双能量CT对胃癌患者术前病理分级及分期的临床研究

发布时间：2018-04-06 05:14

本文选题：双能　切入点：体层摄影术　出处：《郑州大学》2014年博士论文

【摘要】：胃癌是消化道常见恶性肿瘤,占每年新发癌症人数的8%。胃癌的预后和TNM分期及分化程度密切相关。多排螺旋CT(multi-detector row CT,MDCT)成像已广泛的应用于胃癌的术前TNM分期及分化程度的诊断,但是仍有一些问题需要解决。双源双能量CT已应用于临床,它的优势在于一次扫描可以同时获得高能量图像、低能量图像及混合能量图像。还可得到各水平的单能量图像及最佳单能量图像。我们可以根据诊断的需要,选择不同的图像。能得到虚拟平扫图像。虚拟平扫图像因能够避免常规平扫,可减少辐射剂量,尤其是对需要长期随访的患者。本文研究目的是评价双源双能量CT技术是否能优化图像质量,提高TNM分期及分化程度诊断的准确性,以及虚拟平扫图像在降低辐射剂量可行性的评估。第一部分胃癌双能量图像的优化选择及其在术前分期中的应用目的：探讨双源双能量CT图像优化选择后的图像质量,及其在胃癌术前分期中的临床应用。材料和方法：收集我院2011年12月至2013年2月期间怀疑胃癌行腹部双源双能量增强扫描的患者55例。其中男41例,女14例,年龄23-81岁,平均年龄59.38岁。均经手术或胃镜病理证实。其中行手术的患者43例,其中男31例,女12例,年龄23～78岁,平均年龄59.05岁。测量100kV、120kV及70keV各能量下胃癌病灶、淋巴结的CT值、噪声、对比噪声比(signal-to-noise ratio,SNR)。比较各kV能量及70keV图像间图像质量,优化选择最佳的图像。并评估优化后图像的胃癌术前TNM分期,和120kV图像相对比。结果： 1.胃癌病灶动脉期100kV、120kV、70keV图像质量评价：100kV和70keV图像强化程度明显高于120kV。100kV和70keV图像的CT值(87.28±23.91；84.86+21.59)明显高于120kV的的CT值(73.08±17.49)(P0.001)。120kV和70keV的图像噪声(16.67±4.44；17.50±3.48)明显低于100kV(23.80±6.53)的图像噪声(P0.01)。120kV和70keV的SNR(4.58±1.32；4.97±1.44)明显高于100kV(3.844±1.29)(P0.01),70keV的CT值较120kV的的CT值增加了约16%,但是SNR是相仿的。 2.胃癌病灶静脉期100kV、120kV、70keV图像质量评价。100kV和70keV图像强化程度明显高于120kV。100kV和70keV图像的CT值(102.10±21.06；101.33士18.68)明显高于120kV的的CT值(83.70±15.37)(P0.001)。120kV和70keV的图像噪声(18.16±5.25；18.37±5.31)明显低于100kV(25.53±7.93)的图像噪声(P0.01)。70keV的SNR(5.93±2.00)明显高于120和100kV的SNR(5.01±1.91；4.43±2.03)(P0.01),70keV的CT值较120kV的的CT值增加了约21%,但是SNR较120kV的高。 3.70keV和120kV胃癌患者T分期总的符合率分别为83.7%、72.1%。70keV和120kV图像T1符合率分别为88.4%、95.3%,T2-3符合率分别为81.4%、90.7%,T4a符合率分别为83.7%、88.3%,T4b胃癌符合率分别为95.3%、95.3%,两种图像在胃癌浸润深度中差别没有统计学意义(P=0.25)。 4.120kV胃癌患者N分期总的符合率为62.8%,70keV提高到74.4%(P0.05)。70keV和120kV图像NO符合率分别为86.0%、86.0%,N1符合率分别为86.0%、76.7%,N2符合率分别为83.7%、81%,N3胃癌符合率分别为93.0%、88.4%。结论：双能量CT成像70keV单能图像较120kV不仅提高了胃癌病灶的CT值,图像质量。并且提高了胃癌N分期的符合率(P＜0.05)。第二部分双能量CT虚拟平扫技术在胃癌诊断中的价值目的：本文研究的目的主要是定性、定量评价胃癌双能量扫描中虚拟平扫的图像质量及对胃癌术前评价的诊断价值。评估在胃癌患者中虚拟平扫能减少的辐射剂量问题。材料和方法：收集我院2011年12月至2013年2月期间怀疑胃癌行腹部双源双能量增强扫描的患者55例。其中男41例,女14例,年龄23～81岁,平均年龄59.38岁。均经手术或胃镜病理证实。利用双能技术可以得到动脉期及静脉期两组图像产生的虚拟平扫图像(virtual non-enhanced,VNE),分别称为VNEA (VNE images derived from the arterial phases, VNEA)、VNEP (VNE images derived from the portal venous phases,VNEP)。