鼻咽癌放疗后局部复发瘤不同感兴趣血管MSCT灌注阈值及其诊断价值研究

发布时间：2018-11-28 18:16

【摘要】：目的采用颈外动脉-下颌后静脉(简称颈外组)和颈内动脉-颈内静脉(简称颈内组)两组不同感兴趣血管对鼻咽癌(Nasopharyngeal Carcinoma,NPC)放疗后病例进行CT灌注研究,总结鼻咽癌放疗后局部复发瘤(Local Recurrence,后称LR)的CT灌注参数阈值及其诊断价值,并进一步探讨采用不同感兴趣血管相互替代对LR诊断的可行性。方法收集收集2005年1月至2010年5月期间经病理和/或长期随访证实的NPC放疗后病例57例,包括病理证实的31例鼻咽癌放疗后局部复发瘤病例和病理和/或随访证实的26例鼻咽癌放疗后局部纤维化病例(Local Fibrosis后称RF)。所有病例均采用GE/lightspeed Ultra 8层螺旋CT机进行鼻咽部CT平扫和病灶区灌注成像扫描,将获得图像数据传入GE AW4.2工作站,利用Perfusion 3软件进行后处理,分别选择病灶同侧的颈外动脉-下颌后静脉及颈内动脉-颈内静脉分别作为输入动脉和输出静脉,在病灶区选取感兴趣区(region of interest,ROI)后,软件自动计算并生成各组病例的灌注参数值和相应伪彩图；各灌注参值均采用spss13.0统计软件和Medcalcl 1.3.5.0软件进行统计学分析,分别通过两组不同感兴趣血管采集的数据绘制LR的各CT灌注参数[血流速度(blood flow,BF)、血容量(blood volume,BV)、表面通透性(permeability surface,PS)、平均通过时间(mean transition time,MTT)]受试者工作特征曲线(即ROC曲线),确定各灌注参数ROC曲线最佳临界点值作为LR各CT灌注参数阈值,并分别计算采用两组不同感兴趣血管获得的两组阈值对LR的诊断敏感性和特异性。结果颈外组NPC放疗后局部复发组和颈内组NPC放疗后局部复发组各灌注参数BF、BV、MTT和PS均数分别为：(662.80±242.06)ml/min/100g、(38.00±20.00)m1/100g、(2.04±0.72)s、(49.52±21.02)ml/min/g,(217.02±105.35)ml/min/100g、(11.61±6.42)ml/100g、(1.91±0.62)s、(24.60±13.92)ml/min/g。以颈外动脉-下颌后静脉为感兴趣血管时,LR各灌注参数BF、BV、MTT和PS均数分别为：(662.80±242.06)ml/min/100g、(38.00±20.00)ml/100g、(2.04±0.72)s、(49.522±21.02)ml/min/g；同时其LR的BF、BV、MTT和PS阈值(后称颈外组阈值)分别为347.02(ml/min/100g)、13.74(ml/100g)、1.82(s)、15.39(ml/min/g),诊断敏感度分别为90.30%、83.90%、66.70%、93.50%,特异度分别为93.90%、97.00%、60.00%、88.50%。以颈内动脉-颈内静脉为感兴趣血管时,LR各灌注参数BF、BV、MTT和PS均数分别为：(217.02±105.35)ml/min/100g、(11.61±6.42)ml/100g、(1.91±0.62)s、(24.60±13.92)ml/min/g；同时其LR的BF、BV、MTT和PS阈值、(后称颈内组阈值)分别为128.06(ml/min/100g)、3.88(ml/100g)、1.88(s)、11.05(ml/min/g),诊断敏感度分别为80.00%、93.30%、81.80%、96.70%,特异度分别为68.20%、54.50%、63.70%、45.50%。结论颈外组鼻咽癌放疗后局部复发瘤CT灌注参数阈值对复发瘤的定性诊断具有重要价值,颈内组鼻咽癌放疗后局部复发瘤CT灌注参数阈值为复发瘤诊断提供重要的参考依据,即颈外组阈值对LR的定性诊断价值高于颈内组阈值；对于因放疗损伤颈外动脉和/或下颌后静脉导致无法采用该组血管进行CT灌注检查的病例,可考虑采用颈内动脉-颈内静脉作为替代血管进行CT灌注检查。
[Abstract]:Objective To study the local recurrence of nasopharyngeal carcinoma (NPC) after radiotherapy of nasopharygeal carcinoma (NPC) by using external carotid artery-submandibular vein (external carotid group) and internal carotid artery-internal jugular vein (internal carotid group). The CT perfusion parameter threshold and its diagnostic value of LR were also discussed, and the feasibility of using different vessels of interest to replace the LR was further discussed. Method Collection of post-radiotherapy cases confirmed by pathology and/ or long-term follow-up from January 2005 to May 2010 Seven patients, including 31 cases of local recurrence of nasopharyngeal carcinoma after radiotherapy, and 26 cases of local fibrosis after radiotherapy (Local Firosis), confirmed by pathology and/ or follow-up. F). All cases were scanned with the GE/ lightspeed Ultra 8-layer spiral CT machine to scan the CT and the focus area of the nasopharynx. The image data was transferred to the GE AW4. 