宝石能谱CT成像对结直肠癌病理分型及与溃疡性结肠炎鉴别的应用价值

发布时间：2018-03-05 23:37

本文选题：结直肠癌　切入点：管状腺癌　出处：《承德医学院》2017年硕士论文　论文类型：学位论文

【摘要】：目的:通过能谱参数的观察和分析初步探讨能谱CT对结直肠癌病理分型及与溃疡性结肠炎鉴别的应用价值。方法:回顾性选取经结肠镜或术后病理确诊的结直肠病变63例(结直肠癌54例,溃疡性结肠炎9例),分为结直肠管状腺癌组共42例:包括中分化25例、低分化17例;粘液腺癌组12例;溃疡性结肠炎组9例。检查之前签订患者知情同意书,应用GE宝石能谱CT(Discovery CT 750 HD)在能谱扫描模式(GSI)下进行扫描。所有患者均进行动脉期、门脉期及静脉期三期全腹GSI能谱扫描模式扫描,所有患者扫描前均从未进行过相应治疗。扫描范围从膈肌顶至耻骨联合面下缘水平,运用GE ADW4.6工作站的能谱分析软件进行能谱图像分析,得到各组动脉期、门脉期和静脉期能谱曲线以及各期碘基图、水基图、直方图、散点图,观察结直肠管状腺癌组、黏液腺癌组以及结直肠癌组与溃疡性肠炎组和结直肠管状腺癌组中的中分化腺癌与低分化腺癌在各期能谱衰减曲线形态差异,并比较不同组间病灶的碘浓度、水浓度、标准化碘浓度(normalized iodine concentration,NIC)=病灶的碘浓度/腹主动脉的碘浓度、有效原子序数(effective atomic number,Eff-Z)及病灶在各期能谱曲线斜率K值=(HU40kev-HU90kev)/(40-90)的差异,并进行独立样本t检验。最后得出结直肠管状腺癌(colorectal tubular cancer)中、低不同分化程度的各参数ROC曲线下面积AUC、敏感度、特异度、最佳诊断阈值及Youden指数,并评价各项参数的诊断效能。所有能谱数据测量均以病灶最大截面为中心上下测量三次,取其均值。结果:(1)采用两个独立样本t检验方法进行比较,结直肠管状腺癌组与黏液腺癌组在动脉期碘浓度、NIC、有效原子序数及静脉期NIC差异具有统计学意义(P0.05),黏液腺癌组动脉期碘浓度、NIC、有效原子序数稍高于管状腺癌组;黏液腺癌组门脉期及静脉期碘浓度高于动脉期,门脉期及静脉期碘浓度二者之间相近,不具有统计学意义。水浓度在三者间各期均无统计学意义。而结直肠癌组与溃疡性结肠炎组比较显示溃疡性结肠炎组动脉期碘浓度虽高于结直肠癌组,但无统计学意义(P=0.336),其它各期溃疡性结肠炎组碘浓度、NIC、有效原子序数均高于结直肠癌组,具有统计学意义(P0.05)。(2)40~90ke V中不同病理类型各期能谱曲线均呈逐渐递减型(随Ke V值降低病灶的CT值逐渐增大),能谱曲线斜率均为负值,结直肠管状腺癌组动脉期曲线斜率为-1.54±0.84,黏液腺癌曲线斜率为-1.99±0.35,二者具有统计学意义(P=0.01),黏液腺癌曲线斜率的绝对值大于管状腺癌,能谱曲线图上粘液腺癌位于管状腺癌上方,门脉期及静脉期二者无统计学意义。结直肠癌组与溃疡性结肠炎组各期曲线斜率均具有统计学意义,能谱曲线图上溃疡性结肠炎位于结直肠癌上方。(3)采用两个独立样本t检验方法,进行中分化腺癌与低分化腺癌二小组间能谱参数比较,发现中分化腺癌动脉期碘浓度、NIC、有效原子序数及能谱曲线斜率(计算方法同前)均高于低分化腺癌,且二者之间差异均具有统计学意义,P值均0.05;而其它两期所见能谱各参数大小相近,差异不具有统计学意义,水浓度三期均不具有统计学意义。动脉期碘浓度、NIC、有效原子序数、能谱曲线斜率的AUC分别为0.723、0.772、0.750和0.769,当其诊断阈值分别设为5.85(100ug/m1)、0.08、7.95、-1.04时,其判定结直肠管状腺癌中、低分化程度的敏感度、特异度分别为(92.3%、52.6%)、(88.5%、73.7%)、(92.3%、68.4%)、(73.7%、88.5%)。结论:(1)能谱CT碘浓度、NIC、能谱曲线斜率及有效原子序数对鉴别结直肠管状腺癌、粘液腺癌以及结直肠癌与溃疡性结肠炎有价值,能在一定程度上反应其病理特点。(2)水浓度对鉴别结直肠管状腺癌、粘液腺癌以及结直肠癌与溃疡性结肠炎意义不大。(3)动脉期的能谱参数(碘浓度、NIC、有效原子序数及能谱曲线斜率)可以鉴别管状腺癌的分化程度,特别是NIC具有更加可靠的诊断效能。
[Abstract]:Objective: through the observation and analysis of spectral parameters of the preliminary study of spectral CT on colorectal cancer pathological typing and identification of ulcerative colitis application. Methods: a retrospective selection through colonoscopy or postoperative pathological diagnosis of colorectal lesions in 63 cases (54 cases of colorectal cancer, 9 cases of ulcerative colitis). Divided into colorectal adenocarcinoma group: a total of 42 cases including 25 cases in moderate differentiation, 17 cases of poorly differentiated mucinous adenocarcinoma; 12 cases; 9 cases of ulcerative colitis group. Patients signed informed consent before the examination, the application of GE (Discovery gemstone CT CT 750 HD) in the spectrum scanning mode (GSI) under scanning. All patients underwent arterial phase, portal venous phase and venous phase three whole abdominal GSI spectrum scanning scanning mode, all patients were never before scanning the corresponding treatment. The scanning range from the diaphragm to the pubic symphysis of the lower edge of the top level, the use of GE ADW4.6 work station spectrum analysis software Energy spectrum image analysis, get the each arterial phase, portal venous phase and venous phase spectrum curve and the iodine kitu, water-based map, histogram, scatter plot, observation group of colorectal tubular adenocarcinoma, mucinous adenocarcinoma, colorectal cancer group and ulcerative enteritis group and colorectal tubular adenocarcinoma group in differentiated adenocarcinoma and low differentiated adenocarcinoma in the spectrum attenuation curve of morphological differences, and compare the different iodine concentration, water concentration between groups of lesions, the normalized iodine concentration (normalized iodine, concentration, NIC) concentration of iodine iodine concentration / = abdominal aortic lesions, effective atomic number (effective atomic, number, Eff-Z) and the focus in the period of energy spectrum curve slope K = (HU40kev-HU90kev) / (40-90) differences, and independent samples t test. Finally the colorectal tubular adenocarcinoma (colorectal tubular cancer) in the area, the parameters of ROC curve of low differentiated AUC, The sensitivity, specificity and Youden index, the best diagnostic threshold, and to