双源CT虚拟平扫技术在阻塞性黄疸病因诊断中的应用研究

发布时间：2018-04-11 07:40

本文选题：体层摄影术 + X线计算机　；参考：《泰山医学院》2013年硕士论文

【摘要】：目的本研究旨在利用通过双源CT（Somatom Definition flash DSCT）对临床拟诊为阻塞性黄疸的病患行双能量扫描，探讨双源CT双能量虚拟平扫技术（VNC）在阻塞性黄疸病因诊断中的价值。研究方法选择自2012年4月-2012年10月来我院检查的30例经临床诊断为阻塞性黄疸患者，其中男性16例,女性14例,年龄34~75岁,平均57.9岁，口服对比剂前先行常规腹部平扫（CNC），然后口服阳性对比剂500ml，再用双能量扫描模式动脉期强化扫描，最后行常规门静脉期强化扫描，之后采用肝脏虚拟平扫后处理软件Liver VNC，经参数调整，对双能量强化图像进行处理，得到VNC图像，以常规平扫图像为金标准比较VNC图像在病灶检出中的准确性，并利用t检验对比分析图像信噪比（SNR），用轶和检验分析患者不同扫描方式接受的总辐射剂量容积CT剂量指数（CTDIvol）值和剂量长度乘积（DLP）值有无统计学差异。结果以常规平扫图像为标准，VNC图像病灶检出率100%，其中胆囊结石6例，胆总管结石5例，胆管肿瘤11例，壶腹部肿瘤3例，胰腺肿瘤5例，VNC组图像瘤可见度、诊断接受度低于CNC组，差异无明显统计学意义（P0.05），图像CT值及信噪比差异无明显统计学意义， VNC图像质量略有下降，但能满足诊断要求，在结石和肿瘤等病变检出中无明显差异,在剂量统计分析中虚拟组较常规组低，具有明显统计学差异（P=0.0020.05）。结论在阻塞性黄疸患者的CT病因诊断时，虚拟平扫技术能够有效减少辐射剂量，且不影响结石和肿瘤等病变的检出，使其取代常规平扫成为可能。意义黄疸(jaundice)是指由于血浆内胆红素浓度升高所导致的皮肤、结膜和粘膜出现的橙黄色改变，是一种临床常见的征象，其中阻塞性黄疸不仅对肝脏的形态和功能有很大影响，对除了肝脏之外的脏器也有巨大的影响，例如心血管、肾脏、胃肠道、胰腺等。虽然良性病因常占大多数，为胆石症、胆管炎症、寄生虫病、胆管憩室、先天性胆管异常、急性或慢性胰腺炎、手术后胆管狭窄、胆总管周围组织粘连等，但是恶性阻塞性黄疸往往起病隐匿，病因复杂，，既可为原发于肝、胆、胰腺等部位的恶性肿瘤如胆管癌、胆囊癌、胰头癌、肝细胞癌、壶腹周围癌等，也可以为其他部位的恶性肿瘤转移而来侵犯胆道，而且预后较差，因此早期诊断对其临床治疗方案的制定有重大意义。在当前的临床工作中，阻塞性黄疸患者受检方法主要有B超、CT、MRCP、ERCP等，但B超诊断准确率较低，MRCP无法对病变周围血管情况做出评价，ERCP检查存在创伤性和风险性，可能发生并发症，CT扫描速度快,且可以获得任意平面的重建图像,对胆总管下段小病变的显示极为有利，对胆系疾患的诊断更具有独特的优越性，而且当前对阻黄患者过度检查、盲目检查时有发生，不但浪费了患者的时间，加重了患者的负担，而且增加了患者接受的辐射剂量，虚拟平扫技术的应用使阻塞性黄疸的检查状况有了较大改善，虚拟平扫技术的应用不但可以节省扫描时间，减少了患者接受的辐射剂量，且可以为临床提供足够的诊断信息，为治疗方案的制定提供足够的帮助。
[Abstract]:objective
The purpose of this study is to explore the value of dual source CT dual energy virtual flat scan (VNC) in etiological diagnosis of obstructive jaundice by dual energy scanning through dual source CT (Somatom Definition flash DSCT).
research method
Select 30 cases from April 2012 -2012 year in October in our hospital diagnosed by clinical examination of patients with obstructive jaundice, of which 16 were male, 14 were female, aged 34~75 years old, average 57.9 years old, oral contrast agent before routine abdominal plain (CNC), and positive oral contrast agent 500ml, with dual energy scan mode arterial phase enhancement scan, and then routine venous phase enhanced scan of the liver, after using the virtual scan postprocessing software Liver VNC, the parameter adjustment of dual energy image enhancement, VNC images are obtained by conventional unenhanced image standard accuracy of VNC images in the detection of lesions in gold, and the use of T comparative analysis of test image signal-to-noise ratio (SNR) index, the total radiation dose volume CT dose received by different scanning methods and test analysis of patients with Yi (CTDIvol) and dose length product (DLP) value has no statistical difference.
Result
