双能量扫描在肺部占位性病变中的应用研究

发布时间：2018-02-09 07:53

本文关键词： 双源 CT 虚拟平扫肺部病变双源CT 碘图肺部病变双源CT 能谱分析肺部病变　出处：《山西医科大学》2013年硕士论文　论文类型：学位论文

【摘要】：目的：探讨第二代双源CT虚拟平扫图像在肺部占位性病变诊断中的应用研究。方法：回顾性分析2012年4月-2012年10月在本院行胸部平扫及增强扫描58例肺部占位性病变的病例。所有病例均利用德国西门子第二代双源CT（SOMATOM Definition Flash）进行检查，首先采用单源模式对患者进行胸部平扫（管电压120kV，参考电流210mAs），然后经肘静脉注入碘海醇，总量为1ml/kg，流速3.0ml/s，行胸部双能增强扫描（A球管管电压100kV，参考管电流200mAs；B球管管电压140kV，参考管电流170mAs），扫描时开启CARE Dose4D技术。利用Liver VNC模式得到虚拟平扫图像。比较虚拟平扫图像与常规平扫图像质量评分、噪声、病灶平均CT值及辐射剂量。结果：虚拟平扫图像与常规平扫图像质量评分分别为（4.620.52）、（4.710.46）分，两者无显著差异t=2.319，P0.05；虚拟平扫图像和常规平扫图像噪声分别为（8.101.16）、（7.301.06）HU，虚拟平扫噪声略高于常规平扫t=5.246，P0.05；虚拟平扫图像与常规平扫图像显示病变CT值分别为（32.658.09）、(27.947.16）HU，t=-8.154，P0.05；且两组CT值有很好的一致性（r=0.840，P0.05）。虚拟平扫与常规平扫的有效剂量分别为（5.180.96）、（5.551.18）mSv，虚拟平扫有效剂量低于常规平扫t=4.005，P0.05。结论：虚拟平扫图像对肺部病变显示良好，可满足诊断要求，有代替胸部常规平扫的潜在价值。目的：探讨第二代双源CT碘图在肺部占位性病变良恶性鉴别诊断中的应用研究。方法：回顾性分析2012年4月-2012年10月在本院行胸部平扫及增强扫描58例肺部占位性病变的病例，并经病理证实。扫描方式及条件同前。应用LiverVNC模式得到碘图。观察良恶性病变碘图伪彩色分布的情况。测量碘图中病灶的CT值，常规平扫及增强时期病灶的CT值。比较碘图CT值与强化CT值以及以20HU为阈值，碘图CT值与强化CT值对病灶良恶性鉴别诊断的准确度。结果：肺部不同性质病变的碘图伪彩色分布不同。8例结节状良性病变碘图显示病灶未见明显伪彩色覆盖，10例炎性病变碘图显示病灶明显覆盖伪彩色且颜色鲜亮。35例恶性病灶碘图显示病灶伪彩色覆盖方式多样，其中10例病灶伪彩色覆盖明显，呈花斑状覆盖，15例病灶伪彩色覆盖不均，病灶内的坏死灶显示伪彩色覆盖缺损。恶性病变的碘图CT值与强化CT值分别为（25.854.62）、（22.43.89）HU，t=-8.022，P0.05；两组CT值具有很好的一致性（r=0.839，P0.05）；良性病变的碘图CT值与强化CT差值分别为（21.9210.8）（21.0810.9）HU，t=-1.129，P＞0.05；两组CT值具有很好的一致性（r=0.947，P＞0.05）。以净增值≥20HU为诊断恶性病变阈值，碘图CT值与强化CT值判断良恶性的灵敏度、特异度、准确度分别为（85.7%，65.2%，77.6%）；（80%，60.9%，72.4%）。结论：双能量碘图将病灶血供分布情况直接可视化，并定量表达病灶的强化程度，判断病灶良恶性的灵敏度高，反映病变血供的能力更加直接、敏感。目的：探讨第二代双源CT多组能谱衍生序列在肺部占位性病变中的应用研究。方法：回顾性分析2012年4月-2012年10月在本院行胸部平扫及增强扫描58例肺部占位性病变的病例，并经病理证实。扫描方式及条件同前。选择MonoEnergetic程序处理得到60kev、80kev、100kev、120kev单能谱图像；经OptimalContrast程序处理得到非线性融合图像，并测量多种衍生序列中病灶CT值，病灶强化差值，，信噪比和噪声，观察不同性质肺部病变在不同kev下的曲线走行趋势。结果：多组单能谱图像间所测得的肺部病变强化CT差值以及噪声差异均有统计学意义（P0.05），其中肺部病变强化CT差值最大的序列是单能谱60kev为（35.6215.94）HU，（P0.05）。Moidal非线性融合图像病变组织、肌肉软组织、降主动脉信噪比分别为（4.291.03）、（4.211.41）、（15.070.93）HU，线性融合图像分别为（3.210.72）、（2.830.99）、（12.224.05）HU，两者差异有统计学意义（P0.05）。Moidal非线性融合图像与线性融合图像病变CT差值分别是（25.8712.64）、（22.2910.19）HU。非线性融合图像显示质量均优于线性融合图像（P0.05）。不同性质肺部病变在不同kev下的曲线走行趋势对诊断有一定帮助。结论：双能量扫描模式经后处理可得到多组能谱衍生序列图像，这些序列的综合应用可以为肺部病变良恶性的鉴别提供新的诊断信息。
[Abstract]:Objective: To explore the application of the second generation of dual source CT virtual plain scan in the diagnosis of pulmonary space occupying lesions.
Methods: a retrospective analysis of 58 cases of lung scan and occupying lesion cases in April 2012 -2012 year in October in our hospital for chest. All cases were using the German SIEMENS second generation dual source CT (SOMATOM Definition Flash) were examined using single source model to patients with chest scan (tube voltage 120kV, reference current 210mAs), then through elbow vein injection of iohexol, total 1ml/kg, velocity 3.0ml/s, dual energy scan chest (A tube voltage 100kV, tube current reference 200mAs; B tube voltage 140kV, tube current reference 170mAs), scanning CARE Dose4D technology opens. Get virtual unenhanced image using Liver VNC model. Comparison of virtual unenhanced images and conventional CT image quality score, noise, mean CT value of the lesions and radiation dose. Results: the virtual unenhanced images and conventional CT image quality scores were (4.620.52), (4.710. 46), had no significant difference between t=2.319 and P0.05; virtual unenhanced images and conventional unenhanced image noise respectively (8.101.16), HU (7.301.06), virtual scan noise is slightly higher than that of conventional plain t=5.246, P0.05; virtual unenhanced images and conventional unenhanced images showed lesions of CT = (32.658.09) (27.947.16), HU, t=-8.154, P0.05; and the two groups of CT values are in good agreement (r=0.840, P0.05). The virtual unenhanced effective dose and conventional plain respectively (5.180.96), (5.551.18) mSv, the effective dose is lower than that of the conventional virtual unenhanced scan t= 4.005, P0.05.
Conclusion: the virtual scan images are good for the pulmonary lesions, which can meet the diagnostic requirements and have the potential value of replacing the routine plain scan of the chest.
Objective: To study the application of second generation double source CT iodide map in the differential diagnosis of pulmonary occupying venereal disease.
