256层螺旋CT全器官灌注成像在胰腺癌中的研究

发布时间：2018-05-09 06:00

本文选题：CT + 灌注成像　；参考：《复旦大学》2013年硕士论文

【摘要】：通过全胰腺CT灌注成像测量正常胰腺和胰腺癌的CT灌注特征,探索全胰腺灌注成像在胰腺癌中的应用价值。并通过对胰腺癌病理标本MVD的检查,探索胰腺癌CT灌注参数值和肿瘤血管生成的相关性。第一部分正常胰腺组织的256层螺旋CT全器官灌注成像研究目的：通过对无胰腺疾病患者的正常胰腺组织进行全器官CT灌注成像,获得相关灌注参数,探索正常胰腺的全器官灌注的特征。材料和方法：2011年1月至2013年3月收集26例非胰腺疾病患者行全胰腺CT灌注。采用256层Philips Brilliance iCT,100kVp,100mAs,5mm层厚,350mm重建视野,512×512矩阵。扫描前经肘静脉置20G留置针,以5ml/s流速,用高压注射器注射非离子型造影剂碘帕醇(Iopamidol,370mgI/ml)50ml,后继续以相同速率注射生理盐水30ml。胰腺全器官CT灌注扫描方案共包含扫描13组,每组扫描7s：2s的扫描时间和5s的间隔时间,总扫描时间85s。数据重建算法：iDose4Level4。数据处理采用第三方灌注软件MIStar (Version3.2),测量26例正常胰腺组织的血流量(Blood Flow, BF)、血容量(Blood Volume, BV),毛细血管表面通透性(Permeability surface of product, PS)和平均通过时间(Mean transit time, MTT)将获得数据进行统计学分析。结果：全器官CT灌注正常胰腺血流量(BF)、血容量(BV)、表面通透性(PS)、平均通过时间(MTT)灌注值分别为：114.08±20.62mL/100g/min,19.34±2.45mL/100g,29.01±4.10mL/100g/min,7.12±2.19s。正常胰腺组织头、体、尾部灌注参数的差异无明显统计学意义(P0.05) 结论：全器官CT灌注正常胰腺表现为组织血流量、血容量、毛细血管平均通透性及造影剂平均通过时间均匀一致的实质性脏器。第二部分胰腺癌的256层螺旋CT全器官灌注成像研究目的：通过对胰腺癌患者进行全胰腺CT灌注成像,获得相关灌注参数,探索胰腺癌的CT灌注的特征。材料和方法：2011年1月至2013年3月收集36例胰腺癌病患者行全胰腺CT灌注。数据处理采用第三方灌注软件MIStar(Version3.2),测量36例胰腺癌的血流量(BF),血容量(BV)、毛细血管表面通透性(PS)、平均通过时间(MTT)及PS/BF,将获得数据进行统计学分析。结果：胰腺癌组织的BF、BV、PS、MTT和PS/BF分别为：30.59±9.46mL/100g/min,6.59±2.41mL/100g,15.56±4.29mL/100g/min,7.69±3.11s和0.533±0.189。胰腺癌组织BV、BF、PS和PS/BF值与正常胰腺组织差异有明显统计学意义,MTT差异无统计学意义。结论：胰腺癌的CT灌注特征表现为组织血流量降低、血容量降低、毛细血管表面通透性降低、PS/BF比值升高、对比剂平均通过时间变化不明显的恶性肿瘤。第三部分胰腺癌256层螺旋CT灌注参数与MVD的相关性研究目的：通过对手术切除的胰腺癌肿瘤标本进行CD31染色,测定胰腺癌和正常胰腺组织的微血管密度(MVD),结合胰腺癌的术前CT灌注参数进行相关性研究,探讨功能性CT灌注成像对胰腺癌血管生成评价的可能性。材料和方法：选取经手术切除并获取肿瘤组织、瘤周组织和正常组织的胰腺癌标本19例,对肿瘤组织、瘤周组织及正常组织标本行CD31抗体免疫组织化学染色,测定组织中的CD31阳性表达并进行微血管计数,分析胰腺癌CT灌注参数与MVD的相关性。结果：胰腺癌组织、瘤周组织及正常胰腺组织的MVD分别为122.25±40.21,245.85±40.17,311.35±52.03。胰腺癌组织的MVD显著低于瘤周组织及正常胰腺组织,三者间差异均有统计学意义。MVD与灌注参数BF显著正相关(P0.0001,r=0.874),其余灌注参数未发现与MVD的显著相关性。结论：胰腺癌CT灌注参数血流量与胰腺癌肿瘤微血管密度呈明显正相关,因此全胰腺CT灌注成像可作为活体评价胰腺癌血管生成的影像学方法。
[Abstract]:The CT perfusion features of normal pancreas and pancreatic cancer were measured by full - pancreas CT perfusion imaging , and the application value of all - pancreatic perfusion imaging in pancreatic cancer was explored .