测量常规平扫(true non-enhanced, TNE)、VNEP、VNEA三组图像胃癌病灶、淋巴结的CT值、噪声、SNR。主观评价三组图像的解剖细节、噪声、伪影及是否能满足诊断。记录三期扫描的容积CT剂量指数(volme CT dose index,CTDIvol)值。比较双能三期(常规平扫、动脉期、门脉期)、及双期(动脉期、门脉期)的容积CT剂量指数剂量来计算辐射剂量降低的百分比。 30例患者于半年内进行了复查。其中和首次检查同在第二代双源的患者15例。记录治疗后单源模式扫描的CTDIvol值。结果： 1.常规平扫和虚拟平扫图像胃癌病灶的CT值、最大厚度差异没有统计学意义(P0.05)。但是常规平扫的噪声高于虚拟平扫,SNR低于虚拟平扫图像(P0.05)。两组虚拟平扫图像间肿瘤的CT值、最大厚度、噪声及SNR没有差别(P0.05)。 TNE、VNE图像肿大淋巴结的直径相仿(P0.05)。TNE较VNEP的CT值高(P0.05)。常规平扫的噪声高于虚拟平扫,SNR低于虚拟平扫图像(P0.05)。VNEA、VNEp两组虚拟图像不论肿大淋巴结的大小、CT值、噪声及SNR差异均没有统计学意义(P0.05)。 2.TNE、VNEA、VNEP三组图像中,在解剖细节显示方面,两两比较,TNE较VNEP解剖细节显示清晰(P0.05),TNE、VNEA间相仿(P0.05)。虚拟平扫较的噪声、界面伪影的评分高于常规平扫(P0.05)。两组虚拟平扫图像间解剖细节的显示、噪声级界面伪影评分没有差异(P0.05)。三组图像均能满足诊断需求(P0.05)。 3.22例结石、钙化中,4例在VNE图像中没有显示,1例在VNEP中没有显影,VNEA中吸收明显。1例在VNEA中没有显影,在VNEp中重度吸收。3例在VNE图像中均变小。 4.胃癌检出及周围侵犯的比较：对病灶检出情况及周围的侵犯的显示,TNE、VNEA、VNEp三组图像结果近似(P0.05)。有2例TNE、VNEA、VNEp三组图像均没有发现病变,1例TNE中发现,2组VNE图像中没有检出病灶,VNEA中1例没有检出处浆膜侵犯,VNEp中2例没有检出浆膜侵犯,三组图像中对邻近胰腺、肝脏的侵犯均检出,对肝脏转移检测的情况相同,在肿大淋巴结中,TNE检测出47例,有1例VNEA检测出,VNEP没有检测出,2例VNEP检测出,VNEA没有检测出,5例二者都没有检测出。 5.双能量扫描模式,虚拟平扫图像可代替常规平扫,如果去掉平扫的辐射剂量,可减少32.41%的辐射剂量。结论：胃癌患者术前分期扫描虚拟平扫图像具有替代常规平扫的潜在能力,从而可以降低32.41%的辐射剂量。第三部分双能量CT碘浓度及能谱曲线在胃癌病理分级中的应用目的：判断双能量CT技术的碘含量及能谱曲线与胃癌病理分级间的关系。材料和方法：收集我院2011年12月至2013年2月期间怀疑胃癌行腹部双源双能量增强扫描的患者55例。其中男41例,女14例,年龄23-81岁,平均年龄59.38岁。均经手术或胃镜病理证实。测量平扫、动脉期和静脉期胃癌病灶的CT值、碘值及同层主动脉碘值。测量肿大淋巴结动静脉双期的碘值,计算标准化碘浓度(normalized iodine concentration,NIC)=病灶内测得的碘值／同层面腹主动脉测得。的碘值。计算胃癌病灶动脉期、静脉期强化的程度。动脉期强化程度CTA为动脉期CT值-平扫的CT值；静脉期强化程度CTP为静脉期CT值-平扫的CT值。CTPA为静脉期肿瘤的CT值-动脉期肿瘤的CT值。将双能量数据传入Dual-Ene(?)gy软件的"Monoenergetic”程序进行观察分析。可以得到40kev-190kev任意kev条件下感兴趣区的CT值。测量胃癌病灶、肿大淋巴结单能量条件下的CT值,每隔10kev保存记录一次。结果： 1.不同分化程度胃癌的平扫、动脉期、静脉期CT值及CTA、CTP差异没有统计学意义(P均大于0.05)。 2.不同分化程度胃癌的CTPA、静脉期的标准化碘值差异有统计学意义(P0.05)。 3.不同性质的淋巴结动脉期、静脉期标准化碘值差异均有统计学意义(P0.05)。 4.不同分化程度胃癌的能谱曲线,动脉期曲线走形是重叠的。静脉期,低分化胃癌的曲线位于中高分化胃癌的上方,keV越低,走形越陡,差别越明显；随着keV增高,走形平缓,差异减小。 5.静脉期低分化胃癌的能谱衰减曲线斜率大于中分化胃癌。动脉期斜率无统计学意义。结论：双能CT技术的标准化碘浓度定量测定及能谱曲线和胃癌的病理分化程度是相关的。
[Abstract]:Multi - detector row CT ( MDCT ) imaging has been widely used in the diagnosis of preoperative TNM staging and differentiation of gastric cancer .

