能谱CT在卵巢肿瘤定位定性中的应用研究

发布时间：2018-05-19 11:47

本文选题：体层摄影术 + X线计算机　；参考：《郑州大学》2017年硕士论文

【摘要】：第一部分能谱CT单能量成像联合迭代重建技术优化卵巢动脉显示的临床价值目的:探讨能谱CT单能量成像联合自适应统计迭代重建(ASIR)技术在优化卵巢动脉图像质量中的临床价值。材料与方法:本研究经我院伦理委员会许可;所有患者在检查前均提供知情同意书。前瞻性的收集2015年8月至2016年12月临床怀疑盆腔占位并在郑州大学第一附属医院行全腹部双期增强扫描的女性患者,最终将显示卵巢动脉的64例(对照组和试验组各32例)女性患者纳入本研究,年龄20~82岁,平均年龄51.30岁。对照组采用120 k Vp管电压常规扫描,联合40%ASIR重建图像;试验组采用能谱(GSI)扫描,原始数据选取40~70 ke V单能量水平图像(以5 ke V为间隔),共7个单能量水平,分别联合30~60%ASIR(以10%为间隔)进行重建,共获得35亚组图像。测量图像动脉期卵巢动脉及同层同侧的腰大肌内的CT值及同层同侧背部皮下脂肪内CT值的标准差(SD),计算卵巢动脉的对比噪声比(CNR)和信噪比(SNR),采用单因素方差分析比较试验组各亚组图像客观评价指标(CT、SNR、CNR),组内两两比较采用LSD法;采用独立样本t检验比较两组图像客观评价指标及年龄、有效辐射剂量。由两名放射科医师采用5分评分制法对两组图像动脉期的图像质量进行主观评价,采用Mann-Whitney U检验比较,一致性采用Kappa检验。结果:对照组和试验组的年龄(岁)(对照组53.78±14.15,试验组48.81±17.29,)及ED(m Sv)(对照组9.80±1.51,试验组10.84±3.55)差异均无统计学意义(P均0.05);随着单能量水平的逐渐升高,卵巢动脉的CT值逐渐降低;卵巢动脉的CNR值及SNR值在40ke V单能量水平联合60%ASIR(26.12±7.92、30.45±8.13)时均最高,与对照组(13.29±5.44、18.67±5.61)比较差异均有统计学意义(P0.05);试验组主观评分在40ke V单能量水平联合50%ASIR时最高(4.18±0.63),与40ke V单能量水平联合60%ASIR(4.12±0.64)比较差异无统计学意义(P0.05)。结论:能谱CT单能量成像联合迭代重建技术既不增加辐射剂量,且在40ke V单能量水平联合60%ASIR可明显提高卵巢动脉的图像质量,对临床诊断和治疗提供帮助。第二部分能谱CT成像在鉴别卵巢肿瘤良恶性中的价值目的:探讨能谱CT成像定量分析在鉴别卵巢肿瘤良恶性中的应用价值。材料与方法:本研究经我院伦理委员会许可;所有患者在检查前均提供知情同意书。前瞻性的收集2015年8月至2016年12月临床怀疑盆腔占位并在郑州大学第一附属医院行盆腔或腹盆腔增强扫描的女性患者,最终将病理结果证实为卵巢肿瘤的98例患者纳入本研究,年龄12~84岁,平均45.01岁。根据囊实性成分的不同将其分为两组,第一组为囊性成分为主的卵巢肿瘤,共64例,其中良性卵巢肿瘤和恶性卵巢肿瘤各32例;第二组为实性成分为主的卵巢肿瘤,共34例,其中良性卵巢肿瘤11例,恶性卵巢肿瘤23例。所有患者在Discover GSI CT机行常规平扫和能谱双期增强扫描。图像重建选用原始数据联合40%自适应统计迭代重建(ASIR)。在后处理站上,分别测量两组图像动静脉两期卵巢病灶囊性成分或实性成分的CT值、碘水浓度(IC)、水碘浓度(WC)、钙水浓度(CC)、病灶同侧同层髂动脉的碘水浓度及病灶的能谱曲线,并计算病灶处的标准化碘浓度(NIC)和能谱曲线的斜率,即标准化碘浓度=病灶的碘浓度/同层髂动脉碘浓度,斜率=(HU40ke V-HU100ke V)/60。采用独立样本t检验对良恶性卵巢肿瘤参数进行统计学比较,并绘制ROC曲线评估相应参数的诊断效能。结果:恶性卵巢肿瘤的年龄(49.33±13.57)较良性卵巢肿瘤(39.49±14.18)大,且差异有统计学意义(P0.01)。以囊性成分为主的恶性卵巢肿瘤碘水浓度、钙水浓度、标准化碘浓度、能谱曲线斜率在动脉期分别为3.63±1.70(100μg/cm3)、5.21±2.47(mg/cm3)、0.05±0.02、0.43±0.20,静脉期分别为3.81±1.62(100μg/cm3)、5.44±2.25(mg/cm3)、0.04±0.01、0.45±0.19;良性卵巢肿瘤碘水浓度、钙水浓度、标准化碘浓度、能谱曲线斜率在动脉期分别为2.08±0.84(100μg/cm3)、2.92±1.25(mg/cm3)、0.03±0.02、0.25±0.10,静脉期分别为2.58±1.22(100μg/cm3)、3.66±1.80(mg/cm3)、0.03±0.01、0.31±0.14;且差异有统计学意义(P均0.01);各参数的特异度在动脉期均较静脉期高,其灵敏度在静脉期均较动脉期高。以实性成分为主的恶性卵巢肿瘤碘水浓度、标准化碘浓度、能谱曲线斜率在静脉期分别为14.50±6.44(100μg/cm3)、0.33±0.12、1.72±0.77,良性卵巢肿瘤碘水浓度、标准化碘浓度、能谱曲线斜率在静脉期分别为8.86±4.04(100μg/cm3)、0.22±0.13、1.05±0.48,其差异有统计学意义(P均=0.01);标准化碘浓度的AUC最大。结论:良恶性卵巢肿瘤的能谱CT参数有显著差异。能谱CT成像可以为卵巢肿瘤良恶性的鉴别诊断提供更多的信息,具有一定的临床应用价值。
[Abstract]:The first part can be used to optimize the clinical value of ovarian artery display by CT single energy imaging combined with iterative reconstruction technique: To explore the clinical value of CT single energy imaging combined with adaptive statistical iterative reconstruction (ASIR) technique in optimizing the quality of the ovarian artery image. An informed consent form was provided before the examination. A prospective collection of female patients who were clinically suspected of pelvic occupying from August 2015 to December 2016 at the First Affiliated Hospital of Zhengzhou University and underwent a full abdominal double phase enhanced scan will eventually show 64 cases of ovarian arteries (32 cases in the control group and the experimental group), aged 20~82 years old, flat. The control group was 51.30 years old. The control group used the 120 K Vp tube