能谱CT成像在乳腺癌诊断中的应用价值研究

发布时间：2018-05-20 14:28

本文选题：乳腺 + 能谱CT　；参考：《兰州大学》2017年硕士论文

【摘要】：第一部分正常乳腺的能谱特征目的:初步探讨正常乳腺的能谱CT特征。方法:收集因胸部其它病变行常规胸部宝石能谱CT平扫及双期增强扫描的正常乳腺15例,应用能谱CT后处理及分析软件进行分析测量,分别获得平扫及动、静脉期显示正常乳腺腺体最佳CNR的平均单能量水平(ke V),正常腺体40ke V~140ke V下的平均CT值(HU),以及特征性能谱曲线并计算40ke V~70ke V水平下的曲线斜率;测量正常乳腺腺体动、静脉期的碘(水)浓度(mg/cc)及相对碘浓度。采用?x±s及95%可信区间进行统计学描述,平扫及动、静脉期曲线斜率间的比较采用单因素方差分析。结果:平扫及动、静脉期显示正常乳腺腺体最佳CNR的平均单能量水平分别为65.55±0.82ke V,65.70±0.80ke V,65.80±0.69ke V;95%可信区间分别为(65.2,65.95)ke V,(65.35,66.05)ke V,(65.50,66.10)ke V。动、静脉期不同单能量下CT值较平扫略高,且静脉期更高。正常腺体平扫、动脉期及静脉期的特征性能谱曲线在40ke V~70ke V水平下的平均曲线斜率分别为:0.46±0.07,0.45±0.05,0.52±0.08,三者间无统计学差异(P0.05)。正常乳腺腺体增强后动、静脉期平均碘(水)浓度分别为:1.42±0.30mg/cc,2.10±0.40mg/cc;95%可信区间分别为(1.13,1.72)mg/cc,(1.63,2.62)mg/cc。正常乳腺腺体动、静脉期平均相对碘浓度分别为:0.02±0.003,0.06±0.005;95%可信区间分别为(0.01,0.03),(0.05,0.08)。结论:正常乳腺腺体能谱CT平扫及增强具有一定特征性,可以为后续相关研究提供一定理论依据。第二部分乳腺癌的能谱特征目的:探讨乳腺癌的能谱特征,评价能谱CT在乳腺癌诊断方面的应用价值。方法:回顾性分析12例经手术病理证实的乳腺癌患者的能谱CT资料,其中10例为浸润性导管癌,余2例分别为浸润性小叶癌、浸润性乳头状癌。所有患者术前行能谱CT双期增强扫描,在后处理软件上分别测量动、静脉期乳腺癌病灶及对侧正常乳腺腺体40ke V~140ke V水平下的平均CT值(HU)及40ke V~70ke V水平下的曲线斜率、碘(水)浓度(mg/cc)、相对碘浓度。随机纳入行胸部常规CT双期增强扫描的女性患者12例作为对照组,分别记录能谱CT及常规CT扫描模式的辐射剂量参数,包括CT容积剂量指数(CTDIvol),剂量长度乘积(DLP),有效辐射剂量(ED)。扫描采用两独立样本t检验比较乳腺癌与正常腺体间能谱参数的差异及胸部常规CT双期增强扫描与能谱CT扫描间辐射剂量的差异。结果:乳腺癌动、静脉期40ke V~140ke V水平下的平均CT值及能谱曲线斜率、碘(水)浓度、相对碘浓度均较正常乳腺腺体高,两者差异具有统计学意义(P0.05);能谱CT胸部双期增强扫描的平均辐射剂量明显低于常规CT,两者差异具有统计学意义(P0.05)。结论:乳腺癌能谱参数具有一定特征性,且能谱CT胸部双期增强扫描的辐射剂量明显低于常规CT,因此,能谱CT在诊断乳腺癌方面具有一定的应用价值。第三部分乳腺癌转移性淋巴结的能谱特征目的:初步探讨能谱CT在评价乳腺癌转移性淋巴结方面的应用价值。方法:回顾性分析经手术病理证实的乳腺癌12例,其中6例伴有淋巴结转移,5例为同侧腋窝淋巴结受累,1例为胸肌间淋巴结受累。对6例转移性淋巴结及原发病灶进行能谱特征分析,绘制其动、静脉期能谱曲线,直方图及散点图并分析其特点,初步探索能谱CT在诊断乳腺癌转移性淋巴结方面的应用。结果:对6例转移性淋巴结进行能谱特征分析发现,转移性淋巴结的能谱曲线形态、直方图及散点图分布与原发病灶相似或基本一致,且静脉期符合程度较动脉期更高。结论:转移性淋巴结与原发病灶能谱曲线、直方图及散点图的一致性在诊断乳腺癌转移性淋巴结方面具有一定的应用价值,尤其是静脉期可靠性更加,因此能谱CT在乳腺癌术前分期方面具有一定的指导作用。
[Abstract]:The first part of the normal breast energy spectrum characteristics Objective: to preliminarily discuss the characteristics of the normal mammary spectrum CT. Methods: 15 cases of normal breast were collected by CT plain scan and double phase contrast enhancement scan because of other thoracic lesions. The energy spectrum CT post-processing and analysis software were used for analysis and measurement. The average single energy level (Ke V) of the best CNR of normal mammary glands, the average CT value (HU) under the normal gland 40ke V~140ke V, the characteristic spectrum and the curve slope at the 40ke V~70ke V level, and the measurement of normal mammary gland movement, iodine (water) concentration (mg/cc) and relative iodine concentration in the venous phase of the mammary glands, are used for statistics and 95% confidence intervals. A single factor variance analysis was used in the comparison of the curve slope of the venous phase. Results: the average single energy level of the best CNR in the normal mammary glands was 65.55 + 0.82ke V, 65.70 + 0.80ke V and 65.80 + 0.69ke V, respectively, and the 95% trusted regions were 65.2,65.95 Ke V, (65.35,66.05) ke. Ke V. movement, the CT value of different single energy in venous phase was higher than that of plain scan, and the venous phase was higher. The average curve of normal glandular scan, arterial and venous phase curves at 40ke V~70ke V level were 0.46 + 0.07,0.45 + 0.05,0.52 + 0.08 respectively, and there was no statistical difference (P0.05) between the three. The average iodine (water) concentration of pulse period was 1.42 + 0.30mg/cc, 2.10 + 0.40mg/cc, 95% confidence interval was (1.13,1.72) mg/cc, (1.63,2.62) mg/cc. normal mammary gland movement, the average relative iodine concentration in venous phase was 0.02 + 0.003,0.06 + 0.005, 95% confidence interval was (0.01,0.03), (0.05,0.08). Conclusion: normal breast gland can be used for plain scanning of CT. And the enhancement has certain characteristics, can provide a certain theoretical basis for follow-up related research. Second part of the spectrum