The Optimal Selection of Dual Energy Image in the First Part of Gastric Cancer and Its Application in Preoperative Staging

Purpose :

Objective To investigate the image quality of dual - source dual - energy CT image optimization and its clinical application in preoperative staging of gastric cancer .

Materials and methods :

Fifty - five patients were collected from our hospital between December 2011 and February 2013 . Among them , 41 males and 14 females , aged 23 - 81 years , mean age of 59.38 years , were confirmed by operation or endoscopy . Among them , 31 males , 12 females , aged 23 - 78 years , mean age of 59.05 years , measured the lesions of gastric cancer , CT value , noise and contrast - to - noise ratio ( SNR ) of lymph nodes at 100kV , 120kV and 70keV . The best image quality was selected by comparing the image quality between each kV energy and 70keV images . The preoperative TNM staging and the relative ratio of 120kV images were evaluated .

Results :

1 . The image quality of 100 kV , 120kV and 70keV images in the arterial phase of gastric cancer was evaluated : the enhancement degree of 100kV and 70keV images was obviously higher than that of 120kV , 100kV and 70keV images ( 87.28 卤 23.91 ;
84.86 + 21.59 ) significantly higher than 120kV ( 73.08 卤 17.49 ) ( P0.001 ) . 120kV and 70keV image noise ( 16.67 卤 4.44 ;
17.50 卤 3.48 ) significantly lower than 100kV ( 23.80 卤 6.53 ) image noise ( P0.01 ) . SNR of 120kV and 70keV ( 4.58 卤 1.32 ) ;
4 . 97 卤 1 . 44 ) was significantly higher than that of 100 kV ( 3 . 844 卤 1 . 29 ) ( P0.01 ) . CT value of 70 keV increased by about 16 % than that of 120kV , but SNR was similar .

2 . The image quality of 100 kV , 120kV and 70keV images was evaluated in 100 kV , 120 kV and 70 keV images , and the enhancement of 100 kV and 70 keV images was significantly higher than that of 120kV . 100kV and 70keV images ( 101.10 卤 21.06 ) .
101.33 卤 18.68 ) significantly higher than 120kV ( 83.70 卤 15.37 ) ( P0.001 ) . 120kV and 70keV image noise ( 18.16 卤 5.25 ;
The SNR ( 5.93 卤 2.00 ) of the 70keV SNR ( 5.93 卤 2.00 ) was significantly higher than that of 120 and 100kV ( 5.01 卤 1.91 ) , which was significantly lower than that of 100kV ( 25.53 卤 7.93 ) .
4.43 卤 2.03 ) ( P0.01 ) , the CT value of 70keV increased by about 21 % compared with that of 120kV , but SNR was higher than 120kV .

The coincidence rate of T staging in patients with 3.70keV and 120kV gastric cancer was 83.7 % , 72.1 % , 70keV and 120kV , respectively 88.4 % , 95.3 % , T4a coincidence rate 81.4 % , 90.7 % , T4a coincidence rate 83.7 % , 88.3 % , T4b gastric cancer coincidence rate was 95.3 % and 95.3 % , respectively . There was no significant difference between the two images in the depth of invasion of gastric cancer ( P = 0.25 ) .

The coincidence rate of N staging of patients with 120kV gastric cancer was 62.8 % , 70keV increased to 74.4 % ( P0.05 ) . The coincidence rates of NO in 70keV and 120kV were 86.0 % , 86.0 % , N1 coincidence rate was 86.0 % , 76.7 % , N2 coincidence rate was 83.7 % , 86.4 % , respectively . Conclusion :

Dual - energy CT imaging 70 keV single - energy image 120 kV not only improved the CT value and image quality of gastric cancer lesions , but also improved the coincidence rate of N staging of gastric cancer ( P & lt ; 0.05 ) .

