寶石能譜CT在肝癌TACE術后殘留病灶供血動脈顯示及活性乏血供病灶診斷中的應用
發(fā)布時間：2019-04-10 13:39
【摘要】：目的評價寶石能譜CT(GSI)最佳單能量血管成像對顯示肝癌經皮肝動脈化療栓塞(TACE)術后殘留病灶供血動脈的價值;評價GSI在肝癌TACE術后乏血供活性病灶診斷中的價值。方法收集2013年2月至2016年2月綿陽市中心醫(yī)院肝癌TACE術后患者進行回顧性分析。所有患者均在術后4~6周行GSI掃描,一次GSI掃描后,通過原始數(shù)據(jù)重建獲得混合能量(QC)圖像及能譜圖像,圖像后處理采用ADW4.6工作站和GSI-viewer軟件。本研究分為以下兩部分:第一部分:按納入、排除標準將42例患者納入研究。運用后處理軟件中的對比噪聲比(CNR)曲線,在能譜圖像中得出動脈期腹主動脈與肝組織間最大CNR時所對應的顯示殘留病灶供血動脈的最佳單能量圖像。在2名從事腹部影像工作的副主任醫(yī)師指導下,分別在QC圖像及最佳單能量圖像上重建殘留病灶供血動脈,并對上述兩種方法重建的動脈進行分級評分,運用配對樣本t檢驗比較兩種方法對殘留病灶供血動脈顯示的評分結果。第二部分:按納入、排除標準將36例患者納入研究。運用CNR曲線,分別得出動脈期、門脈期乏血供病灶與周圍正常肝組織間最大CNR時所對應的最佳單能量圖像,記錄QC圖與最佳單能量圖像中病灶的CNR值,比較動脈期、門脈期的QC圖及最佳單能量圖像CNR值的差異。采用A、B兩種方法觀察肝癌TACE術后肝臟乏血供病灶,A法通過觀察QC圖平掃、動脈期及門靜脈期圖像進行診斷;B法采用最佳單能量圖、基物質圖、能譜工具進行觀察、診斷。由2名從事腹部影像的副主任醫(yī)師在不知情的情況下分別在后處理工作站上對乏血供病灶性質進行判斷,診斷結果與DSA及后續(xù)隨訪結果對照,采用2c檢驗比較A、B兩種方法診斷肝癌TACE術后活性(殘留、復發(fā)、轉移)乏血供病灶的差異。結果第一部分:CT共檢出殘留病灶供血動脈52支,顯示供血動脈的最佳單能量值在61-65Ke V間。QC圖供血動脈圖像評分為1.86±0.68,最佳單能量圖像供血動脈圖像評分為2.60±0.54,兩種方法在評價肝癌TACE術后殘留病灶供血動脈血管顯示中存在顯著差異(t=8.15,P0.001),GSI最佳單能量圖像對肝癌TACE術后殘留病灶供血動脈的顯示優(yōu)于QC圖像。第二部分:36例TACE術后復查患者CT檢查共檢出乏血供病灶82個。動脈期QC圖與最佳單能量圖像中乏血供病灶CNR值分別為3.18±1.20、3.85±1.31;門脈期QC圖與最佳單能量圖像中乏血供病灶CNR值分別為3.85±1.52、4.50±1.48;上述兩組數(shù)據(jù)差異均有統(tǒng)計學意義。A法敏感性為72.00%,特異性為81.30%;B法敏感性為94.00%,特異性為90.60%,兩種方法敏感性及特異性差異均有統(tǒng)計學意義(2?=9.09,2?=5.14,P0.05)。結論與常規(guī)混合能量CT比較,GSI最佳單能量成像可以更好的顯示肝癌TACE術后殘留病灶供血動脈,GSI能更清晰的顯示肝癌TACE術后肝臟乏血供病灶,并能根據(jù)能譜分析圖的不同特征,有效地鑒別肝臟活性乏血供病灶與其他病變,可為后續(xù)治療提供更為全面的信息。
[Abstract]:Objective to evaluate the value of best single energy angiography (CT (GSI) with gemstone energy spectrum in the diagnosis of residual foci after percutaneous transhepatic arterial chemoembolization (TACE) in hepatocellular carcinoma (HCC) and to evaluate the value of GSI in the diagnosis of hepatic carcinoma after TACE. Methods from Feb.2013 to Feb.2016, the patients with hepatocarcinoma TACE in Mianyang Central Hospital were retrospectively analyzed. All patients underwent GSI scan at 4-6 weeks after operation. After one GSI scan, mixed-energy (QC) images and energy spectrum images were obtained by raw data reconstruction. ADW4.6 workstation and GSI-viewer software were used in the post-processing of the images. This study is divided into two parts: part one: 42 patients were included in the study according to the criteria of inclusion and exclusion. By using the (CNR) curve of the contrast noise ratio in the post-processing software, the optimal single-energy image for displaying the residual focus supplying artery was obtained in the energy spectrum image when the maximum CNR between the abdominal aorta and the liver tissue was obtained during the arterial phase. Under the guidance of two deputy chief doctors engaged in abdominal imaging, the residual foci supplying arteries were reconstructed on the QC images and the best single energy images respectively, and the reconstructed arteries were graded according to the above two methods. The t-test of paired samples was used to compare the results of the two methods on the display of the blood supply artery of the residual lesion. Part two: 36 patients were included in the study