双源CT在大肠癌诊断中的应用价值

发布时间：2018-03-13 08:08

本文选题：双源CT　切入点：碘浓度　出处：《华中科技大学》2013年硕士论文　论文类型：学位论文

【摘要】：目的：研究双源CT大肠癌碘浓度与癌组织CD31标记MVD计数的相关性，探讨碘浓度对判断肿瘤侵袭及转移能力的价值；以及癌周脂肪碘浓度对进展期大肠癌周围脂肪侵犯评价的能力。材料与方法：收集中南医院2012年1月-2012年10月经结肠镜活检或术后病理证实大肠癌患者30例，其中男性17例，女性13例，，年龄41-74岁，平均年龄约67岁。所有病例均在术前行常规平扫和双源CT增强扫描（50-55s），得到的数据资料传入后处理工作站对图像进行后处理及相关分析，分别测量病灶及癌周脂肪碘浓度；大肠癌病理组织采用S-P免疫组化法进行CD31表达的检测，并计数微血管密度（MVD）。根据术后病理结果，30例患者分别按有、无浆膜侵犯及转移进行分组，分析各组间碘浓度与MVD计数的相关性，碘浓度与肿瘤浆膜侵犯、转移能力大小的关系；以及癌周脂肪碘浓度与脂肪受侵的关系。结果：30例病例中，参照术后病理结果：20例大肠癌浆膜侵犯病例碘浓度为2.40±0.44mg/ml，10例无浆膜侵犯病例碘浓度测值为1.97±0.34mg/ml；11例有转移的病例碘浓度测值为2.56±0.38mg/ml，19例无转移的病例为2.07±0.39mg/ml,两组差别均有统计学意义(P0.05)；10例有肠周脂肪受侵的病例，癌周脂肪碘浓度为0.75±0.28mg/ml,20例无肠周脂肪侵犯病例碘浓度测值为0.11±0.11mg/ml，差异有统计学意义（P0.05）。Pearson相关分析显示：病灶碘浓度与MVD计数呈正相关（P0.01）。利用SPSS18软件ROC曲线法选取最佳灵敏度和特异度最佳临界值：浆膜侵犯组碘浓度当界值为2.05mg/ml时，灵敏度是75%，特异度是70%；转移组碘浓度当界值为2.25mg/ml时，灵敏度81.8%，特异度78.9%；脂肪侵犯组癌周脂肪碘浓度当界值为0.25mg/ml时，灵敏度是100%，特异度是86.4%。结论：双源CT大肠癌碘浓度测定与MVD计数呈正相关，可以评价肿瘤血管生成；癌周脂肪碘浓度测定有助于判断脂肪是否受侵。碘图能够成为评价大肠癌局部侵犯及远处转移能力大小的工具。
[Abstract]:Objective: to study the correlation between iodine concentration and CD31 labeled MVD count in colorectal carcinoma with dual-source CT, and to explore the value of iodine concentration in judging tumor invasion and metastasis. And the ability of pericancerous fat iodine concentration to evaluate peripheral fat invasion of advanced colorectal cancer. Materials and methods: thirty patients with colorectal cancer confirmed by colonoscopic biopsy or postoperative pathology from January 2012 to 2012 in Central South Hospital were collected, including 17 males and 13 females aged 41-74 years. The average age was about 67 years old. All the patients underwent conventional plain scan and dual-source CT enhanced scan for 50-55 s. The data were transmitted to the post-processing workstation for post-processing and correlation analysis, and the concentration of fat and iodine in the lesion and pericancerous area were measured respectively. S-P immunohistochemical method was used to detect the expression of CD31, and the microvessel density (MVD) was counted. According to the pathological results, 30 patients were divided into groups according to their presence, no serosal invasion and metastasis. The correlation between iodine concentration and MVD count, the relationship between iodine concentration and tumor serosa invasion and metastasis ability, and the relationship between iodine concentration in pericancerous fat and fat invasion were analyzed. Results of the 30 cases, According to postoperative pathological results, iodine concentration in 20 patients with serosal invasion of colorectal cancer was 2.40 卤0.44 mg / ml, the iodine concentration of 10 cases without serosal invasion was 1.97 卤0.34 mg / ml, the iodine concentration of 11 cases with metastasis was 2.56 卤0.38 mg / ml, and that of 19 cases without metastasis was 2.07 卤0.39 mg / ml, there was statistical difference between the two groups. There were 10 cases with periintestinal fat invasion. The iodine concentration of pericancerous fat was 0.75 卤0.28 mg / ml in 20 cases without pericardial fat invasion, and the iodine concentration was 0.11 卤0.11 mg / ml. The difference was statistically significant (P 0.05). Pearson correlation analysis showed that there was a positive correlation between iodine concentration and MVD count (P 0.01). The best Ling was selected by ROC curve method of SPSS18 software. The best critical value of sensitivity and specificity: iodine concentration in the serosal invading group when the boundary value was 2.05 mg / ml, The sensitivity was 75 and the specificity was 70. When the threshold of iodine concentration in the metastatic group was 2.25 mg / ml, the sensitivity was 81.8 and the specificity was 78.9. In the fat invasion group, the sensitivity was 100 and the specificity was 86.4 when the limit was 0.25 mg / ml. Conclusion: the measurement of iodine concentration in colorectal carcinoma with double source CT is positively correlated with MVD count, which can be used to evaluate tumor angiogenesis. The determination of iodine concentration in pericancerous fat is helpful to determine whether the fat is invaded or not. Iodograms can be used to evaluate the ability of local invasion and distant metastasis of colorectal cancer.
【学位授予单位】：华中科技大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R735.34;R730.44

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