能谱CT对肺内占位良恶性诊断价值的研究

发布时间：2018-01-17 01:11

  本文关键词：能谱CT对肺内占位良恶性诊断价值的研究　出处：《石河子大学》2017年硕士论文　论文类型：学位论文

  更多相关文章： 结核球 肺癌 炎症 鉴别 能谱成像

【摘要】：目的本研究是利用能谱CT多参数成像技术(包括碘浓度、能谱曲线斜率、70kev单能量CT值和有效原子序数)来分析能谱CT对肺内良恶性占位性病变诊断的可行性,探索能谱CT在肺部良恶性占位性病变的诊断及鉴别诊断中的应用价值。材料和方法第一部分:能谱CT在不典型结核球与肺癌中的诊断价值对经病理证实的11例肺结核与34例肺癌患者行宝石能谱CT扫描:平扫、动脉期(arterial phase,AP)及静脉期(venous phase,VP)。将平扫、AP及VP图像进行能谱薄层重建,并将薄层图像传至ADW(Advanced Workstation)4.6工作站上,双盲法测量各能谱参数。选取70ke V薄层能谱图像测量平扫、动脉期和静脉期CT值,动脉期和静脉期碘浓度(iodine concentrations,IC),动脉期和静脉期能谱曲线斜率(λHU),同时测量同层面主动脉期的降主动脉或锁骨下动脉的碘浓度(IC动脉)。计算病灶标准化碘浓度值(normalized iodine concentrations,NIC)及病灶动、静脉期的70ke V图像净增CT值。感兴趣区(Region of interest,ROI)放置在病变密度均匀的层面,避开空洞、钙化及血管。为保证数据尽可能的准确,所有数据测量均在连续3个ROI层面上,并取其平均值。第二部分:能谱CT对炎性病变与肺癌的鉴别诊断价值选取经病理证实的49例肺占位患者(肺炎性病变15例,肺癌34例)行能谱CT扫描。首先进行能谱平扫,然后于造影剂注射后8s-16s及25s-32s分别行肺动脉期和主动脉期能谱扫描。将平扫、肺动脉期和主动脉期图像进行能谱薄层重建,并将薄层图像传至ADW 4.6工作站上,双盲法测量各能谱参数。选取70ke V薄层能谱图像测量平扫、肺动脉期和主动脉期CT值和IC。计算病灶肺动脉期和主动脉期净增碘浓度值(d IC)及病灶肺动脉期和主动脉期的70ke V图像净增CT值(d CT)。ROI放置在病变密度均匀的层面,避开空洞、钙化及血管。为保证数据尽可能的准确,所有数据测量均在连续3个ROI层面上,并取其平均值。结果第一部分:能谱CT在不典型结核球与肺癌中的诊断价值1)CT表现结果:11例结核球患者,获取病理结果前均考虑肺癌可能。其中5例分布不典型,分别位于上叶前段、中叶及下叶各基底段区;4例可见分叶征;5例边缘有不同程度的毛刺状突起;9例无钙化灶;4例周围无卫星灶;3例明显强化。2)能谱参数结果:NIC、70ke V图像的净增CT值(AP和VP)以及λHU(AP和VP),肺癌组均高于不典型结核球组,差异有统计学意义(P�d0.05);但平扫CT值两组无统计学差异(P�e0.05)。3)能谱参数ROC曲线分析:选取有统计学意义的能谱参数生成ROC曲线,得到相应能谱参数鉴别两组病灶的最佳诊断阈值、灵敏度和特异度。其中,NIC的诊断价值最大,阈值为0.105,灵敏度和特异度分别为82.4%和90.9%。第二部分:能谱CT对炎性病变与肺癌的鉴别诊断价值1)能谱参数结果:炎性病变组与肺癌组比较,肺动脉期IC、d IC和70ke V图像d CT值依次为(11.95±2.52和6.40±3.18)、(9.77±2.13和4.23±2.51)(100ug/ml)和(11.70±3.41和6.16±3.75)HU;主动脉期IC和d IC分别为(23.36±5.37和15.84±4.65)和(21.18±6.06和13.64±3.29)(100ug/ml)。以上能谱参数炎性病变组均高于肺癌组,差异有统计学意义(P�d0.05)。主动脉期70ke V图像d CT值和有效原子序数分别为(35.64±9.30和29.11±12.83)(100ug/ml)和(7.70±0.17和7.71±0.18),差异无统计学意义(P�e0.05)。2)能谱参数ROC曲线分析:选取有统计学意义的能谱参数生成ROC曲线,得到相应能谱参数鉴别两组病灶的最佳诊断阈值、灵敏度和特异度。其中,肺动脉期的d IC的诊断价值最大,阈值为7.385(100ug/ml),灵敏度和特异度分别为93.3%和91.2%。结论1)能谱CT碘浓度值、70ke V单能量CT值及能谱曲线斜率对不典型结核球与肺癌的鉴别诊断有帮助,尤其是NIC值诊断价值较高。2)能谱CT碘浓度值及70ke V单能量CT值有助于炎性病变和肺癌的鉴别诊断,尤其是肺动脉期d IC值诊断价值较高。
[Abstract]:The purpose of this study is to use the energy spectrum of CT multi parameter imaging techniques (including iodine concentration, energy spectrum curve slope, 70kev single energy CT value and effective atomic number) to analyze the spectrum of CT in benign and malignant pulmonary space occupying lesion of the feasibility, explore the energy spectrum CT accounted for malignant diagnosis and differential diagnosis of lesions in the benign lung. Materials and methods the first part: the diagnostic value of spectral CT in atypical tuberculoma and lung cancer in 11 cases with pulmonary tuberculosis confirmed by pathology and 34 cases of lung cancer underwent gemstone