能谱CT在囊型肝包虫诊断中的应用价值

发布时间：2018-04-16 04:24

本文选题：肝 + 包虫病　；参考：《石河子大学》2017年硕士论文

【摘要】：目的:探讨能谱CT在诊断囊性肝包虫中的应用价值。方法:收集于我院接受腹部能谱CT扫描的36例患者,共71枚包虫,其中男21例,女15例;年龄18~83岁,平均(48.67±18.43)岁,BMI(22.34±3.32)kg/m2。36例肝囊性包虫患者根据临床资料、超声和(或)CT及MRI综合诊断且Casoni氏试验阳性以确保诊断的可靠性,其中26例共54枚包虫(单囊型13枚,多子囊型11枚,内囊塌陷型3枚,实变型14枚,钙化型13枚)均经手术证实(20例行外膜内外囊完整剥离术,6例行外囊大部分切除术),术后病理均符合细粒棘球蚴。使用GE Discovery 750HD 64排宝石CT机,采用GSI模式行平扫、动脉期、门静脉期、延迟期扫描,扫描后先产生混合能量120ke V的QC图像;然后使用影像重组标准算法,重组出40-140 ke V单能量图像,层厚和层间距均为1.25 mm。应用能谱软件GSI General进行分析,测得肝包虫与皮下脂肪的最佳对比噪声比(Contrast to Noise Ratio,CNR)在65 ke V左右。将病灶平均分为10个层面,每份重复测量三次,取各份算数平均值,每份相隔层数=(最大层数-最小层数)/10,层间距为1.25mm,放置圆形感兴趣区(ROI)尽可能大的包括囊液,尽量避开囊壁和子囊,对实变型和钙化型选择整体测量并避开囊壁,尽量避开囊壁、钙化灶和小子囊,测量65ke V下包虫囊液的CT值、有效原子序数,钙(水)浓度,水(钙)浓度,磷(水)浓度,水(磷)浓度的平均值;由于囊壁较薄ROI面积较小误差较大,最大值对同一包虫变化不大,遂选取最大值为其平均值,放置ROI面积为25mm2测量65ke V下囊壁的上述7项指标,并计算能谱曲线的斜率,曲线斜率=CT(40ke V)-CT(100ke V)/60ke V;结果:包虫囊液的各项指标在GSI扫描的各型之间差异明显(P均0.05),除包虫囊壁水(钙)浓度在各型之间无差异(P0.05)外,囊壁的各项指标在各型之间差异明显(P0.05);GSI平扫在65ke V下包虫CT值小于15.54±4.30,钙(水)平均浓度小于1.57±0.90mg/cm3,磷(水)平均浓度小于3.04±1.16mg/cm3,能谱曲线斜率小于0.12±0.17时包虫活性较高,反之则活性较低;GSI平扫在65ke V下包虫CT值大于37.83±4.36,钙(水)平均浓度大于5.33±1.78mg/cm3,磷(水)平均浓度大于10.34±2.02mg/cm3,能谱曲线斜率大于0.42±0.37时包虫无活性。各项指标的ROC曲线对实变型诊断效能最高,对单纯囊肿型诊断效能最低。囊液和囊壁的钙(水)浓度与磷(水)浓度存在显著相关性,Pearson相关系数均为0.999。结论:能谱CT的多参数分析和图像,较传统CT有独特优势,值得在临床进一步推广应用,尤其是包虫活性及分型的判断,对口服药物或手术治疗的选择,有重要的指导意义。
[Abstract]:Objective: to evaluate the value of energy dispersive CT in the diagnosis of hepatic hydatid cyst.Methods: a total of 71 hydatidae (21 male and 15 female) were collected from 36 patients with abdominal energy dispersive CT scan in our hospital. The age of 18 to 83 years old (mean 48.67 卤18.43) years old was 48.67 卤18.43 years old. According to the clinical data, the patients with hepatic cystic hydatid disease were treated with BMI22.34 卤3.32)kg/m2.36.In order to ensure the reliability of the diagnosis, there were 54 hydatidae (13 single cyst type, 11 multiple daughter cyst type, 3 collapse type of internal capsule and 14 solid type) in 26 cases, which were diagnosed by ultrasound and / or CT and MRI and positive Casoni's test.All of the 13 calcified ones were confirmed by operation. 20 cases were treated with complete excision of outer and outer capsule and 6 cases with excision of the outer capsule. The pathology of all cases was consistent with that of echinococcus granulosus.GE Discovery 750HD 64 row gemstone CT machine was used to perform plain scan, arterial phase, portal vein phase and delayed phase scanning with GSI mode. After scanning, QC images of mixed energy 120ke V were generated first, and then the standard algorithm of image recombination was used.The single energy images of 40-140ke V were reconstructed, and the thickness and spacing of the layers were 1.25 mm.The best contrast noise ratio of hepatic hydatid and subcutaneous fat was measured by GSI General software. The ratio of Contrast to Noise Ratio C was about 65 Kev.The lesions were divided into 10 layers on average, measured three times each time, and the mean values of each number of arithmetic were taken, and each interval was as large as possible, including sac fluid (maximum layer number, minimum layer number, interval of 1.25 mm, circular ROI).Avoid the cyst wall and ovary as far as possible, measure and avoid the cyst wall as a whole for solid and calcified type selection, avoid the cyst wall, calcified foci and small cyst as far as possible, measure the CT value of hydatid fluid under 65ke V, effective atomic number, and calcium (water) concentration.The average value of water (calcium) concentration, phosphorus (water) concentration, water (phosphorus) concentration, and the maximum value for the same hydatid was chosen as the average value because of the smaller error of the thinner ROI area of the cyst wall.The ROI area was placed to measure the above 7 indexes of the inferior wall of 65ke V by 25mm2, and the slope of the energy spectrum curve was calculated.Results: the indexes of hydatid cyst fluid were significantly different among the types of GSI scanning (P < 0.05), except the water (Ca) concentration of hydatid cyst wall was not different among the different types (P 0.05).There were significant differences in the indexes of the cyst wall between different types. The CT value of hydatid was less than 15.54 卤4.30 under 65ke V, the average concentration of calcium (water) was less than 1.57 卤0.90 mg / cm ~ 3, the average concentration of phosphorus (water) was less than 3.04 卤1.16 mg / cm ~ (3), the slope of energy spectrum curve was less than 0.12 卤0.17, and the activity of hydatid was higher when the average concentration of phosphorus (water) was less than 3.04 卤1.16 mg / cm ~ (3).On the contrary, under 65ke V, the CT value of hydatid worms was more than 37.83 卤4.36, the average concentration of calcium (water) was more than 5.33 卤1.78 mg / cm ~ 3, the average concentration of phosphorus (water) was more than 10.34 卤2.02mg / cm ~ (-3), and the slope of energy spectrum curve was larger than 0.42 卤0.37.The ROC curve of each index was the most effective for solid variant diagnosis and the lowest for simple cyst type.There was significant correlation between calcium (water) concentration and phosphorus (water) concentration in cyst fluid and wall. Pearson correlation coefficient was 0.999.Conclusion: the multiparameter analysis and image of EDS CT have unique advantages compared with traditional CT. It is worth popularizing and applying in clinic, especially the judgement of hydatid activity and classification, which has important guiding significance for the choice of oral medicine or surgical treatment.
【学位授予单位】：石河子大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R532.32

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