64层螺旋CT后处理技术在喉及喉咽疾病诊断中的应用价值

发布时间：2018-06-23 03:10

本文选题：喉疾病 + 喉咽疾病　；参考：《浙江大学》2011年硕士论文

【摘要】：喉及喉咽疾病多种多样,除血管瘤、脂肪瘤、软骨瘤等少数病变具有特异性CT征象外,其余病变CT表现没有特异性,给CT诊断带来一定的困难。术前若能通过CT检查充分了解喉部病变的性质及范围,便可以制定合适的治疗计划,对病人的恢复及愈后非常重要。虽然常规CT在喉及喉咽肿瘤术前分期中的价值已得到普遍认可,但常规CT由于扫描层厚较厚及易受运动伪影的影响,容易遗漏较小的声带病变,如声带息肉及早期喉癌。近几年发展的64层螺旋CT采用容积扫描,速度快,极大的提高了图像的空间分辨率和密度分辨率,可避免层面的遗漏和运动伪影的影响。64层螺旋CT具有强大的软件后处理功能,能在一次横断面扫描基础上完成多平面重建(MPR)、仿真喉镜(CTVL)等多种后处理技术,相互结合不仅可以早期发现病变,并可以在冠状位、矢状位等多个方位上观察病变的形态及侵犯范围,使喉及喉咽疾病显示更加直观,提高病变诊断率。 CT扫描使用飞利浦64层螺旋CT扫描机,患者取仰卧位,扫描过程中嘱病人平静呼吸,勿做吞咽及屏气动作,然后行螺旋CT容积扫描。扫描范围自颅底至胸廓入口。扫描参数采用120KV,200mAs,准直器宽度为0.625mm,螺距1.0。增强扫描采用CT高压注射器,对比剂使用非离子型对比剂优维显(300mg I/mL)90ml,经肘静脉注入,注射速度2.5-3.0ml/s,增强扫描动脉期为28-30s,静脉期为55-60s。扫描结束后利用原始容积数据行层厚1mm的横断面重建。然后在后处理工作站进行多平面重建(MPR)和仿真喉镜(CTVL)等二维及三维后处理。在病变为中心的矢状面及冠状面图像上分别与气道长轴平行制定冠状及矢状位重组线,进行1mm层厚、1mm间隔的重建。使用工作站的仿真喉镜软件功能,分别从头侧或足侧对喉及喉咽进行CTVL成像。采用SAS9.1统计软件,应用X2检验或Fish精确检验法对获得的数据进行统计学处理,确定P0.05为差异具有统计学意义。 1喉癌及喉咽癌术前CT分期与术后临床病理分期两者之间无显著性差异。 2多平面重建(MPR)是喉部螺旋CT最基本的图像后处理技术,与横断面图像联合可以多方位的观察喉部解剖及肿瘤病变的范围,是横断面图像的有力补充。 3仿真喉镜(CTVL)图像质量与病变的大小、范围有关：喉部较小病灶如声带息肉、慢性炎症(肿块型)图像质量好；喉部肿瘤生长未导致喉腔狭窄时,CTVL图像质量好；肿瘤弥漫生长导致喉腔明显狭窄时,CTVL图像质量明显下降,甚至不能成像。 4X2检验或Fish精确检验显示在选取的7个CT征象中,病变发生部位、病变界限、病变强化程度、会厌前间隙或喉旁间隙是否受累等4个征象在鉴别喉部疾病性质中具有统计学意义。 64层螺旋CT各向同性容积扫描及各种后处理技术的综合应用,对于喉及喉咽疾病诊断与鉴别诊断具有一定的临床应用价值。
[Abstract]:Larynx and laryngopharynx diseases are various except hemangioma lipoma chondroma and other few lesions with specific CT signs other CT findings are not specific which brings some difficulties to CT diagnosis. If we can fully understand the nature and scope of laryngeal lesions by CT scan before operation, we can make appropriate treatment plan, which is very important to the recovery and recovery of patients. Although the value of conventional CT in preoperative staging of laryngeal and laryngopharyngeal tumors has been generally recognized, conventional CT is prone to omit smaller vocal cord lesions, such as vocal cord polyps and early laryngeal cancer, because of its thicker slice thickness and its susceptibility to motion artifacts. The 64-slice spiral CT, developed in recent years, uses volumetric scanning, which can greatly improve the spatial resolution and density resolution of the image, and can avoid the influence of dimension omission and motion artifact. 64-slice spiral CT has powerful software post-processing function. Multiplanar reconstruction (MPR), virtual laryngoscope (CTVL) and other post-processing techniques can be completed on the basis of a cross-sectional scan. Sagittal position and other directions were used to observe the shape and invasion range of the lesions, so that the larynx and laryngopharynx diseases were displayed more intuitively, and the diagnostic rate of the lesions was improved. The CT scan was performed with Philips 64-slice spiral CT scanner, and the patients were supine. During the scanning, the patient is told to breathe calmly, not to swallow or hold breath, and then to perform spiral CT volume scan. Scan from the base of the skull to the thoracic entrance. The scanning parameters are 120kV / 200mAs. the width of the collimator is 0.625mm and the pitch is 1.0. The contrast medium was 300mg I / mL (300mg I / mL) 90 ml. The injection speed was 2.5-3.0 ml / s, and the arterial phase was 28-30 s and the venous phase was 55-60 s. After scanning, the cross section of 1mm was reconstructed with the original volume data. Two and three dimensional postprocessing such as multiplanar reconstruction (MPR) and virtual laryngoscope (CTVL) were performed on the post processing workstation. On the sagittal and coronal images with the center of the lesion, coronal and sagittal reconstruction lines were made parallel to the long axis of the airway, respectively, and the thickness of 1mm lamina was reconstructed by 1 mm interval. CTVL imaging of larynx and larynx were performed on the head or foot using the virtual laryngoscope software of the workstation. Using SAS9.1 statistical software, using X2 test or Fish precision test to carry on the statistical processing to the obtained data, (1) there was no significant difference between preoperative CT staging and postoperative clinicopathological staging of laryngeal carcinoma and laryngopharyngeal carcinoma. 2 MPR was the most basic spiral CT of larynx. Image post-processing technology, Combined with cross-sectional images, the laryngeal anatomy and the range of tumor lesions can be observed in multiple directions, which is a powerful supplement to cross-sectional images. 3 the quality of virtual laryngoscope (CTVL) images and the size of the lesions. The range is related to: small laryngeal lesions such as vocal cord polyps, chronic inflammation (mass type) image quality, laryngeal tumor growth did not cause laryngeal cavity stenosis, CTVL image quality is good; The quality of CTVL images in laryngeal cavity was obviously decreased when the tumor was diffusely growing, and the quality of CTVL image could not even be imaged. 4X2 test or Fish's accurate examination showed that in the selected 7 CT signs, the location of lesion, the limit of lesion, the degree of enhancement of lesion, and so on. The four signs of preepiglottic space or paralaryngeal space involvement have statistical significance in distinguishing laryngeal diseases. Comprehensive application of 64-slice spiral CT isotropic volumetric scanning and various post-processing techniques. It has certain clinical application value for the diagnosis and differential diagnosis of larynx and laryngopharynx diseases.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2011
【分类号】：R767;R816.96

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