寶石能譜CT在肝癌TACE術(shù)后殘留病灶供血?jiǎng)用}顯示及活性乏血供病灶診斷中的應(yīng)用
發(fā)布時(shí)間：2019-04-10 13:39
【摘要】：目的評(píng)價(jià)寶石能譜CT(GSI)最佳單能量血管成像對(duì)顯示肝癌經(jīng)皮肝動(dòng)脈化療栓塞(TACE)術(shù)后殘留病灶供血?jiǎng)用}的價(jià)值;評(píng)價(jià)GSI在肝癌TACE術(shù)后乏血供活性病灶診斷中的價(jià)值。方法收集2013年2月至2016年2月綿陽(yáng)市中心醫(yī)院肝癌TACE術(shù)后患者進(jìn)行回顧性分析。所有患者均在術(shù)后4~6周行GSI掃描,一次GSI掃描后,通過(guò)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(biāo)準(zhǔn)將42例患者納入研究。運(yùn)用后處理軟件中的對(duì)比噪聲比(CNR)曲線,在能譜圖像中得出動(dòng)脈期腹主動(dòng)脈與肝組織間最大CNR時(shí)所對(duì)應(yīng)的顯示殘留病灶供血?jiǎng)用}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(dǎo)下,分別在QC圖像及最佳單能量圖像上重建殘留病灶供血?jiǎng)用},并對(duì)上述兩種方法重建的動(dòng)脈進(jìn)行分級(jí)評(píng)分,運(yùn)用配對(duì)樣本t檢驗(yàn)比較兩種方法對(duì)殘留病灶供血?jiǎng)用}顯示的評(píng)分結(jié)果。第二部分:按納入、排除標(biāo)準(zhǔn)將36例患者納入研究。運(yùn)用CNR曲線,分別得出動(dòng)脈期、門脈期乏血供病灶與周圍正常肝組織間最大CNR時(shí)所對(duì)應(yīng)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(dòng)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(shù)后肝臟乏血供病灶,A法通過(guò)觀察QC圖平掃、動(dòng)脈期及門靜脈期圖像進(jìn)行診斷;B法采用最佳單能量圖、基物質(zhì)圖、能譜工具進(jìn)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(duì)乏血供病灶性質(zhì)進(jìn)行判斷,診斷結(jié)果與DSA及后續(xù)隨訪結(jié)果對(duì)照,采用2c檢驗(yàn)比較A、B兩種方法診斷肝癌TACE術(shù)后活性(殘留、復(fù)發(fā)、轉(zhuǎn)移)乏血供病灶的差異。結(jié)果第一部分:CT共檢出殘留病灶供血?jiǎng)用}52支,顯示供血?jiǎng)用}的最佳單能量值在61-65Ke V間。QC圖供血?jiǎng)用}圖像評(píng)分為1.86±0.68,最佳單能量圖像供血?jiǎng)用}圖像評(píng)分為2.60±0.54,兩種方法在評(píng)價(jià)肝癌TACE術(shù)后殘留病灶供血?jiǎng)用}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(duì)肝癌TACE術(shù)后殘留病灶供血?jiǎng)用}的顯示優(yōu)于QC圖像。第二部分:36例TACE術(shù)后復(fù)查患者CT檢查共檢出乏血供病灶82個(gè)。動(dòng)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(jì)學(xué)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(jì)學(xué)意義(2?=9.09,2?=5.14,P0.05)。結(jié)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(shù)后殘留病灶供血?jiǎng)用},GSI能更清晰的顯示肝癌TACE術(shù)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(xué)位授予單位】：西南醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R735.7;R730.44
本文編號(hào)：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(xué)位授予單位】：西南醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R735.7;R730.44
【參考文獻(xiàn)】
相關(guān)期刊論文 前10條
1 黃丹;劉啟榆;何川東;周瑩;林華;陳嬌;管彬;王晉秋;廖麗萍;;寶石CT能譜成像在乳腺浸潤(rùn)性導(dǎo)管癌腋窩轉(zhuǎn)移淋巴結(jié)診斷中的初步應(yīng)用[J];腫瘤預(yù)防與治療;2016年04期
2 Qi-Yu Liu;Chuan-Dong He;Ying Zhou;Dan Huang;Hua Lin;Zhong Wang;Dong Wang;Jin-Qiu Wang;Li-Ping Liao;;Application of gemstone spectral imaging for efficacy evaluation in hepatocellular carcinoma after transarterial chemoembolization[J];World Journal of Gastroenterology;2016年11期
3 Norihiro Imai;Masatoshi Ishigami;Yoji Ishizu;Teiji Kuzuya;Takashi Honda;Kazuhiko Hayashi;Yoshiki Hirooka;Hidemi Goto;;Transarterial chemoembolization for hepatocellular carcinoma: A review of techniques[J];World Journal of Hepatology;2014年12期
4 次旦旺久;盧再鳴;林坤;王曉明;;增強(qiáng)MRI對(duì)肝癌TACE術(shù)后殘余癌及復(fù)發(fā)癌診斷的Meta分析[J];中國(guó)臨床醫(yī)學(xué)影像雜志;2014年08期
5 高國(guó)政;;原發(fā)性肝癌TACE術(shù)后血管改變及復(fù)發(fā)轉(zhuǎn)移的因素分析[J];實(shí)用癌癥雜志;2014年06期
6 趙金鳳;張同;劉建宇;吳海云;;寶石CT能譜掃描檢查肝內(nèi)占位性病變敏感性的研究[J];大家健康(學(xué)術(shù)版);2014年09期
7 熊瑜琦;李鏑;康寧;喬梁;;3.0 T MRI動(dòng)態(tài)增強(qiáng)與64層螺旋CT多期掃描診斷肝硬化背景下小肝癌的價(jià)值比較[J];山東醫(yī)藥;2014年16期
8 楊忠誠(chéng);;CT和MRI評(píng)價(jià)原發(fā)性肝癌TACE治療后腫瘤殘存和病灶穩(wěn)定性的臨床分析[J];國(guó)際醫(yī)藥衛(wèi)生導(dǎo)報(bào);2014年04期
9 紀(jì)建松;楊宏遠(yuǎn);王祖飛;盧陳英;惠俊國(guó);;超聲、CT及MRI隨訪在肝硬化結(jié)節(jié)惡變篩查及診斷中的價(jià)值[J];中華醫(yī)學(xué)雜志;2014年05期
10 邱國(guó)欽;劉昌華;陳玉強(qiáng);曾英瑯;;320排CT血管成像在肝癌介入治療中的應(yīng)用[J];實(shí)用癌癥雜志;2014年01期
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