能谱CT对肺癌诊断及鉴别诊断的初步研究

发布时间：2018-02-12 10:47

本文关键词： 肺结节体层摄影术 X线计算机诊断鉴别　出处：《安徽医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的探讨能谱电子计算机断层扫描(CT)成像定量分析对肺癌与肺结核及肺结核以外炎性病变的鉴别诊断及肺癌病理类型鉴别诊断的应用价值。方法选取129例经病理证实的肺结节/肿块的患者,其中肺癌99例(腺癌49例、鳞癌37例,小细胞肺癌13例),炎性病变19例,肺结核11例;对所有患者进行宝石CT能谱成像模式三期增强扫描并重建,将1.25mm层厚的单能量图像传至A w4.5工作站,由两位高年资影像科诊断医师分别进行能谱图像分析,并分别测量动脉期(30s)、静脉期(60s)及延迟期(90s)病灶的标准化碘浓度(NIC)、(40kev)CT值以及能谱曲线斜率,比较肺癌、肺炎、肺结核各参数间的差异。数据的统计学分析软件采用SPSS16.0;首先对数据进行正态分布检验,若数据为正态分布再检验其方差齐性;方差齐时,数据的组间差异比较采用单因素方差分析(L SD-t)法;方差不齐时,数据的组间差异比较采用两样本的校正t检验法;以P0.05为差异有统计学意义。再分别测量动脉期(30s)、静脉期(60s)肺腺癌与鳞癌的标准化碘浓度(NIC)、(40kev)CT值以及能谱曲线斜率,比较二者参数间的差异。采用两独立样本的t检验比较肺腺癌与鳞癌(40kev)CT值,能谱曲线斜率、标准碘基值的差异性;以P0.05为差异有统计学意义。绘制特性曲线(RO C),计算曲线下面积(AUC),并分析各指标诊断效能,求得鉴别肺腺癌与鳞癌的各能谱CT定量指标的阈值。结果125例患者经手术或纤维支气管镜取得病理证实,4例炎性病变患者由随访结果证实,所有患者资料齐全;共分为三大组:肺癌组、炎性组、结核组;其中肺癌组再分为腺癌组和鳞癌组。动脉期、静脉期及延迟期肺癌组、炎性组、结核组的NIC值、(40kev)CT值以及能谱曲线斜率(40-80kev)基本为炎性组最高,均为结核组最低,肺癌组居中。结核组与其他两组进行比较,病灶在三期扫描中N IC值、(40kev)CT值及能谱曲线斜率差异均有统计学意(P0.05);炎性组与肺癌组比较,仅在延迟期NIC值及(40kev)CT值差异有统计学意义(P0.05),其它数据无统计学意义。肺腺癌组与鳞癌组进行比较,腺癌组在双期扫描中NIC值、(40kev)CT值及能谱曲线斜率均大于鳞癌组,差异均有统计学意(P0.05)。ROC曲线分析显示:动脉期能谱曲线斜率下面积最大,为0.746;当阈值为105.5时,动脉期(40kev)CT值对鉴别腺癌与鳞癌的特异度最高,为78%;当阈值为0.247时,静脉期标准化碘浓度对鉴别腺癌与鳞癌的敏感度最高,为76%。结论能谱CT成像定量参数在肺癌、炎性病变、肺结核之间及腺癌与鳞癌之间差异均有统计学意义,对其鉴别诊断提供了可靠的帮助;能谱CT成像定量分析对肺癌的诊断及鉴别诊断存在很大临床应用价值。
[Abstract]:Objective to evaluate the value of quantitative analysis of energy dispersive computed tomography (ECDT) imaging in the differential diagnosis of lung cancer from pulmonary tuberculosis and pulmonary tuberculosis and the differential diagnosis of lung cancer pathological types. Methods 129 cases of lung cancer were selected by pathology. Confirmed pulmonary nodules / masses, Among them, 99 cases of lung cancer (49 cases of adenocarcinoma, 37 cases of squamous cell carcinoma, 13 cases of small cell lung cancer, 19 cases of inflammatory lesions, 11 cases of pulmonary tuberculosis) were performed three phase enhanced scanning and reconstruction of sapphire CT energy dispersive imaging. A single energy image with a thickness of 1.25 mm was transferred to workstation Aw4.5, and the energy spectrum image was analyzed by two senior imaging diagnostics. The CT value and the slope of energy spectrum curve of the lesions of 30 s, 60 s of arterial phase, 60 s of venous phase and 90 s of delayed phase were measured respectively, and the lung cancer and pneumonia were compared. SPSS 16.0 is used to analyze the data. First, the normal distribution of the data is tested, and if the data is normal distribution, the homogeneity of variance is tested. The method of single factor analysis of variance (ANOVA) was used to compare the differences between groups, and when the variance was not equal, the method of corrected t test was used to compare the differences between groups of data with two samples. The difference was statistically significant (P0.05). The standardized iodine concentrations of lung adenocarcinoma and squamous cell carcinoma were measured in arterial phase 30 s and vein phase 60 s, respectively, and the CT value and the slope of energy spectrum curve of 40 kevs of lung adenocarcinoma and squamous cell carcinoma were measured, respectively. T test of two independent samples was used to compare the difference of CT value, slope of energy spectrum curve and standard iodine base value between lung adenocarcinoma and squamous cell carcinoma. The difference was statistically significant. The characteristic curve was drawn, the area under the curve was calculated, and the diagnostic efficacy of each index was analyzed. Results 125 cases of lung adenocarcinoma and squamous cell carcinoma were proved pathologically by operation or fiberoptic bronchoscopy, 4 cases of inflammatory lesions were confirmed by follow up results, all the data were complete. The lung cancer group was divided into three groups: lung cancer group, inflammatory group, tuberculosis group, the lung cancer group was divided into adenocarcinoma group and squamous cell carcinoma group, arterial stage, venous phase and delayed stage lung cancer group, inflammatory group, The CT value of NIC and the slope of energy spectrum curve were the highest in the inflammatory group, the lowest in the tuberculosis group and the middle in the lung cancer group. The tuberculosis group was compared with the other two groups. There were significant differences in the CT value and the slope of the energy spectrum curve between the Nic value and the 40 kevel CT value of the lesion in the third phase scan, and the difference between the inflammatory group and the lung cancer group was significant (P 0.05). The difference of NIC value and CT value in delayed phase was significant (P 0.05), but there was no significant difference in other data. Compared with squamous cell carcinoma group, the CT value of NIC and the slope of energy spectrum curve in adenocarcinoma group were higher than those in squamous cell carcinoma group. The difference was statistically significant (P 0.05) .ROC curve analysis showed that the area under the slope of the arterial phase energy spectrum curve was the largest (0.746); when the threshold value was 105.5, the CT value of 40 kevel in arterial phase had the highest specificity in differentiating adenocarcinoma from squamous cell carcinoma, and when the threshold was 0.247, The sensitivity of standardized iodine concentration in venous phase to differentiating adenocarcinoma from squamous cell carcinoma was 76.Conclusion the quantitative parameters of energy dispersive CT imaging have statistical significance among lung cancer, inflammatory lesions, pulmonary tuberculosis and adenocarcinoma and squamous cell carcinoma. The quantitative analysis of energy dispersive CT imaging has great clinical value in the diagnosis and differential diagnosis of lung cancer.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R734.2;R730.44

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