能谱CT在食管胃结合部鳞癌与腺癌鉴别诊断中的初步研究

发布时间：2018-04-14 10:34

本文选题：食管胃接合处 + 肿瘤　；参考：《山东中医药大学》2017年硕士论文

【摘要】：目的:探讨能谱CT成像在食管胃结合部鳞癌与腺癌鉴别诊断中的应用价值。方法:回顾性分析我院经病理证实并行能谱CT增强扫描的食管胃结合部占位患者45例,鳞癌20例、腺癌25例。利用能谱后处理分析软件分别测量两组动脉期及静脉期肿块内同一感兴趣区的碘浓度(IC)、水浓度(WC)、有效原子序数(Eff-Z)及能谱曲线斜率(λHU);在满足正态分布条件下采用独立样本t检验比较鳞癌组与腺癌组各能谱参数有无差异;对差异有统计学意义的参数进一步绘制ROC曲线,利用曲线下面积(AUC)衡量其各自的鉴别诊断效能并选择最佳诊断阈值。结果:动脉期IC、Eff-Z和λHU的平均值,腺癌分别为(1.75±0.40)mg/mL、8.65±0.22、3.33±0.74,鳞癌相应参数分别为(1.40±0.35)mg/mL、8.50±0.20及2.71±0.66,腺癌均大于鳞癌,差异有统计学意义(t值分别为-2.833、-2.879、-2.678,P值均0.05);静脉期IC、Eff-Z和λHU的平均值,腺癌分别为(2.17±0.23)mg/mL、8.87±0.11、4.10±0.44,鳞癌相应参数分别为(1.67±0.20)mg/mL、8.60±0.11及3.19±0.41,腺癌均大于鳞癌,差异也均有统计学意义(t值分别为-6.963、-7.218、-6.521,P均0.05)。而动脉期WC的平均值,腺癌和鳞癌分别为(1016.04±7.80)mg/mL和(1020.40±10.43)mg/mL;静脉期WC的平均值,腺癌和鳞癌分别为(1019.94±6.51)mg/mL和(1020.23±10.09)mg/mL,差异均无统计学意义(t值分别为1.435和0.104,P均0.05)。对动脉期及静脉期IC、Eff-Z和λHU行ROC曲线分析显示静脉期IC、Eff-Z和λHU具有较高的诊断效能,尤其是静脉期Eff-Z,AUC为0.97,以8.72为阈值,其鉴别鳞癌与腺癌的敏感度和特异度分别为88.9%、94.7%。结论:能谱CT多参数定量分析对食管胃结合部鳞癌与腺癌的鉴别诊断具有价值。
[Abstract]:Objective: to evaluate the value of energy dispersive CT in differential diagnosis of esophageal and gastric squamous cell carcinoma and adenocarcinoma.Methods: 45 patients with esophageal and gastric junction, 20 with squamous cell carcinoma and 25 with adenocarcinoma were retrospectively analyzed.Using the software of energy spectrum post-processing analysis, the iodine concentration of the same area of interest in the two groups of arterial and venous tumors were measured, and the slope of the energy spectrum curve (位 HUU) and the effective atomic number (Eff-Z) were measured under the condition of satisfying the normal distribution of the tumor by using the iodide concentration, the water concentration, the effective atomic number and the slope of the energy spectrum curve.T test was used to compare the difference of energy spectrum parameters between squamous cell carcinoma group and adenocarcinoma group.The ROC curve was further drawn for the parameters with statistical significance. The area under the curve was used to evaluate their differential diagnostic effectiveness and select the best diagnostic threshold.Results: the mean values of ICEff-Z and 位 Hu in arterial stage were 1.75 卤0.40 mg / mL, 8.65 卤0.22 mg / mL, 3.33 卤0.74, respectively, and the corresponding parameters of squamous cell carcinoma were 1.40 卤0.35 mg / mL, 8.50 卤0.20 and 2.71 卤0.66, respectively. The mean values of ICEff-Z and 位 Hu were higher in adenocarcinoma than in squamous cell carcinoma (P = -2.83 3, -2.879- 2.678, P = 0.05, respectively).The corresponding parameters of squamous cell carcinoma were 1.67 卤0.20 mg / mL, 8.60 卤0.11 and 3.19 卤0.41, respectively. The difference between adenocarcinoma and squamous cell carcinoma was statistically significant (-6.963- 7.218- 6.521, P < 0.05).The mean values of WC in arterial phase, adenocarcinoma and squamous cell carcinoma were 1016.04 卤7.80)mg/mL and 1020.40 卤10.43 mg / mL, respectively, while the mean values of WC in venous phase, adenocarcinoma and squamous cell carcinoma were 1019.94 卤6.51)mg/mL and 1020.23 卤10.09 mg / mL, respectively. The difference was not statistically significant (t = 1.435 and 0.104g / mL, respectively).The ROC curve analysis of ICEff-Z and 位 Hu in arterial phase and venous phase showed that ICEff-Z and 位 Hu had high diagnostic efficacy, especially in venous phase, Eff-Z and 位 Hu were 0.97. The sensitivity and specificity of Eff-Z and 位 Hu in differentiating squamous cell carcinoma from adenocarcinoma were 88.994. 77.The sensitivity and specificity of Eff-Z and 位 Hu were 88.994.Conclusion: multiparameter quantitative analysis of energy dispersive CT is valuable in the differential diagnosis of esophageal and gastric squamous cell carcinoma and adenocarcinoma.
【学位授予单位】：山东中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735;R730.44

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