能谱CT及MRI在直肠癌术前N分期评估中的应用

发布时间：2018-02-09 14:29

本文关键词： 体层摄影术 X线计算机断层成像核磁共振能谱成像直肠癌淋巴结　出处：《郑州大学》2017年硕士论文　论文类型：学位论文

【摘要】：研究目的:第一,通过能谱CT成像,定量及定性评估术前直肠癌区域淋巴结性质。第二,研究能谱CT较常规CT和MRI对直肠癌术前N分期价值优势。第三,探讨直肠癌淋巴结转移的相关因素。材料与方法:前瞻性收集2015年9月至2016年12月临床确诊直肠癌患者,检查前1晚清洁肠道,检查前肌注654-2,并经肛门注水500-1000ml。采用GE HealthCare Discovery CT进行常规全腹平扫及GSI增强双期扫描。部分患者一周内行GE3.0T MRI常规及增强扫描。观察记录CT扫描患者原发灶部位、最大径、各期CT值、碘基值、标准化碘浓度及能谱曲线斜率;观察淋巴结分组、形态学特点(短径、长径和短长径比)、数目、各期CT值、碘基值、标准化碘浓度(normalized iodine concentration,NIC)及能谱曲线斜率;然后计算淋巴结与原发灶能谱曲线斜率(λHu比值)及NIC比值。观察并记录MRI检查患者淋巴结分组、数目、短径、长径、短长径比及DWI信号。应用独立样本t检验、χ2检验、单因素相关分析、多因素回归分析等统计学方法检验。检验水准α为0.05。结果:纳入直肠癌患者86例,其中男47例,女39例,年龄39-77岁,平均年龄为(56±10)岁,中位年龄为56岁。其中有47例患者行MRI检查。27例无淋巴结转移,59例有淋巴结转移,CT共检出淋巴结473枚,其中59例N1-2期患者CT分组与病理分组完全对应检出阳性淋巴结97枚,纳入转移性淋巴结组,27例N0期患者共检出113枚淋巴结,纳入非转移性淋巴结组。t检验结果显示直肠癌转移性淋巴结短径、短长径比值均高于非转移性淋巴结组。而转移性淋巴结组动、静脉期CT值和动、静脉期碘基值均低于非转移性淋巴结组。其淋巴结短长径比、动脉期碘基值、动脉期CT值、静脉期碘基值、静脉期CT值、短径的ROC曲线的曲线下面积(AUC)分别为0.847、0.841、0.792、0.758、0.746和0.704,且所对应的各阈值和阈值的灵敏度及特异度分别为0.721、82.4%、75.0%,16.89(100ug/cm3)、84.3%、75.3%,69.18HU、80.4%、74.1%,20.31(100ug/cm3)、70.6%、66.7%,74.78HU、78.4%、68.5%,7.82mm、55.9%、79.6%。转移性淋巴结组λHu比值和NIC比值与均低于非转移组,均有统计学差异,且前者接近1。转移性淋巴结组λHu比值和NIC比值ROC曲线的AUC分别为O.879和0.835,且λHu比值为1.12的敏感性、特异性分别为86.3%、77.8%,NIC比值为1.03的的敏感性、特异性分别为82.4%、75.9%。在直肠癌术前N分期评估中,常规CT正确评估68例,准确性、灵敏性、特异性、阳性预测值(positive predictive value,PPV)和阴性预测值(negative predictive value,NPV)分别为79.07%、81.36%、74.07%、87.27%、64.52%;MRI正确评估38例,准确性、灵敏性、特异性、PPV和NPV分别为80.85%、82.14%、78.95%、85.19%、75.00%;能谱CT正确评估74例,准确性、灵敏性、特异性、PPV和NPV分别为85.11%、88.14%、81.48%、91.23%、75.86%。能谱CT直肠癌术前N分期的准确性、敏感性、特异性、NPV及PPV均高于常规CT和MRI。Kappa一致性检验结果显示,常规CT和MRI两种检查存在一致性,但一致性较差,Kappa值=0.670,P0.001。能谱CT和MRI两种检查存在一致性,且一致性较好,Kappa值=0.896,P0.001。相关因素分析显示患者的性别、肿瘤部位和肿瘤大小在直肠癌淋巴结转移性质上没有差异,患者年龄、肿瘤的大体类型、组织类型、浸润程度、分化类型这5项参数是影响直肠癌淋巴结转移的因素,多因素分析表明肿瘤浸润程度是直肠癌淋巴结转移的主要因素。结论:1.能谱曲线斜率比值、NIC比值、淋巴结短径、短长径比和动、静脉期碘基值对直肠癌淋巴结转移有较高的鉴别效能。2.能谱CT和MRI在术前直肠癌N分期的诊断中一致性较好,而且能谱CT较常规CT和MRI价值更高。3.直肠癌患者的年龄、原发肿瘤的大体类型、组织类型、分化程度、浸润程度可以预测直肠癌淋巴结转移,肿瘤浸润程度是直肠癌淋巴结转移的主要影响因素。
[Abstract]:Research purposes: first, through the spectral CT imaging, quantitative and qualitative assessment of preoperative rectal cancer lymph node. Second, the research of spectral CT compared with conventional CT and MRI on the preoperative N staging of rectal cancer. The third value advantage, to explore the related factors of lymph node metastasis in rectal cancer. Materials and methods: collected prospectively from September 2015 to December 2016 clinical diagnosis of patients with rectal cancer, check 1 nights before bowel cleaning check before intramuscular injection of 654-2, and by using GE HealthCare Discovery 500-1000ml. anal injection CT for routine abdominal scan and GSI enhanced dual phase scanning. Part of the patients within one week of GE3.0T MRI and conventional enhanced scan. Observe and record the CT scanning in patients with primary tumors, maximum diameter each period, CT value, iodine value, normalized iodine concentration and energy spectrum curve slope; observation of lymph node grouping, morphological characteristics (short diameter, long diameter and short diameter ratio), the number of the CT value, iodine value, standard iodine The concentration of (normalized iodine concentration, NIC) and energy spectrum curve slope; then calculate the lymph node and the primary energy spectrum curve slope (lambda Hu ratio) and the ratio of NIC. To observe and record the MRI examination in patients with lymph node grouping, the number of short diameter, long diameter, short diameter and the ratio of the DWI signal. Using independent sample t test 2, chi square test, single factor correlation analysis, regression analysis and other statistical test methods. Test level a 0.05. results: a total of 86 cases of colorectal cancer patients, 47 were male, 39 were female, age 39-77 years old, the average age was (56 + 10) years old, the