双能量能谱CT在Vater壶腹周围癌诊断及手术可切除性评估中的价值研究

发布时间：2018-04-15 00:36

本文选题：腹部 + 计算机体层摄影　；参考：《安徽医科大学》2014年博士论文

【摘要】：双能量能谱CT(dual-energy spectral computed tomography,DESCT)是一项崭新的影像技术,它具有以下技术特征:去除硬化伪影;优化图像及图像的对比噪声比;进行物质定量分析;进行能谱综合分析。本研究应用DESCT能谱分析软件(gemstone spectral imaging,GSI)对壶腹周围癌的图象进行分析,并与手术病理结果进行对照,探讨能谱CT在壶腹周围癌的的术前诊断及手术可切除性评估中的价值。研究分为三个部分:第一部分:对腹部双能量能谱CT成像中混合能量模式与单能量模式重建图像的进行比较研究,探讨单能量重建模式对图像质量的影响;第二部分,通过双能量能谱CT的物质定量分析技术对病变进行分析,探讨CT能谱成像在鉴别壶腹周围癌的组织起源中的价值;第三部分,应用双能量能谱CT对壶腹周围癌手术可切除性进行评价,并与手术病理进行对照。第一部分目的通过比较单源双能量CT腹部能谱成像后,混合能量重建图像与单能量重建图像质量,筛选适合临床应用的重建模式。方法应用能谱CT(Discovery CT750HD,GE Healthcare,USA)对40例患者行CT平扫及双期增强扫描。分别采用混合能量模式及单能量模式重建。测量并比较肝脏、胰腺、脾脏及腹腔脂肪的CT值,分别计算各组织脏器的信噪比、对比噪声比及背景噪声。并对两组图像进行评分。结果单能量重建图像中组织及器官的SNR、CNR均高于混合能量重建图像,且单能量重建图像质量评分高于混合能量重建图像。结论单能量重建图像质量优于混合能量重建图像,可以作为临床常规重建方式使用。第二部分目的通过分析壶腹周围癌双能量能谱CT参数特征,探讨CT能谱成像在判断不同组织来源壶腹部肿瘤中的应用价值。方法将行能谱CT检查并经手术或活检病理证实的壶腹周围88例分为三组:胰头腺癌39例,胆总管末端腺癌22例,十二指肠乳头腺癌27例。分别测量及比较各组间能谱参数间的差异。结果三期增强扫描中,三组之间水浓度均无统计学差异;碘浓度、标准化碘浓度及斜率均为胆总管末端腺癌组最大,胰头腺癌组最小,且两两比较均有统计学差异。在十二指肠乳头腺癌与胆总管末端腺癌组间,当门脉期及延迟期NIC(normalized iodine concentration)分别大于0.44及0.72时,鉴别诊断的敏感性为89%、85%,特异性达73%、78%;在胆总管末端腺癌与胰腺癌组间,各测量值的诊断效能均较好,其中当门脉期碘浓度25.50mg/m L作为阈值时,敏感度达100%,当延迟期碘浓度16.46mg/m L作为阈值时,特异度达100%;胰腺癌与十二指肠乳头腺癌组间,各期碘浓度值效能较好:当门脉期碘浓度10.20mg/m L及延迟期碘值13.49mg/m L作为阈值时,鉴别诊断的敏感度达100%。结论CT能谱成像多参数联合诊断有助于鉴别壶腹周围癌的起源。第三部分目的:探讨双能量能谱CT在评估壶腹周围癌手术可切除性中的价值。方法:98例壶腹周围癌患者(后来经临床综合诊断或病理证实)行DESCT三期增强扫描。原始数据采用单能重建模式,采用最佳对比噪声比对图像进行优化,并应用物质定量分析技术及能谱综合分析技术分析图像。判断肿瘤对血管、淋巴等的浸润与否,对其进行可切除性评估,并与手术结果进行对照分析,计算DESCT预测壶腹周围癌手术可切除的敏感性、特异性、阳性预测值及阴性预测值和准确率。结果:DESCT判断壶腹周围癌血管侵犯的灵敏度达93.8%,特异度达98.3%,准确率达96.7%;DESCT预测壶腹周围癌可切除性灵敏度达96%,特异度达95.7%,准确率达96%,阳性预测值为98.6%,阴性预测值为88%。结论:DESCT对壶腹周围癌术前可切除性评估的敏感性、特异性和准确性均较高,为壶腹周围癌术前分期的理想的影像技术手段。
[Abstract]:Dual energy spectral CT (dual-energy spectral computed tomography, DESCT) is a new imaging technology, it has the following technical characteristics: the removal of hardening artifacts; optimizing contrast noise ratio of image and image; quantitative analysis; energy spectrum analysis. This research used DESCT spectrum analysis software (gemstone spectral imaging, GSI) on the image of periampullary carcinoma were analyzed and compared with surgical pathology results, to explore the spectrum of CT in the preoperative periampullary cancer diagnosis and surgical resectability evaluation value. Research is divided into three parts: the first part: the spectral CT imaging in mixed mode and energy single mode energy reconstruction image comparison research to explore the influence of abdominal double energy, single energy reconstruction on the image quality; the second part quantitative material by dual energy spectrum analysis of CT lesions were analyzed, Study of spectral CT imaging in differentiating tissue origin of periampullary carcinoma in value; third part, application of dual energy spectral CT of periampullary carcinoma surgical resectability was evaluated, and compared with surgical pathology. The first part through comparison of single source dual energy CT abdominal spectral imaging after reconstruction of mixed energy reconstruction the single energy image and image quality, selection of reconstruction mode suitable for clinical application. Methods using spectral CT (Discovery CT750HD, GE Healthcare, USA) of 40 patients who underwent CT plain and dual phase enhanced scanning. By using mixed mode and single mode of energy energy reconstruction. To measure and compare the liver, pancreas, spleen and abdominal cavity fat CT values were calculated for each organ of SNR, contrast noise ratio and background noise. And scores on two groups of image. In the image reconstruction of the tissues and organs of single energy SNR, CNR are higher than the mixed