characteristics of breast cancer: To explore the spectrum characteristics of breast cancer and evaluate the application value of CT in the diagnosis of breast cancer. Methods: retrospective analysis of 12 cases of breast cancer confirmed by operation and pathology of the spectrum CT data, 10 cases were infiltrative ductal carcinoma, and the other 2 were invasive lobular carcinoma and invasive papillary carcinoma. All the patients underwent CT double phase enhanced scan before operation. In the post-processing software, the lesions of breast cancer and the average CT value (HU) and 40ke V~70ke V level under the 40ke V~140ke V level of the contralateral normal mammary gland were measured respectively. The slope, iodine (mg/cc) concentration (water) concentration and relative iodine concentration were randomly included in 12 female patients with routine chest CT double phase enhanced scan as the control group. The radiation dose parameters of the energy spectrum CT and the conventional CT scanning mode were recorded, including the CT volume dose index (CTDIvol), the dose length product (DLP), the effective radiation dose (ED). The scanning was two independent. Sample t test compared the difference of energy spectrum parameters between breast cancer and normal gland and the difference of radiation dose between routine chest CT double phase enhanced scan and energy spectrum CT scan. Results: the average CT value and the slope of energy spectrum curve, iodine (water) concentration and relative iodine concentration were higher than normal mammary glands in breast cancer movement, 40ke V~140ke V level in the venous phase, and the relative iodine concentration was higher than that of normal mammary gland. The difference had statistical significance (P0.05); the average radiation dose of the dual phase enhanced scan of the CT chest was significantly lower than that of the conventional CT, and the difference was statistically significant (P0.05). Conclusion: the spectral parameters of breast cancer were characteristic, and the radiant dose of the dual phase enhanced scan of the chest CT was significantly lower than that of the conventional CT, so the energy spectrum CT was diagnosed in the mammary gland. Third part of the energy spectrum of metastatic lymph nodes in breast cancer: a preliminary study of the value of CT in the evaluation of metastatic lymph nodes of breast cancer. Methods: retrospective analysis of 12 cases of breast cancer confirmed by surgery and pathology, including 6 cases with lymph node metastasis and 5 cases of the ipsilateral axillary lymph nodes. 1 cases were involved in the inter pectoral lymph node involvement in 1 cases. 6 cases of metastatic lymph nodes and primary foci were analyzed, the energy spectrum curve of the venous phase, the histogram and scatter plot were plotted and the characteristics were analyzed. The application of energy spectrum CT in the diagnosis of metastatic lymph nodes of breast cancer was preliminarily explored. Results: the spectrum of metastatic lymph nodes in 6 cases was characterized. The characteristic analysis showed that the distribution of the energy spectrum curve of the metastatic lymph nodes, the distribution of histogram and scatter plot was similar or basically consistent with the primary focus, and the conformity of the venous phase was higher than that of the arterial phase. Conclusion: the characteristics of the metastatic lymph node and the primary focus energy spectrum curve, the histogram and the scatter plot are in the diagnosis of the metastatic lymph nodes of the breast cancer. Certain application value, especially in the venous phase, is more reliable, so the energy spectrum CT has a certain guiding role in preoperative staging of breast cancer.
【学位授予单位】：兰州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R737.9;R730.44

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