Methods: a retrospective analysis of 58 cases of lung scan and occupying lesion cases in April 2012 -2012 year in October in our hospital for chest, and confirmed by pathology. Scanning mode and conditions. With application of LiverVNC model to get iodine map. Observation of benign and malignant lesions of the iodine image pseudo color distribution situation. Focus measurement of iodine map CT values in the conventional plain and enhanced CT. The lesions value during the comparison of iodine maps CT value and CT value and strengthen the 20HU threshold, iodine graph of CT and enhanced CT value in differential diagnosis of benign and malignant lesions. Results: the accuracy of iodine iodine Maps map pseudo color distribution of.8 cases of benign nodules lung lesions of different lesions showed no obvious pseudo color cover, 10 cases of inflammatory lesions showed obvious lesions iodine pseudo color and bright color covering.35 cases of malignant lesions showed lesions of iodine pseudo color covering diverse ways, among them 10 cases were pseudo color coating The cover was a piebald cover, 15 cases were pseudo color uneven coverage, necrotic foci showed pseudo color coverage defect. Figure CT iodine value and malignant lesions enhanced CT respectively (25.854.62), (22.43.89) HU, t=-8.022, P0.05; the two group CT value has a good consistency (r=0.839, P0.05); iodine figure CT benign lesions and enhanced CT value difference respectively (21.9210.8) (21.0810.9) HU, t=-1.129, P > 0.05; two group CT value has a good consistency (r=0.947, P > 0.05). The net value added more than 20HU for the diagnosis of malignant lesions threshold, iodine maps the value of CT and CT to strengthen the value judgement of benign and malignant sensitivity, specificity and accuracy were (85.7%, 65.2%, 77.6%); (80%, 60.9%, 72.4%).
Conclusion: dual energy iodine map can directly visualize the distribution of blood supply, and quantitatively express the degree of enhancement of lesions. It is highly sensitive and sensitive to identify benign and malignant lesions. It is more direct and sensitive to reflect the blood supply of lesions.
Objective: To investigate the application of the second generation CT multi group energy spectrum derived sequence in the lung space occupying lesions.
Methods: a retrospective analysis of 58 cases of lung scan and occupying lesion cases in April 2012 -2012 year in October in our hospital for chest, and confirmed by pathology. Scanning mode and conditions as before. Select the MonoEnergetic program to get the 60keV, 80kev, 100keV, 120kev single spectral image; nonlinear fusion by OptimalContrast program. The image and measure various derived sequence lesions were enhanced CT value difference, SNR and noise, the observed curve of lung lesions on different keV under the running trend.
Results: a series of single spectral image of lung lesions measured by enhanced CT and the difference between the noise differences were statistically significant (P0.05), the pulmonary lesions enhanced CT sequence is the maximum difference between the single energy spectrum 60keV (35.6215.94) HU, (P0.05).Moidal nonlinear image fusion disease tissue, muscle and soft tissue, drop aortic signal-to-noise ratio (4.291.03), respectively (4.211.41), HU (15.070.93), linear image fusion respectively (3.210.72), (2.830.99), HU (12.224.05), the difference was statistically significant (P0.05).Moidal nonlinear image fusion and linear image fusion lesions CT difference (25.8712.64), respectively (22.2910.19) HU. nonlinear fusion image quality was better than that of linear image fusion (P0.05). Different curve lung lesions under different keV running trend is helpful to the diagnosis.
Conclusion: the dual energy scanning mode can get multiple sets of energy spectrum derived sequence images after post-processing. The comprehensive application of these sequences can provide new diagnostic information for identification of benign and malignant lung lesions.

【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R816.41

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