二代双源CT双能量衍生图像对胰腺癌诊断的临床价值研究

发布时间：2018-05-20 15:50

本文选题：胰腺癌 + 双期增强扫描　；参考：《浙江大学》2017年硕士论文

【摘要】：目的:探讨二代双源CT双能量衍生图像在胰腺癌诊断中的临床应用价值。方法:本研究收集经手术病理证实为胰腺癌患者33例。所有患者均行双能CT(DECT)双期增强扫描,经后处理得到虚拟平扫图(VNC)、线性融合图、非线性融合图、碘图、能谱曲线图、最佳对比噪声比单能量图、70kev单能量图。分析胰腺癌组织虚拟平扫图与真实平扫图之间CT值、标准差值(SD)、信号噪声比(SNR)、主观图像质量的差异;分析线性融合图、非线性融合图、碘图的胰腺癌组织绝对强化值(AEV)、胰腺-胰腺癌组织相对强化差值(REV)、强化比值(ER)和图像对比噪声比(CNR)的差异;分析胰腺癌组织与周围胰腺实质、腰大肌能谱曲线斜率差异及胰腺实质-胰腺癌组织最佳对比噪声比单能量图与70kev单能量图之间对比噪声比(CNR);评价以上双期增强双能衍生图像对胰腺癌组织的分辨能力和诊断价值。结果:虚拟平扫图像(VNC)与真实平扫(TNC)图像胰腺癌组织CT值相关性好,图像质量主观评分相似;SD值差异有统计学意义(P0.05),VNCTNC;SNR值差异有统计学意义(P0.05),VNCTNC;碘图具有额外价值。在双期增强扫描中,动脉期线性融合图、非线性融合图、碘图的AEV、REV和CNR值差异均有统计学意义(P0.05);实质期三组REV、ER、CNR值差异均有统计学意义(P0.05);动脉期和实质期之间线性融合图、非线性融合图、碘图中胰腺癌组织相同的强化参数一一对应比较,AEV及REV值均有统计学差异(P0.05);线性融合图ER值、碘图CNR值在双期增强中差异有统计学意义(P0.05)。周围胰腺实质、胰腺癌组织、腰大肌能谱曲线斜率分别为:动脉期(1.451、0.769、0.357),实质期(1.502、1.076、0.603),三者之间双期增强曲线斜率均有统计学差异(P0.05);且胰腺癌组织及腰大肌在动脉期与实质期之间曲线斜率有统计学差异(P0.05),而周围胰腺实质双期增强之间曲线斜率无统计学差异(P0.05);胰腺癌组织CNR在最佳对比噪声比单能量图与70kev单能量图之间双期相均无统计学差异,但在动脉期及实质期之间均有统计学差异,动脉期实质期。结论:双源CT双能虚拟平扫技术在胰腺癌检查中可以代替以往多期增强扫描中的常规平扫;双源CT双能模式双期增强扫描结合多种衍生图像能够优化显示胰腺癌病灶。双源CT双能模式所得能谱曲线斜率可以半定量分析胰腺癌组织衰减特征,能谱成像在胰腺癌的诊断中具有潜在的辅助价值。
[Abstract]:Objective: to evaluate the clinical value of 2-generation dual-source CT dual-energy-derived images in the diagnosis of pancreatic cancer. Methods: 33 cases of pancreatic cancer confirmed by operation and pathology were collected. All patients were performed dual phase enhanced CT scan. After post-processing, virtual plain scan, linear fusion, nonlinear fusion, iodine, energy spectrum and 70 Kev single energy map of optimal contrast noise ratio were obtained. The difference of CT value, standard difference between virtual plain scan and real plain scan of pancreatic cancer tissue, signal to noise ratio (SNRR), subjective image quality was analyzed. The difference of absolute enhancement value of pancreatic cancer tissue in iodograms and the difference between pancreatic and pancreatic carcinoma tissues were analyzed, and the contrast noise ratio (CNR) and enhancement ratio (ERR) of pancreatic carcinoma tissue were compared with those of peripheral pancreatic carcinoma tissue, and the relationship between pancreatic carcinoma tissue and surrounding pancreatic tissue was analyzed. The difference of the slope of the energy spectrum curve of psoas major muscle and pancreatic parenchyma-the best contrast noise ratio of pancreatic cancer tissue and the contrast noise ratio between the single energy ratio image and the 70kev single energy image. To evaluate the resolution of pancreatic cancer tissue by the above two phase enhanced dual energy derivative images Ability and diagnostic value. Results: there was a good correlation between virtual plain scan (VNCC) and real plain scan (TNC) CT value of pancreatic cancer tissue. There was significant difference in subjective score of image quality and SD value. There was significant difference in SNR of VNCTNCMr (P 0.05). In dual phase enhanced scanning, there were significant differences in AEVV REV and CNR values between arterial phase linear fusion map, nonlinear fusion map and iodine map, there were significant differences in the three groups of essential phase REVERN CNR values (P0.05), and linear fusion map between arterial phase and parenchymal phase (P 0.05), and there was no significant difference between them in arterial phase and parenchymal phase (P < 0.05), but there was no significant difference in CNR between arterial phase and parenchymal phase. There were significant differences in the enhancement parameters of pancreatic cancer between the two groups (P 0.05), and the ER value of linear fusion map and the CNR value of iodine graph were significantly different in two phase enhancement (P 0.05). Peripancreatic parenchyma, pancreatic cancer tissue, The slope of the energy spectrum curve of psoas major muscle was 1.451U 0.769U 0.357m in arterial phase and 1.502n 1.076-0.603m in parenchymal phase respectively. There was statistical difference between the slope of two-phase enhancement curve and that of pancreatic cancer tissue and psoas major muscle in arterial phase and parenchymal phase (P 0.05), and there was a statistical difference in the slope between arterial phase and parenchymal phase in pancreatic cancer tissue and psoas major muscle. There was no significant difference in the slope of the curve between the two phase enhancement of peripancreatic parenchyma, and there was no significant difference in CNR between the optimal contrast noise ratio single energy map and 70kev single energy map. But there was statistical difference between arterial phase and parenchymal phase. Conclusion: Dual-source CT dual-energy virtual plain scan can replace the conventional multi-phase enhanced CT scan in pancreatic cancer and dual-source CT dual-phase enhanced scan combined with multiple derivative images can optimize the display of pancreatic cancer lesions. The slope of energy spectrum curve obtained by dual-source CT dual-energy mode can be used for semi-quantitative analysis of tissue attenuation characteristics of pancreatic cancer. Energy spectrum imaging has potential auxiliary value in the diagnosis of pancreatic cancer.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.9;R730.44

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