evaluate the diagnostic efficacy of various parameters. All spectrum data measurements were using maximum section lesions centering on the three measurements, the mean value. Results: (1) using two independent sample t test method, colorectal adenocarcinoma group with mucinous adenocarcinoma in iodine concentration, arterial NIC, significant effective atomic number and venous phase difference of NIC (P0.05), mucinous adenocarcinoma group, arterial iodine concentration, NIC, effective atomic number is slightly higher than that of tubular adenocarcinoma; mucinous adenocarcinoma and iodine concentration in portal venous phase and venous phase than in arterial phase similar, between the portal venous phase and venous phase iodine concentration two, not statistically significant. The concentration of water in between the three periods were not statistically significant. While the colorectal cancer group and ulcerative colitis group comparison showed that iodine concentration in ulcerative colitis group was higher than that in colorectal arterial phase Colorectal cancer group, but no statistical significance (P=0.336) and other ulcerative colitis group iodine concentration, NIC, effective atomic number was higher than that in colorectal cancer group, with statistical significance (P0.05). (2) 40~90ke V in different pathological types of the spectrum curve showed a gradually decreasing (to reduce the CT values of lesions with increasing Ke value of V), energy spectrum curve slope were negative, colorectal adenocarcinoma group, the arterial phase slope of the curve is -1.54 + 0.84, mucinous adenocarcinoma curve slope is -1.99 + 0.35, the two groups was statistically significant (P=0.01), the absolute value of the slope of the curve is greater than that of mucinous adenocarcinoma of tubular adenocarcinoma, energy spectrum the graph of mucinous adenocarcinoma of tubular adenocarcinoma located above the portal venous phase and two was not statistically significant. Colorectal cancer group and ulcerative colitis group in each stage of the slope of the curve was statistically significant, energy spectrum curve on ulcerative colitis in colorectal cancer (3) collected above. Two independent samples t test, comparison of spectral parameters of moderately differentiated adenocarcinoma and poorly differentiated adenocarcinoma were found between the two groups, the iodine concentration in differentiated adenocarcinoma, arterial phase NIC, effective atomic number and energy spectrum curve slope (calculation method with) were higher than that of low differentiated adenocarcinoma, and the difference between the two were statistically significant, P value was 0.05; while the other two see spectral parameters of similar size, the difference was not statistically significant, the water concentration of three was not statistically significant. The iodine concentration, arterial NIC, effective atomic number, energy spectrum curve of AUC 0.723,0.772,0.750 and 0.769 respectively, when the diagnosis the threshold was set to 5.85 (100ug/m1), 0.08,7.95, -1.04, the determination of colorectal tubular adenocarcinoma, low differentiation degree of sensitivity and specificity were respectively (92.3%, 52.6%), (88.5%, 73.7%), (92.3%, 68.4%), (73.7%, 88.5%). Conclusion: (1) energy spectrum CT iodine concentration, NIC, Energy spectrum curve slope and the effective atomic number in the differential diagnosis of colorectal tubular adenocarcinoma, mucinous adenocarcinoma, colorectal cancer and ulcerative colitis can have value, the pathological features of reaction to a certain extent. (2) the water concentration in differential diagnosis of colorectal tubular adenocarcinoma, mucinous adenocarcinoma, colorectal cancer and ulcerative colitis significance (a little. 3) spectral parameters of arterial phase (iodine concentration, NIC, effective atomic number and energy spectrum curve slope) can identify the degree of differentiation of tubular adenocarcinoma, especially NIC has diagnostic performance more reliable.

【学位授予单位】：承德医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.34;R730.44

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