In conventional unenhanced image as the standard, the VNC images of the lesion detection rate of 100%, including 6 cases of cholecystolithiasis, 5 cases of common bile duct stones, bile duct tumor in 11 cases, 3 cases of ampullary carcinoma, 5 cases of pancreatic cancer, VNC images of tumor visibility, diagnosis of acceptance is lower than the CNC group, the difference was not statistically significant (P0.05) the value of CT, the image signal-to-noise ratio and the difference was not statistically significant, the image quality of VNC decreased slightly, but to meet the diagnostic requirements, no significant difference in the detection of calculus and tumor lesions, at the doses of statistical analysis in virtual group lower than the conventional group, with significant statistical difference (P=0.0020.05).
conclusion
In the diagnosis of CT in patients with obstructive jaundice, virtual scanning technology can effectively reduce the radiation dose, and does not affect the detection of stones and tumors, making it possible to replace conventional plain scan.
Significance
Jaundice (jaundice) refers to the bilirubin concentration in plasma increased in the skin, conjunctiva and mucosa appeared orange color change, is a common clinical signs of obstructive jaundice, which not only on the morphology and function of the liver has great influence, also have a huge impact on the outside, in addition to the liver organs such as cardiovascular. Kidney, gastrointestinal tract, pancreas. Although benign etiology is often the majority for cholelithiasis, bile duct inflammation, parasitic disease, biliary diverticulum, congenital bile duct abnormalities, acute or chronic pancreatitis, biliary stricture after surgery, common bile duct tissue adhesion, but malignant obstructive jaundice is often insidious onset, complex causes, can for the primary liver, gallbladder, bile duct cancer such as malignant gallbladder carcinoma, pancreas, pancreatic carcinoma, hepatocellular carcinoma and periampullary carcinoma, can also invade other parts of the biliary tract for malignant tumor metastasis, and The prognosis is poor, therefore making early diagnosis of the clinical treatment scheme is of great significance in clinical work. The current in the patients with obstructive jaundice. Methods include ultrasound, CT, MRCP, ERCP and so on, but the accuracy rate of ultrasound diagnosis is low, MRCP will not be able to do the evaluation of peripheral vascular disease, ERCP examination traumatic and the risk of possible complications, CT scanning speed, the reconstructed image can be obtained and arbitrary, for common bile duct lesions showed extremely beneficial for diagnosing biliary diseases has unique advantages, and when the patients with obstructive jaundice excessive examination, blind checks have occurred not only a waste of time, patients, increased the burden on patients, but also increase the radiation dose of patients, application of virtual scan technology to check the status of obstructive jaundice has greatly improved, not only the application of virtual scan technology It can save scanning time, reduce the radiation dose of patients, and provide enough information for clinical diagnosis, so as to provide enough help for the formulation of treatment plan.

【学位授予单位】：泰山医学院
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R816.5;R575

【参考文献】