energy The reconstructed image and the reconstructed image quality score was higher than that of single energy mixed energy images are reconstructed. The reconstructed image quality is better than the single energy conclusion mixed energy reconstruction images can be used as a routine clinical reconstruction. In the second part, through the spectral CT parameters of periampullary carcinoma double energy analysis, investigate the CT spectral imaging diagnostic value on different tissue sources ampullary tumors. Methods for spectrum around CT examination and confirmed by surgery or biopsy of 88 cases were divided into three groups: 39 cases of pancreatic adenocarcinoma, 22 cases of distal common bile duct carcinoma, 27 cases of duodenal adenocarcinoma. The nipples were measured and compared between different spectral parameters results. Three phase enhanced scan, between the three groups were no significant difference between the concentration of water; iodine concentration, normalized iodine concentration and slope were the highest at the end of common bile duct adenocarcinoma, pancreatic adenocarcinoma and 22 comparison group minimum. There were significant differences. In papillary adenocarcinoma of the duodenum and distal common bile duct adenocarcinoma group, and venous phase and delayed phase NIC (normalized iodine concentration) were greater than 0.44 and 0.72, the diagnostic sensitivity was 89%, specificity was 85%, 73%, 78%; end of adenocarcinoma and pancreatic cancer group in the end of common bile duct between the diagnostic efficacy of the measured values are good, which when the pulse period 25.50mg/m L iodine concentration as a threshold, the sensitivity was 100%, when the delay time of 16.46mg/m L as the iodine concentration threshold, the specificity reached 100%; pancreatic carcinoma and papillary adenocarcinoma of the duodenum between groups, the concentration of iodine value better performance when the door pulse 10.20mg/m L and the concentrations of iodine during delayed phase iodine 13.49mg/m L as threshold, differential diagnosis sensitivity was 100%. conclusion CT spectral imaging diagnosis with multipleparameters origin is helpful in the differential diagnosis of periampullary carcinoma. The third part objective: To investigate the dual energy spectral CT in Evaluation of surgical resectability of periampullary carcinoma in value. Methods: 98 cases of patients with periampullary carcinoma (later by clinical diagnosis and pathology) three phase enhanced DESCT scanning. The original data can be reconstructed by single mode, the optimal contrast noise ratio of image is optimized, and the application of quantitative analysis technology and image analysis spectrum. Comprehensive analysis technology to determine the tumor vascular invasion and lymph, such as whether the assessment of resectability, and compared with surgical results, calculate the sensitivity of DESCT in predicting surgical resectable ampullary carcinoma, specificity, positive predictive value and negative predictive value and accuracy. Results: the sensitivity of DESCT judgment the vascular invasion of periampullary carcinoma was 93.8%, specificity was 98.3%, accuracy was 96.7%; DESCT prediction sensitivity of 96% resected periampullary carcinoma, a specificity of 95.7%, positive predictive accuracy rate of 96%. The value is 98.6%, and the negative predictive value is 88%.. Conclusion: DESCT is highly sensitive, specific and accurate in evaluating the preoperative resectability of periampullary carcinoma. It is an ideal imaging technique for preoperative staging of periampullary carcinoma.

【学位授予单位】：安徽医科大学
【学位级别】：博士
【学位授予年份】：2014
【分类号】：R735.0;R730.44

【参考文献】