voltage routine scan and the combined 40%ASIR reconstruction image. The test group used the energy spectrum (GSI) scan, the original data selected the 40~70 Ke V single energy level image (5 Ke V interval), a total of 7 single energy levels, respectively combined 30~60%ASIR (10% interval) for reconstruction, a total of 35 subgroups of images were obtained. The standard deviation (SD) of the CT value and the CT value of the subcutaneous fat in the same layer on the same side of the same layer of the arterial phase of the arterial phase and the same side of the same layer (SD) was used to calculate the contrast noise ratio (CNR) and the signal-to-noise ratio (SNR) of the ovarian artery. The objective evaluation indexes (CT, SNR, CNR) were compared by the single factor analysis of variance (CT, SNR, CNR) in the experimental group, and 22 in the group were compared to LSD. Methods: the independent sample t test was used to compare the objective evaluation indexes of the two groups of images and the age and effective radiation dose. The image quality of the two groups of images was evaluated by two radiologists using the 5 score score system, and the consistency was compared with the Kappa test. The results were as follows: the age of the control group and the test group (years old). (53.78 + 14.15, 48.81 + 17.29 in the control group, 48.81 + 17.29 in the test group) and ED (m Sv) (9.80 + 1.51 in the control group), there was no significant difference (P 0.05). As the level of single energy increased, the CT value of the ovarian artery decreased gradually; the CNR value and SNR value of the ovarian artery were in 40ke V single energy level combined 60%ASIR (26.12 + 7.92,30.45 + 8.13. It was the highest, compared with the control group (13.29 + 5.44,18.67 + 5.61), the difference was statistically significant (P0.05); the subjective score of the test group was highest at 40ke V single energy level (4.18 + 0.63), and 60%ASIR (4.12 + 0.64) combined with 40ke V single energy level was not statistically significant (P0.05). Conclusion: the spectrum CT single energy imaging combined superposition. The reconstructive technique does not increase the dose of radiation, and the 40ke V single energy level combined with 60%ASIR can obviously improve the image quality of the ovarian artery and provide help for the clinical diagnosis and treatment. The second part can be used to identify the value of CT imaging in the differentiation of benign and malignant ovarian tumors: the quantitative analysis of the spectral CT imaging is used to identify the benign and malignant ovarian tumors. Application value. Materials and methods: This study was licensed by the ethics committee of our hospital; all patients provided informed consent before the examination. A prospective collection of women who suspected pelvic space occupying from August 2015 to December 2016 and underwent pelvic or pelvic enhanced scan at the First Affiliated Hospital of Zhengzhou University eventually resulted in the pathological results. 98 cases of ovarian tumors were included in this study, aged 12~84 years old, with an average of 45.01 years of age. They were divided into two groups according to the different cystic components. The first group was the ovarian tumor of the cystic component, of which 64 cases were benign ovarian tumors and 32 malignant ovarian tumors, and the second groups were mainly ovarian tumors, with 34 cases. 