小細(xì)胞肺癌(NSCLC)雙源CT灌注參數(shù)與區(qū)域淋巴結(jié)轉(zhuǎn)移的相關(guān)性,探討雙源CT灌注成像診斷NSCLC區(qū)域淋巴結(jié)轉(zhuǎn)移的價(jià)值。方法:收集遵義醫(yī)學(xué)院附屬醫(yī)院2015年1月至2016年9月經(jīng)胸部CT平掃發(fā)現(xiàn)肺部結(jié)節(jié)或腫塊并成功行雙源CT灌注掃描,后經(jīng)病理證實(shí)為非小細(xì)胞肺癌的患者42例,其中男性患者28例,女性患者14例,年齡25~74歲,平均53.64歲。將灌注圖像傳輸至工作站(Siemens Syngo Multimodality workplace),選擇VPCT body軟件進(jìn)行圖像后處理分析,獲得時(shí)間-密度曲線(T-DC)及血流量(BF)、血容量(BV)、通透性(PMB)、平均通過時(shí)間(MTT)等灌注參數(shù)和相應(yīng)灌注偽彩圖。采用PV-9000二步法免疫組化檢測(cè)系統(tǒng)對(duì)42例NSCLC組織標(biāo)本染色,然后對(duì)微血管密度(MVD)及有腔血管數(shù)目(LVN)、有腔血管面積(LVA)、有腔血管周長(zhǎng)(LVP)進(jìn)行計(jì)數(shù)。根據(jù)病理結(jié)果將42例NSCLC分為有淋巴結(jié)轉(zhuǎn)移組(20例)和無淋巴結(jié)轉(zhuǎn)移組(22例)。觀察NSCLC有淋巴結(jié)轉(zhuǎn)移組與無淋巴結(jié)轉(zhuǎn)移組之間雙源CT灌注參數(shù)、MVD及有腔血管參數(shù)的差異;分析NSCLC雙源CT灌注參數(shù)與MVD及有腔血管參數(shù)的相關(guān)性;利用ROC曲線分析雙源CT灌注參數(shù)評(píng)價(jià)NSCLC區(qū)域淋巴結(jié)轉(zhuǎn)移的診斷效能。結(jié)果:NSCLC有淋巴結(jié)轉(zhuǎn)移組的BF及LVA均高于無淋巴結(jié)轉(zhuǎn)移組,MTT及PMB低于無淋巴結(jié)轉(zhuǎn)移組,差異均有統(tǒng)計(jì)學(xué)意義。BV、LVN、LVP及MVD差異無統(tǒng)計(jì)學(xué)意義。BF與LVA及LVP均呈正相關(guān),BV、MTT及PMB與LVN、LVA、LVP均無相關(guān)性。NSCLC雙源CT各灌注參數(shù)與MVD均無相關(guān)性。根據(jù)ROC曲線分析,BF對(duì)診斷NSCLC區(qū)域淋巴結(jié)轉(zhuǎn)移具有較高的價(jià)值,當(dāng)以BF87.23 ml/100ml/min作為提示區(qū)域淋巴結(jié)轉(zhuǎn)移的可能性時(shí),其診斷符合率為71.4%。結(jié)論:BF及LVA與NSCLC發(fā)生區(qū)域淋巴結(jié)轉(zhuǎn)移存在密切關(guān)系;雙源CT灌注參數(shù)BF可作為術(shù)前預(yù)測(cè)NSCLC區(qū)域淋巴結(jié)轉(zhuǎn)移的參考指標(biāo)。
[Abstract]:Objective: to study the correlation between CT perfusion parameters and regional lymph node metastasis in non-small cell lung cancer (NSCLC), and to evaluate the value of dual-source CT perfusion imaging in the diagnosis of regional lymph node metastasis in NSCLC. Methods: from January 2015 to September 2016, 42 patients with non-small cell lung cancer (NSCLC) confirmed by pathology were collected from the affiliated Hospital of Zunyi Medical College. Among them, 28 cases were male and 14 cases were female, the average age was 53.64 years old (25 ~ 74 years). The perfusion images were transferred to the workstation (Siemens Syngo multimodality workplace),) for post-processing analysis with VPCT body software. The perfusion parameters such as time-density curve (T-DC), blood flow (BF), blood volume (BV), permeability (PMB), mean transit time (MTT), and the corresponding perfusion pseudo-color images were obtained. The microvessel density (MVD), the number of luminal vessels (LVN), the area of luminal vessels (LVA) and the circumference of luminal vessels (LVP) were counted in 42 cases of NSCLC by using PV-9000 two-step immunohistochemical method. The microvessel density (MVD), the number of luminal vessels (LVN), the area of luminal vessels (LVA) and the circumference of cavities (LVP) were counted. According to the pathological results, 42 cases of NSCLC were divided into lymph node metastasis group (20 cases) and no lymph node metastasis group (22 cases). To observe the difference of MVD and luminal vascular parameters between NSCLC with lymph node metastasis group and without lymph node metastasis group, analyze the correlation between MVD and luminal vascular parameters of NSCLC double source CT perfusion parameters. Dual CT perfusion parameters were used to evaluate the diagnostic efficacy of regional lymph node metastasis in NSCLC. Results the BF and LVA of the patients with lymph node metastasis were higher than those of the patients without lymph node metastasis, and the MTT and PMB levels of the patients with lymph node metastasis were lower than those of the patients without lymph node metastasis. There was no significant difference in LVP and MVD. BF was positively correlated with LVA and LVP, and there was no correlation between PMB and LVNV LVP. No correlation was found between the perfusion parameters of NSCLC and MVD. According to the analysis of ROC curve, BF has a high value in diagnosing regional lymph node metastasis of NSCLC. When BF87.23 ml/100ml/min is used as the indication of the possibility of regional lymph node metastasis, the diagnostic coincidence rate is 71.4%. Conclusion there is a close relationship between the ratio of 1: BF and LVA and the regional lymph node metastasis in NSCLC, and the double source CT perfusion parameter BF can be used as a reference index to predict the regional lymph node metastasis of NSCLC before operation.
【學(xué)位授予單位】：遵義醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R734.2;R730.44

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