median age was 56 years. Among them 47 patients were examined with MRI.27 cases without lymph node metastasis, 59 cases with lymph node metastasis, CT 473 lymph nodes were detected, which were CT group and pathology of 59 patients with stage N1-2 completely corresponding positive lymph nodes was 97 in metastatic lymph nodes and 27 cases of N0 patients were detected in 113 lymph knot into Non metastatic lymph node group.T test showed that rectal cancer metastatic lymph nodes with short diameter, short diameter ratio was higher than that in non metastatic lymph nodes. The metastatic lymph node group, and the value of CT in venous phase, venous phase iodine radical was lower than that in non metastatic lymph nodes. The lymph node length diameter ratio, arterial phase iodine value, arterial CT value, iodine value and venous phase, venous phase CT, the short diameter ROC area under the curve (AUC) were 0.847,0.841,0.792,0.758,0.746 and 0.704 respectively, the sensitivity threshold and the corresponding threshold and and specificity were 0.721,82.4%, 75%, 16.89, 84.3% (100ug/cm3). 75.3%, 69.18HU, 80.4%, 74.1%, 20.31 (100ug/cm3), 70.6%, 66.7%, 78.4%, 68.5%, 74.78HU, 7.82mm, 79.6%. 55.9%, metastatic lymph node group lambda Hu and NIC ratios and were lower than that in non metastasis group, were statistically significant difference, and the former is close to 1. metastatic lymph node group. The ratio of Hu The ratio of NIC and ROC curves of AUC O.879 and 0.835 respectively, and a Hu ratio of 1.12 of the sensitivity and specificity were 86.3%, 77.8%, NIC was 1.03 sensitivity, specificity were 82.4%, 75.9%. in the preoperative N staging of rectal cancer in the assessment of conventional CT correct evaluation of 68 cases, accuracy the sensitivity, specificity, positive predictive value (positive predictive value, PPV) and negative predictive value (negative predictive value, NPV) were 79.07%, 81.36%, 74.07%, 87.27%, 64.52%; MRI, 38 cases of correct evaluation, accuracy, sensitivity, specificity, PPV and NPV were 80.85%, 82.14%, 78.95%, 85.19%, 75%; spectral CT correct evaluation of 74 cases, the accuracy, sensitivity, specificity, PPV and NPV were 85.11%, 88.14%, 81.48%, 91.23%, 75.86%. spectrum CT preoperative N staging accuracy, sensitivity, specificity, NPV and PPV were higher than that of conventional CT and MRI.Kappa consistency test results, The conventional CT and MRI two methods are consistent, but the consistency is poor, the value of Kappa =0.670, P0.001. CT and MRI spectra of two kinds of inspection are consistent, and good consistency, Kappa value =0.896, P0.001. related factors analysis showed that gender, tumor location and tumor size in colorectal cancer lymph nodes no difference. Transfer properties on the age of patients, tumor gross type, histological type, degree of infiltration and differentiation of these 5 parameters is the transfer factors of lymph nodes in rectal cancer, the multivariate analysis showed that tumor infiltrating degree are the main factors of lymph node metastasis in rectal cancer. Conclusion: 1. energy spectrum curve slope ratio, NIC ratio, short diameter of lymph node, short diameter ratio and dynamic, intravenous iodine based value on lymph node metastasis of rectal cancer with high efficiency.2. differential energy spectrum of CT and MRI in the preoperative diagnosis of colorectal cancer N staging in good agreement, and the energy spectrum of CT than the conventional CT and MRI value Age, primary tumor type, histological type, differentiation degree and infiltration degree can predict lymph node metastasis of rectal cancer, and the degree of invasion is the main influencing factor of lymph node metastasis in patients with higher.3. rectal cancer.

【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.37;R445.2;R730.44

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