2 workstation, using the Perfusion3 software. performing post-treatment, respectively selecting the common carotid artery-mandibular posterior vein and the internal carotid artery-internal jugular vein on the same side as the input artery and the output vein, and after the region of interest (ROI) is selected, the software automatically calculates and generates the perfusion parameter value of each group of cases; The parameters of blood flow (BF), blood volume (BV) and surface permeability (surface permeability) were calculated by using the statistical software of the spss13. 0 and the software of Medcalcl 1. 3. 5. 0, respectively. e, PS), mean pass time (MTT)] subject's working characteristic curve (i.e., ROC curve), determine the optimal critical point value of the ROC curve for each perfusion parameter as the LR each CT irrigation The parameter threshold is given, and the two sets of thresholds obtained with different blood vessels of the two groups are respectively calculated to be sensitive to the diagnosis of LR Results The mean number of perfusion parameters BF, BV, MTT and PS in the local recurrence group and the local recurrence group after radiotherapy of NPC treated with NPC were: (662. 80-242.06) ml/ min/ 100g, (38. 00-20.00) ml/ 100g, (2.04-0.72) s, (49. 52-21.02) ml/ min/ g, (217.02-105.35) ml/ min/ 100g, (11.61-6.42). )ml/100g,(1.91卤0.62)s,(24.60卤13.92) The mean of BF, BV, MTT and PS were as follows: (662. 80-242.06) ml/ min/ 100g, (38. 00-20. 00) ml/ 100g, (2.04-0.72) s, (49. 522-21.02) ml/ min/ g, respectively. At the same time, the values of BF, BV, MTT and PS of the LR were 347.02 (ml/ min/ 100g), 13.74 (ml/ 100g), 1.82 (s), 15.39 (ml/ min/ g), respectively. The diagnostic sensitivity was 90. 30%, 80.90%, 66. 70%, 90.50%, and the specificity was 90.90%, 97.00%, 60. When the internal carotid artery-internal jugular vein was the vessel of interest, the mean of BF, BV, MTT and PS were: (217.02, 105.35) ml/ min/ 100g, (11.61-6.42) ml/ 100g, (1.91-0.62) s, (24.60-13.92) ml/ min/ g, and LR The values of BF, BV, MTT and PS were 128. 06 (ml/ min/ 100 g), 3.88 (ml/ 100 g), 1.88 (s), 11.05 (ml/ min/ g), respectively. The diagnostic sensitivity was 80.00%, 93.3%, 81.80%, 96.70%, and the specificity was 68. 20%, 54. 50%, respectively. Conclusion The threshold of CT perfusion parameters of local recurrent tumor after radiotherapy for nasopharyngeal carcinoma is of great value in the diagnosis of recurrent tumor, and the CT perfusion parameters of local recurrent tumor after radiotherapy in the internal carotid group are of great value. The threshold is an important reference for the diagnosis of recurrent tumor, that is, the value of the external set threshold for LR is higher than that of the internal carotid group; for the external carotid artery and/ or the post-mandibular vein due to radiotherapy, The use of the set of vessels for CT perfusion examination may take into account the use of the internal carotid artery-neck
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2011
【分类号】：R739.63

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