spectral CT scanning: plain scan, arterial phase (arterial phase, AP (venous) and portal venous phase phase, VP). The AP and VP scan, image spectrum reconstruction and thin, thin image to the ADW (Advanced Workstation) 4.6 workstation, double blind method to measure the spectral parameters. Select the 70ke V thin spectral image measurement scan, arterial phase and venous phase CT, arterial phase and vein During the period of iodine concentration (iodine concentrations, IC), arterial phase and venous phase spectrum curve slope (2 HU), simultaneous measurement of the same level of aortic phase and descending aorta or subclavian artery iodine concentration (IC artery) were calculated. The normalized iodine concentration value (normalized iodine concentrations, NIC) and the lesion, vein the 70ke V CT. Net value of image region of interest (Region of, interest, ROI) placed in the lesion density level, avoid holes, calcification and blood vessels. In order to ensure the data is as accurate as possible, all the data were measured in 3 consecutive ROI level, and their average value. The second part: the CT spectrum for diagnosis and differential diagnosis of inflammatory lesions and lung cancer were selected from 49 cases of lung pathology lesions (15 cases of pneumonia, 34 cases of lung cancer lesions) underwent CT scanning spectrum. First spectrum scan, and then to the contrast agent injection after 8s-16s and 25s-32s respectively for pulmonary arterial phase And spectrum scanning. The arterial phase scan, pulmonary arterial and aortic phase image spectra and thin layer reconstruction, thin layer images were transferred to ADW 4.6 workstation, double blind method to measure the spectral parameters. Select the 70ke V thin spectral image measurement scan, pulmonary arterial and aortic CT value and IC. calculate the net increase of iodine concentration in pulmonary artery and aortic lesions (D IC) and the value of pulmonary artery and aortic lesions during the period of the 70ke V image (D CT) CT net value of.ROI is placed in the lesion density level, avoid holes, calcification and blood vessels. In order to ensure the data is as accurate as possible, all measurement data are in for the 3 ROI level, and their average values. Results the first part: the spectrum of CT in atypical tuberculoma and lung cancer in the diagnostic value of 1 CT) results: 11 cases of tuberculosis patients, pathological results were obtained including 5 cases of lung cancer may be considered. The distribution of typical, are located in the 涓婂彾鍓嶆��,涓�鍙跺強涓嬪彾鍚勫熀搴曟�靛尯;4渚嬪彲瑙佸垎鍙跺緛;5渚嬭竟缂樻湁涓嶅悓绋嬪害鐨勬瘺鍒虹姸绐佽捣;9渚嬫棤閽欏寲鐏，

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