融合成像技术诊断肝脏局灶性病变的价值

发布时间：2018-03-16 10:15

  本文选题：超声检查　切入点：融合成像　出处：《山东大学》2014年硕士论文　论文类型：学位论文

【摘要】：研究背景与目的 肝脏是人体内最大的、最重要的消化腺,它承担维持人体生命活动的重要功能,参与机体的消化、代谢、分泌、解毒、排泄、吞噬与防御等过程。近年来,随着科学技术水平的不断提高,超声医学的成像技术和检查方法的迅速发展,超声以其无创、实时、高效、廉价等优点在临床诊断、治疗中被广泛应用,肝脏局灶性病变的检出率、定位和定性诊断的准确性得以大大提高。肝脏局灶性病变主要包括肝囊肿、肝血管瘤、肝脓肿、肝脏局灶性结节性增生、肝脏孤立坏死结节等良性病变及肝脏原发性、继发性恶性肿瘤。由于良恶性病变的生物学特点明显不同,对人体的影响有显著差别,因此区别良恶性病变对临床治疗方案的选择、预后的判断具有重大意义。 受超声波物理学特性、超声诊断仪性能、检查者操作手法等因素影响,常规超声对等回声病灶、肝硬化背景、多次介入术后、位于膈下、被胃肠道气体遮挡的病灶等显示存在一定的困难。而CT不易受上述因素影响,成像质量较高,但实时性差,检查费用较高,具有放射性损伤。融合成像技术成功地结合两种成像技术的优势,即超声的实时性和CT的空间分辨力,采用磁定位技术将超声与CT图像在空间上配对融合,实现二者在任意切面实时同屏显示,不但扩大了显像范围,而且还能够对病灶进行定性诊断,具有广阔的临床应用前景。 本研究应用融合成像技术对肝脏局灶性病变进行定位、定性诊断,以明确该技术的可行性及准确性,探讨其临床应用价值。 资料与方法 1.临床资料收集2013年7月至2014年1月在山东大学齐鲁医院检查发现肝脏局灶性病变的患者共42例,其中男24例,女18例,年龄31岁至73岁,平均(55.88±9.94)岁。其中7例有结肠癌病史,3例有肾癌病史,1例有肺癌病史, 1例有胃癌病史,1例有宫颈癌病史。 2.仪器与方法 2.1实验仪器超声仪器为美国GE公司生产的LOGIQ E9彩色多普勒超声诊断仪,配备有C5-1宽频凸阵探头,频率为3～5MHz。融合成像系统由内置于超声诊断仪的融合成像软件及场频信号发生器、示踪仪器、工具连接单元等构成。CT使用SIEMENS16层和Philip MAX80004层螺旋CT,造影剂为优维显或碘海醇。 2.2研究方法选择肝内管道结构及病灶均显示清晰的增强CT图像,将DICOM格式的CT图像导入彩色多普勒超声诊断仪内,采用内部点配准法中的点-面配准法进行图像融合。图像融合成功后,记录融合成像所需时间、病灶的数目及声像图特征,并做出定性诊断。将诊断结果与综合临床表现、其他影像学检查、实验室检查、术后病理、穿刺活检及随访得出的结论对比,比较融合成像技术与CT检查技术对病灶定性诊断的准确性。 3.统计学处理采用SPSS19.0软件包进行统计学分析,计量资料采用(x±s)表示。组间对比采用两独立样本的非参数检验,P0.05为差异具有统计学意义。 结果 1.42例患者融合成像成功率为100%,融合成像所需时间为4～9min,平均(5.90±1.20)min。 2.42例患者共64个肝脏局灶性病变,其中26例患者有1个病灶,13例患者有2个病灶,4例患者有3个病灶。病灶直径为0.29～10.05cm,平均(1.92±1.97)cm。常规超声共显示51个病灶,病灶检出率为79.69%(51/64),增强CT共显示63个病灶,病灶检出率为98.43%(63/64),融合成像技术成功显示62个病灶,病灶检出率为96.87%(62/64),其中61个病灶与CT图像显示位置一致,1个病灶在CT图像中未显示。常规超声与融合成像技术病灶检出率的差异具有统计学意义(P0.05),增强CT与融合成像技术病灶检出率的差异不具有统计学意义(P0.05)。 3.64个肝脏局灶性病变,CT明确诊断38个病灶,明确诊断率为58.46%(38/64),包括17个肝血管瘤病灶(包括融合成像技术未能显示的2个病灶),1个肝脏假脂瘤病灶,8个肝细胞肝癌病灶,12个转移性肝癌病灶。其余26个病灶未能做出明确诊断。融合成像技术明确诊断病灶59个病灶,‘明确诊断率为92.18%(59/64),其中36个病灶与CT诊断结果一致,另外还包括9个肝血管瘤病灶,1个肝脏孤立坏死结节病灶,5个肝细胞肝癌病灶,8个转移性肝癌病灶。增强CT与融合成像技术的明确诊断率的差异具有统计学意义(P0.05)。4.与最终临床诊断结果对比,CT检查技术诊断准确率为59.38%(38/64),包括17个肝血管瘤病灶,1个肝脏假脂瘤病灶,8个肝细胞肝癌病灶,11个转移性肝癌病灶。融合成像技术诊断准确率为89.06%(57/64),包括26个肝血管瘤病灶,1个肝脏孤立坏死结节病灶,1个肝脏假脂瘤病灶,11个肝细胞肝癌病灶,22个转移性肝癌病灶。增强CT与融合成像技术的诊断准确率的差异具有统计学意义(P0.05)。 结论 融合成像技术操作简便,安全无创,对于肝脏局灶性病变的检出、定位、定性诊断开辟了一条新的途径,展现出广阔的临床应用前景。
[Abstract]:Research background and purpose
The liver is the body's largest, the most important digestive gland, its important function to undertake the maintenance of human life activities, involved in digestion, metabolism, excretion, secretion, detoxification, phagocytosis and defense process. In recent years, with the improvement of science and technology, the rapid development of imaging technology and inspection method of ultrasonic medicine the ultrasound with its non-invasive, real-time, efficient, cheap and other advantages is widely used in clinical diagnosis, treatment, detection rate of focal liver lesions, and the positioning accuracy can be greatly improved. The qualitative diagnosis of focal liver lesions mainly include liver cyst, liver hemangioma, liver abscess, hepatic focal nodular hyperplasia, solitary necrotic nodule of liver benign lesions such as liver and primary and secondary malignant tumor. The biological characteristics of benign and malignant lesions were significantly different. There was a significant difference between the effects on the human body, so the difference between benign and malignant lesions It is of great significance to the choice of the clinical treatment plan and the judgement of the prognosis.
By ultrasonic physics characteristics, ultrasonic diagnostic instrument performance, effect examination practices and other factors, the conventional ultrasonic echo equivalence lesion, cirrhosis, multiple times after PCI, located under the diaphragm, the gastrointestinal tract gas occlusion lesions showed that there are some difficulties. But CT is not affected by the above factors, high imaging quality, but the real-time inspection cost is higher, with radiation injury. Imaging techniques successfully combined the two imaging technology, namely real-time ultrasound and CT spatial resolution, using the magnetic positioning technology with ultrasonic CT image matching in space fusion, the two section in real time with the screen display. Not only to expand the range of imaging, but also can make a qualitative diagnosis of the lesions, has broad clinical application prospect.