according to the criteria of inclusion and exclusion. Using CNR curve, the best single energy images corresponding to the maximum CNR between arterial phase, portal phase and surrounding normal liver tissue were obtained, and the CNR values of lesions in QC and optimal single energy images were recorded, and the arterial phase was compared. Difference of CNR value between portal phase QC diagram and optimal single energy image. Methods A and B methods were used to observe hepatic hypovascular lesions after TACE. Plain scan of QC images, arterial phase and portal phase images of A method were used for diagnosis. B method used the best single energy diagram, base material diagram, energy spectrum tools to observe and diagnose. Two deputy chief doctors who were engaged in abdominal imaging were used to judge the nature of ischemic lesions on post-processing workstations without their knowledge. The diagnosis results were compared with DSA and follow-up results, and the results were compared with those of DSA and follow-up with 2c test A, and the results were compared with those of follow-up by 2c test. B the difference of activity (residual, recurrence and metastasis) in diagnosis of hepatocellular carcinoma (HCC) after TACE. Results in the first part, 52 residual feeding arteries were detected by CT. The best single energy value of the feeding arteries was between 61-65Ke V. the image score of QC map was 1.86 鹵0.68, The best single-energy image was 2.60 鹵0.54. There was significant difference between the two methods in the evaluation of residual blood supply arteries after TACE (t = 8.15, P0.001), and there was a significant difference between the two methods in the evaluation of residual lesions of HCC after operation (t = 8.15, P0.001). The best single energy image of GSI was superior to QC image in displaying the feeding artery of residual foci after TACE for hepatocellular carcinoma (HCC). In the second part, 82 lesions were detected by CT in 36 patients with TACE. The CNR values in arterial phase QC and optimal single energy images were 3.18 鹵1.20,3.85 鹵1.31, 3.85 鹵1.52 and 4.50 鹵1.48 in portal phase QC and optimal single energy images, respectively, and the CNR values in arterial phase and optimal single energy images were 3.18 鹵1.20,3.85 鹵1.31, 3.85 鹵1.52 and 4.50 鹵1.48respectively. The sensitivity and specificity of A method were 72.0% and 81.30% respectively. The sensitivity and specificity of method B were 94.00% and 90.60% respectively. There was a significant difference in sensitivity and specificity between the two methods (2 / 9.09, 2 / 5.14, P0.05). Conclusion compared with conventional mixed-energy CT, the best single-energy imaging of GSI can better display the residual lesion feeding arteries after TACE, and GSI can more clearly show the hepatic hypovascular lesions after TACE. According to the different characteristics of the energy spectrum analysis map, we can effectively distinguish the liver active ischemic lesions from other lesions, which can provide more comprehensive information for the follow-up treatment.
