CT测量肾肿瘤患者肾体积与肾功能的相关性研究

发布时间：2018-02-28 00:48

本文关键词： 肾脏体积测量体外实验 CT CT 肾小球滤过率肾皮质体积肾实质体积　出处：《南京医科大学》2014年硕士论文　论文类型：学位论文

【摘要】：第一部分不同周围环境及CT扫描参数对体积测量准确性的影响目的：体外条件下,探讨不同周围环境、管电压、管电流和重建层厚对CT图像上测量肾脏体积准确性的影响。材料与方法：选择土豆与猪肾作为体外研究的对象,各12个。土豆与猪肾的真实体积通过排水法获得。CT扫描设置不同的条件：周围环境(暴露在空气中；浸没在植物油中),管电压／管电流(80kVp/200mAs;120kVp/200mAs;120kVp/100mAs),重建层厚(0.75mm;1.5mm)。用一款自主研发的软件在CT图像上进行物体的体积测量,测量的准确性用误差百分比(percentage errors,PEs)表示,PEs定义为在CT图像上测得的体积与真实体积的差值再除以真实体积。运用配对t检验分析不同周围环境及扫描参数对体积测量准确性的影响。结果：浸没在植物油中进行CT扫描测得的体积更接近真实值(P0.001)。相同管电流及重建层厚条件下,120kVp和80kVp间PEs差异无统计学意义(0.8±1.9 vs.0.9±1.8,P=0.240,层厚为0.75mm时；0.4±1.9 vs.0.5±1.9,P=0.421,层厚为1.5mm时)。相同管电压及重建层厚条件下,200mAs和100mAs间PEs差异有统计学意义(0.8±1.9 vs.1.0-±1.8,P=0.002,层厚为0.75mm时；0.4±1.9 vs.0.6±1.9,P0.001,层厚为1.5mm时)。相同管电压和管电流条件下,层厚为1.5mm时的PEs值更小(P0.001)。结论：周围环境、管电流及重建层厚均会影响CT图像上物体体积测量的准确性。本研究结果表明在体外实验时,浸没在植物油中、120kVp/200mAs和1.5mm重建层厚条件下所测量的物体体积最准确。第二部分CT测量肾肿瘤患者肾体积与肾功能的相关性研究目的：评估肾肿瘤患者术前、术后CT测量的肾皮质体积(renal cortical volume, RCV)/肾实质体积(renal parenchymal volume, RPV)与肾功能的相关性。材料与方法：回顾性分析于本院行经腹腔镜肾部分切除术(laparoscopic partial nephrectomy, LPN)的肾肿瘤患者35例。所有患者均于术前、术后行中腹部增强CT检查及核素肾显像检查。在CT动脉期图像上,用软件分别测量术前肾肿瘤体积,术前患侧虚拟的去除肾肿瘤后的RCV、肾髓质体积(renal medullary volume, RMV),术前健侧RCV、RMV,术后患侧残余的RCV、RMV和术后健侧RCV、RMV。RPV是指不包括肾盏、肾盂及肾窦的肾脏皮髓质体积之和。分别将术前、术后RCV和RPV与术前、术后核素肾显像测得的肾小球滤过率(Glomerular filtration rate, GFR)行Pearson相关性分析。结果：患侧术前虚拟的去除肿瘤后的RCV (r=0.502, P=0.002)/RPV(r=0.527, P=0.001)与患侧术前的GFR呈中度相关。健侧术前的RCV (r=0.384,P=0.023) /RPV (r=0.412,P=0.014)与健侧术前的GFR呈中度相关。患侧术后残余的RCV (r=0.619, P0.001)/RPV (r=0.593,P0.001)与患侧术后的GFR呈中度相关。健侧术后的RCV(r=0.434,P=0.009)/RPV(r=0.522,P=0.001)与健侧术后的GFR呈中度相关。患侧LPN手术前后RCV/RPV变化百分比与GFR变化百分比间的相关系数为r=0.416,P=0.013／r=0.477,P=0.004。健侧术后RCV/RPV变化百分比与GFR变化百分比之间无相关性。结论：无论术前、术后,CT图像上测量的RCV和RPV均在一定程度上反映了肾功能,但RCV不能比RPV更好地反映肾功能。生长肿瘤侧肾脏体积与肾功能的相关性在术前术后均高于健侧。CT图像上用软件测量肾体积可以作为评估术后远期肾功能的有效方法之一。
[Abstract]:The effects of different environment , tube voltage , tube current and reconstructed layer thickness on the accuracy of renal volume measurement on CT images were discussed in the first part . The effects of different environment , tube voltage , tube current and reconstructed layer thickness on the accuracy of renal volume were studied . The volume measurement of the object was performed on the CT image with a self - developed software . The accuracy of the measurement was expressed by the percentage errors , which was defined as the difference between the volume measured on the CT image and the real volume divided by the real volume . The results showed that the volume measured by CT scanning in the vegetable oil was closer to the real value ( P0.001 ) . The difference between 120kVp and 80kVp was not statistically significant ( 0 . 8 卤 1.9 vs . 0 . 9 卤 1.8 , P = 0.240 , layer thickness 0.75 mm ; 0 . 4 卤 1.9 vs . 0.5 卤 1.9 , P = 0.421 , thickness of 1.5 mm ) . There was significant difference between 200mAs and 100mAs under the same tube voltage and reconstructed layer thickness ( 0.8 卤 1.9 vs . 1.0 - 卤 1.8 , P = 0.002 , layer thickness 0.75 mm ; 0.4 卤 1.9 vs . 0.6 卤 1.9 , P0.001 , layer thickness 1.5 mm ) . The results showed that the volume of renal cortical volume ( RMV ) , renal medullary volume ( RMV ) and renal parenchyma volume ( RMV ) measured before and after operation were analyzed retrospectively . There was a moderate correlation between the percentage of RPV ( r = 0.416 , P = 0 . 009 ) / RPV ( r = 0.522 , P = 0 . 001 ) and GFR .

【学位授予单位】：南京医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R737.11;R730.44

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