Whole organ perfusion imaging of 256 - slice spiral CT in the first part of normal pancreatic tissue

Objective : To study the perfusion parameters of all organs in normal pancreatic tissue of patients with no pancreatic disease , and to explore the characteristics of the whole organ perfusion of normal pancreas .

Materials and Methods : Twenty - six patients with non - pancreatic diseases were collected from January 2011 to March 2013 .

Results : Normal pancreatic blood flow ( BF ) , blood volume ( BV ) , surface permeability ( PS ) , mean transit time ( MTT ) perfusion values were 114 . 08 卤 20.62 mL / 100 g / min , 19.34 卤 2.45 mL / 100 g , 29.01 卤 4.10 mL / 100 g / min , and 7.12 卤 2 . 19s respectively .

Conclusion : Normal pancreas in whole - organ CT perfusion is a substantial organ with uniform blood flow , blood volume , capillary mean permeability and average transit time of contrast agent .

Imaging Study of 256 - slice Spiral CT Whole Organ Perfusion Imaging in the Second Part of Pancreatic Cancer

Objective : To study the characteristics of CT perfusion of pancreatic cancer by performing full - pancreatic CT perfusion imaging on pancreatic cancer patients .

Materials and Methods : 36 patients with pancreatic cancer were collected from January 2011 to March 2013 . Data processing was performed with third - party perfusion software MIStar ( Version 3.2 ) . Blood flow ( BF ) , blood volume ( BV ) , capillary surface permeability ( PS ) , mean transit time ( MTT ) and PS / BF were measured in 36 patients with pancreatic cancer . The data were analyzed statistically .

Results : The BF , BV , PS , MTT and PS / BF of pancreatic carcinoma were 30.59 卤 9.46mL / 100g / min , 6.59 卤 2.41mL / 100g , 15.56 卤 4.29mL / 100g / min , 7.69 卤 3.11s and 0.533 卤 0.189 respectively .

Conclusion : The characteristics of CT perfusion in pancreatic cancer are the decrease of tissue blood flow , the decrease of blood volume , the decrease of capillary surface permeability and the increase of PS / BF ratio .

A study on the correlation between the parameters of spiral CT perfusion and MVD in the third part of pancreatic cancer

Objective : To determine the microvessel density ( MVD ) of pancreatic cancer and normal pancreatic tissue by means of CD31 staining of pancreatic cancer tumor specimens from surgical resection , and to study the possibility of functional CT perfusion imaging on the evaluation of angiogenesis in pancreatic cancer .

Materials and Methods : 19 cases of pancreatic cancer specimens from tumor tissues , tumor tissues and normal tissues were resected and acquired by operation , and CD31 antibody immunohistochemical staining was performed on tumor tissues , tumor tissues and normal tissues . The expression of CD31 in tissues was measured and the correlation of CT perfusion parameters with MVD was analyzed .

Results : MVD was 122.25 卤 40.21 , 245.85 卤 40.17 , 311.35 卤 52.03 , MVD was significantly lower than that of normal pancreatic tissue ( P < 0.01 , r = 0.874 ) .

Conclusion : The CT perfusion parameters of pancreatic cancer are positively correlated with the microvessel density of pancreatic cancer , so the whole pancreas CT perfusion imaging can be used as an imaging method to evaluate the angiogenesis in pancreatic cancer .

【学位授予单位】：复旦大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R735.9;R730.44

【参考文献】