11 cases of benign ovarian tumors and 23 cases of malignant ovarian tumors. All patients were performed routine plain scan and biphasic enhanced scan on Discover GSI CT. The image reconstruction selected original data combined with 40% adaptive statistical iterative reconstruction (ASIR). At the post treatment station, the two groups were measured as the cystic components or real components of the two phases of the ovarian focus. The CT value, iodine concentration (IC), iodine concentration (WC), calcium water concentration (CC), the iodine concentration of the iliac artery on the same side of the same side of the lesion and the spectrum curve of the focus, and the calculation of the standard iodine concentration (NIC) and the slope of the energy spectrum curve at the lesion, that is, the iodine concentration of the lesion = the concentration of iodine in the lesion / the iodine concentration of the iliac artery in the same layer, and the slope = (HU40ke V-HU100ke V) /60. adoption An independent sample t test was used to compare the parameters of benign and malignant ovarian tumors, and the ROC curve was drawn to evaluate the diagnostic efficiency of the corresponding parameters. Results: the age of malignant ovarian tumors (49.33 + 13.57) was larger than that of benign ovarian tumors (39.49 + 14.18), and the difference was statistically significant (P0.01). Calcium water concentration and standardized iodine concentration were 3.63 + 1.70 (100 g/cm3), 5.21 + 2.47 (mg/cm3), 0.05 + 0.02,0.43 + 0.20, respectively, 3.81 + 1.62 (100 u g/cm3), 5.44 + 2.25 (mg/cm3) and 0.04 + 0.01,0.45, respectively, and iodine concentration of benign ovarian tumors, calcium concentration, standard iodine concentration, spectrum curve slope The arterial phase was 2.08 + 0.84 (100 mu g/cm3), 2.92 + 1.25 (mg/cm3) and 0.03 + 0.02,0.25 + 0.10 respectively. The venous phase was 2.58 + 1.22 (100 u g/cm3), 3.66 + 1.80 (mg/cm3) and 0.03 + 0.01,0.31 +; and the difference was statistically significant (P). The specificity of the parameters was higher in the arterial phase than in the venous phase, and the sensitivity was higher in the venous phase than in the arterial phase. The iodine water concentration of the malignant ovarian tumor and the standard iodine concentration were 14.50 + 6.44 (100 g/cm3) and 0.33 + 0.12,1.72 + 0.77 respectively, and the iodine concentration of benign ovarian tumors and the standard iodine concentration were 8.86 + 4.04 (100 u g/cm3) and 0.22 + 0.13,1.05 + 0.48 respectively in the venous phase, respectively. The difference is statistically significant (P =0.01), and the AUC of standardized iodine concentration is the largest. Conclusion: the CT parameters of the benign and malignant ovarian tumors are significantly different. The energy spectrum CT imaging can provide more information for the differential diagnosis of benign and malignant ovarian tumors, and has a certain clinical value.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R737.31;R730.44

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