Value of the second partial double - energy CT virtual plain scanning technique in the diagnosis of gastric cancer

Purpose :

The purpose of this study is to qualitatively and quantitatively evaluate the image quality of virtual plain scan in gastric cancer dual energy scan and the diagnostic value of preoperative evaluation of gastric cancer .

Materials and methods :

Fifty - five patients were collected from our hospital between December 2011 and February 2013 . Among them , 41 males and 14 females , aged 23 - 81 years , mean age of 59.38 years , were confirmed by operation or pathology . Virtual non - enhanced , VNE images produced by both arterial and venous phases were obtained by dual - energy technique , respectively , and VNEP ( VNE images derived from the portal venous phases , VNEP ) . The volume CT dose index ( CTDIvol ) values of three groups of images , such as normal plain scan ( true non - enhanced , TNE ) , VNEP and Vnea , were measured . The volume CT dose index ( CTDIvol ) of three groups of images was recorded .

Thirty patients were re - examined in half a year , and 15 patients with second - generation dual - source were examined for the first time and CTDIvol values were recorded for single - source mode scans after treatment .

Results :

1 . There was no significant difference in the CT value and the maximum thickness difference between conventional plain scan and virtual plain scan images ( P0.05 ) , but the noise of conventional plain scan was higher than that of the virtual plain scan ( P0.05 ) . There was no difference in the CT value , the maximum thickness , the noise and SNR between the two groups of virtual plain scan images ( P0.05 ) .

Compared with VNEP ( P0.05 ) , TNE and VNE were higher than those of VNEP ( P0.05 ) . The noise of conventional plain scan was higher than that of virtual plain scan ( P0.05 ) .

2 . In three groups of images of TNE , Vnea and VNEP , the anatomical details of TNE and VNEP showed clear ( P0.05 ) , TNE and Vnea were similar ( P0.05 ) .

3 . In 22 cases of stone and calcification , 4 cases did not show in the VNE image , 1 case did not develop in VNEP , 1 case did not develop in Vnea , moderate to severe absorption in VNEp . 3 cases were smaller in VNE image .

4 . Comparison of detection and peripheral invasion of gastric cancer : There were no lesions in the three groups of TNE , Vnea and VNEp ( P0.05 ) . There were 2 cases of TNE , Vnea and VNEp . There were no lesions in the two groups .

5 . Dual - energy scanning mode , the virtual plain scan image can replace the conventional plain scan , and if the radiation dose of the plain scan is removed , the radiation dose of 32.41 % can be reduced . Conclusion :

The preoperative staging scan of the virtual plain scan image has the potential to replace the conventional plain scan , thereby reducing the radiation dose of 32.41 % .

Application of the third partial double - energy CT iodine concentration and energy spectrum curve in the pathological grade of gastric cancer

Purpose :

The relationship between iodine content , energy spectrum curve and pathological grade of gastric cancer was determined .

Materials and methods :

In this study , 55 patients were collected from our hospital between December 2011 and February 2013 . Among them , 41 male , 14 female , aged 23 - 81 years , mean age 59.38 years , were confirmed by operation or pathology .
The CT value of CT value - plain scan in venous phase is CTPA . CTPA is the CT value of venous phase tumor - CT value of arterial phase tumor .

The CT value of the region of interest can be measured with the single energy condition of 40 keV to 190 keV . The CT value of the lesion of gastric cancer and the single energy condition of the lymph node of the enlarged lymph node is measured , and the record is saved every 10 keV .

Results :

1 . There was no significant difference between CT value and CT value of different degrees of differentiation ( P > 0.05 ) .

2 . There was significant difference in the standardized iodine value between CTPA and venous phase in different degrees of differentiation ( P0.05 ) .

3 . There was significant difference in the standardized iodine value between lymph node arterial phase and venous phase in different properties ( P0.05 ) .

4 . The curve of energy spectrum of gastric cancer with different differentiation degree and the shape of arterial phase were overlapped . The curve of venous phase and low differentiation gastric cancer was located above the middle and high differentiated gastric cancer . The lower the keV , the steeper the shape , the more obvious the difference .
With the increase of keV , the shape is gentle and the difference is reduced .

5 . The slope of energy spectrum attenuation curve of venous phase low differentiation gastric cancer was larger than that in middle - differentiated gastric cancer . There was no statistical significance in the slope of arterial phase .

Conclusion :

The quantitative determination of standardized iodine concentration in dual - energy CT and the degree of pathological differentiation of gastric cancer were correlated .

【学位授予单位】：郑州大学
【学位级别】：博士
【学位授予年份】：2014
【分类号】：R735.2;R730.44

【参考文献】