【學位授予單位】：西南醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R735.7;R730.44
本文編號：2455842
[Abstract]:Objective to evaluate the value of best single energy angiography (CT (GSI) with gemstone energy spectrum in the diagnosis of residual foci after percutaneous transhepatic arterial chemoembolization (TACE) in hepatocellular carcinoma (HCC) and to evaluate the value of GSI in the diagnosis of hepatic carcinoma after TACE. Methods from Feb.2013 to Feb.2016, the patients with hepatocarcinoma TACE in Mianyang Central Hospital were retrospectively analyzed. All patients underwent GSI scan at 4-6 weeks after operation. After one GSI scan, mixed-energy (QC) images and energy spectrum images were obtained by raw data reconstruction. ADW4.6 workstation and GSI-viewer software were used in the post-processing of the images. This study is divided into two parts: part one: 42 patients were included in the study according to the criteria of inclusion and exclusion. By using the (CNR) curve of the contrast noise ratio in the post-processing software, the optimal single-energy image for displaying the residual focus supplying artery was obtained in the energy spectrum image when the maximum CNR between the abdominal aorta and the liver tissue was obtained during the arterial phase. Under the guidance of two deputy chief doctors engaged in abdominal imaging, the residual foci supplying arteries were reconstructed on the QC images and the best single energy images respectively, and the reconstructed arteries were graded according to the above two methods. The t-test of paired samples was used to compare the results of the two methods on the display of the blood supply artery of the residual lesion. Part two: 36 patients were included in the study according to the criteria of inclusion and exclusion. Using CNR curve, the best single energy images corresponding to the maximum CNR between arterial phase, portal phase and surrounding normal liver tissue were obtained, and the CNR values of lesions in QC and optimal single energy images were recorded, and the arterial phase was compared. Difference of CNR value between portal phase QC diagram and optimal single energy image. Methods A and B methods were used to observe hepatic hypovascular lesions after TACE. Plain scan of QC images, arterial phase and portal phase images of A method were used for diagnosis. B method used the best single energy diagram, base material diagram, energy spectrum tools to observe and diagnose. Two deputy chief doctors who were engaged in abdominal imaging were used to judge the nature of ischemic lesions on post-processing workstations without their knowledge. The diagnosis results were compared with DSA and follow-up results, and the results were compared with those of DSA and follow-up with 2c test A, and the results were compared with those of follow-up by 2c test. B the difference of activity (residual, recurrence and metastasis) in diagnosis of hepatocellular carcinoma (HCC) after TACE. Results in the first part, 52 residual feeding arteries were detected by CT. The best single energy value of the feeding arteries was between 61-65Ke V. the image score of QC map was 1.86 鹵0.68, The best single-energy image was 2.60 鹵0.54. There was significant difference between the two methods in the evaluation of residual blood supply arteries after TACE (t = 8.15, P0.001), and there was a significant difference between the two methods in the evaluation of residual lesions of HCC after operation (t = 8.15, P0.001). The best single energy image of GSI was superior to QC image in displaying the feeding artery of residual foci after TACE for hepatocellular carcinoma (HCC). In the second part, 82 lesions were detected by CT in 36 patients with TACE. The CNR values in arterial phase QC and optimal single energy images were 3.18 鹵1.20,3.85 鹵1.31, 3.85 鹵1.52 and 4.50 鹵1.48 in portal phase QC and optimal single energy images, respectively, and the CNR values in arterial phase and optimal single energy images were 3.18 鹵1.20,3.85 鹵1.31, 3.85 鹵1.52 and 4.50 鹵1.48respectively. The sensitivity and specificity of A method were 72.0% and 81.30% respectively. The sensitivity and specificity of method B were 94.00% and 90.60% respectively. There was a significant difference in sensitivity and specificity between the two methods (2 / 9.09, 2 / 5.14, P0.05). Conclusion compared with conventional mixed-energy CT, the best single-energy imaging of GSI can better display the residual lesion feeding arteries after TACE, and GSI can more clearly show the hepatic hypovascular lesions after TACE. According to the different characteristics of the energy spectrum analysis map, we can effectively distinguish the liver active ischemic lesions from other lesions, which can provide more comprehensive information for the follow-up treatment.
【學位授予單位】：西南醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R735.7;R730.44
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