能谱GSI技术界定颈动脉斑块性质及病理对照研究

发布时间：2018-07-24 11:12

【摘要】：目的:利用宝石CT(Computed Tomography)能谱成像技术(Gemstone Spectral Imaging,GSI)综合性分析颈动脉粥样硬化症(carotid atherosclerosis,CA)患者的颈动脉斑块的组织成分,界定其斑块性质,为预警缺血风险和干预治疗提供重要的影像学依据。方法:42位患者,经颈动脉彩色多普勒超声筛查,确诊为颈动脉硬化症的患者。其中,20例患者行经颈动脉内膜剥脱术(carotid endarterectomy,CEA)作为对照组(B组),其切除的斑块行病理学分析并确认斑块性质。未行CEA手术的22例患者作为研究组(A组)。两组行CT血管造影(computed tomography angiography,CTA),采集质量控制(quality control,QC)图像(140Kvp混合能量)和70kev单能量成像,传至GE能谱CT工作站AW4.4,获得并计算QC图像下和最佳kev值下的各斑块的对比噪声比(contrast to noise ratio,CNR),比较二者差异性。重建A、B组斑块的能谱曲线图、碘基物质浓度值和有效原子序数(Effective-Z)图谱,绘制其对三种斑块的ROC(receiver operating characteristic)曲线图,以敏感度和特异度之合最大者为最佳诊断阀值,并获得相应的敏感度和特异度,评估曲线斜率、标准化碘基物质浓度以及有效原子序数对于检测不同类型斑块的效果。结果:最佳kev下A、B两组的平均CNR值明显高于QC图像下的平均CNR值,二者有显著性差异(P0.01)。最佳kev下,以平均CT值判定斑块性质较QC图像更可靠。能谱GSI技术中的能谱曲线斜率对界定脂类斑块的敏感度最低但特异度最高;碘基物质浓度和有效原子序数对脂类斑块的敏感性最高,对纤维斑块和混合斑块的敏感度和特异度均较低。能谱曲线是界定脂类斑块相对最可靠的指标。结论:GSI技术是研究颈动脉粥样硬化斑块的新型可靠手段。利用高灵敏度和高特异性的GSI技术所得的不同指标参数,可对颈动脉粥样斑块进行定量、定性分析,获得可靠的临床诊断效果。
[Abstract]:Objective: to analyze the tissue components of carotid plaques in patients with carotid atherosclerosis (carotid) by using gem CT (Computed Tomography) imaging technique, and to determine the nature of carotid plaques. To provide an important imaging basis for early warning of ischemic risk and intervention therapy. Methods 42 patients with carotid arteriosclerosis were screened by color Doppler ultrasound. Carotid endarterectomy (carotid) was performed in 20 patients as control group (group B). Twenty-two patients without CEA operation served as study group (group A). Two groups were performed (computed tomography angiography (CTA), quality control QC images (140Kvp mixed energy) and 70kev single energy imaging. The contrast noise ratio of each plaque under QC image and optimal kev value was obtained and calculated, and the difference between the two groups was compared. The spectral curve, iodine based substance concentration and effective atomic number (Effective-Z) map of the plaques in group A and B were reconstructed and their ROC (receiver operating characteristic) curves for the three plaques were plotted. The best diagnostic threshold was the one with the greatest sensitivity and specificity. The sensitivity and specificity were obtained to evaluate the effect of curve slope, concentration of standardized iodized substance and effective atomic number on the detection of different types of plaque. Results: the average CNR value of Agna B group was significantly higher than that of QC image under optimal kev (P0.01). Under the optimal kev, the average CT value is more reliable than QC image in judging plaque property. The slope of energy spectrum curve in GSI technique has the lowest sensitivity but the highest specificity in the determination of lipid plaques, the concentration of iodized substances and the effective atomic number have the highest sensitivity to lipid plaques. The sensitivity and specificity to fibrous plaques and mixed plaques were low. The energy spectrum curve is the most reliable index to define the lipid plaque. ConclusionGSI is a new and reliable method for the study of carotid atherosclerotic plaques. The quantitative and qualitative analysis of carotid atherosclerotic plaques can be made by using different parameters obtained by high sensitivity and high specificity GSI technique, and reliable clinical diagnosis results can be obtained.
【学位授予单位】：青岛大学
【学位级别】：博士
【学位授予年份】：2015
【分类号】：R743;R816.1

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