In this study, we applied the fusion imaging technology to locate the liver focal lesions and make qualitative diagnosis, so as to clarify the feasibility and accuracy of the technology, and to explore its clinical application value.
Information and methods
Focal liver lesions were found in 42 cases of 1. clinical data collected from July 2013 to January 2014 in Qilu Hospital of Shandong University, including 24 male cases, 18 female patients, aged 31 to 73 years old, the average (55.88 + 9.94) years old. There were 7 cases with colon cancer, 3 cases of renal cell carcinoma and 1 cases of history. History of lung cancer,
1 cases had a history of gastric cancer and 1 had a history of cervical cancer.
2. instruments and methods
2.1 experimental instrument ultrasonic instrument was produced by American GE company LOGIQ E9 color Doppler ultrasonic diagnostic apparatus, equipped with a C5-1 broadband convex array probe, frequency of 3 ~ 5MHz. fusion imaging system by fusion imaging software and built-in audio signal generator, the ultrasonic diagnostic instrument tracing instrument, tool connecting unit composed of.CT and Philip use the SIEMENS16 layer. MAX80004 slice CT, contrast agent Ultravist or iohexol.
2.2 research methods of pipeline structure and lesions showed enhanced clear CT images, DICOM format image into CT color Doppler ultrasonic diagnostic apparatus, using the internal point registration method of point surface registration method for image fusion. Image fusion is successful, as the time required for integration into the record, number and specific map features of lesions, and make qualitative diagnosis. The diagnostic results and clinical manifestations, laboratory examination, other imaging examination, postoperative pathology, biopsy and follow-up comparison conclusion, comparing the fusion imaging and CT technology on the accuracy of qualitative diagnosis of the lesions.
3. statistical processing was carried out by SPSS19.0 software package, and the data were expressed by (x + s). Compared with two independent samples, P0.05 was statistically significant.
Result
The successful rate of fusion imaging in 1.42 patients was 100%, and the time required for fusion imaging was 4 ~ 9min, with an average of (5.90 + 1.20) min.
2.42 patients with 64 focal liver lesions, including 26 patients with 1 lesions, 13 patients with 2 lesions, 4 patients with 3 lesions. The lesion diameter was 0.29 ~ 10.05cm, the average (1.92 + 1.97) cm. ultrasound showed a total of 51 lesions, the lesion detection rate was 79.69% (51/64), enhanced CT a total of 63 lesions, the lesion detection rate was 98.43% (63/64), fusion imaging technology showed 62 lesions, the lesion detection rate was 96.87% (62/64), of which 61 lesions and CT images showed the same location, 1 lesions did not appear in the CT image. The difference was statistically significant conventional ultrasound imaging and fusion lesion detection rate (P0.05), enhance the difference between CT and fusion imaging lesions detection rate was not statistically significant (P0.05).
3.64 focal liver lesions, CT diagnosed 38 lesions, the diagnosis rate was 58.46% (38/64), including 17 hepatic hemangiomas (including fusion imaging failed to display of 2 lesions), 1 liver pseudolipoma lesions, 8 lesions of hepatocellular carcinoma, 12 metastatic liver lesions. The remaining 26 lesions failed to make a clear diagnosis. Fusion imaging technique in diagnosis of lesions in 59 lesions, "the diagnosis rate was 92.18% (59/64), of which 36 lesions and CT diagnosis results, also including 9 hepatic hemangiomas, 1 hepatic isolated section 5 bad knot lesions of hepatocellular carcinoma the lesion, 8 metastatic liver lesions. The differences of CT and enhance the fusion imaging diagnosis rate was statistically significant (P0.05) compared to.4. with the final clinical diagnosis results, the diagnostic accuracy of CT examination was 59.38% (38/64), including 17 hepatic hemangiomas, 1 hepatic false 鑴傜槫鐥呯伓,8涓�鑲濈粏鑳炶倽鐧岀梾鐏�,11涓�杞�绉绘，

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