双能量能谱CT分析体内尿路结石的诊断价值

发布时间：2018-05-14 08:16

本文选题：泌尿系结石 + 结石成分　；参考：《安徽医科大学》2017年硕士论文

【摘要】：研究背景:泌尿系结石是泌尿外科常见病、多发病,尿石症的典型症状有绞痛、血尿等,长期未治疗的泌尿系结石可能会导致肾脏功能破坏,严重的会影响人们生活健康。临床治疗中因结石成分的不同而选择不同的治疗手段,其中尿酸结石的治疗与其它结石的治疗存在明显的差异。尿酸结石的形成机制目前尚未完全明确,一般认为与嘌呤代谢紊乱以及体内的异常矿化有关,大部分可通过内科治疗取得良好的效果。鸟粪石体外冲击碎石可以达到很好的效果(但治疗前需要预防感染的发生);草酸钙结石、磷酸钙结石体外冲击波碎石往往效果不佳,适合腹腔镜下气压弹道碎石或是经皮肾镜碎石。因此,术前若可以明确诊断结石成分采取不同的治疗方法,则有助于降低并发症的发生。双能量能谱CT通过单个球管高低压瞬时切换,同向、几乎同时扫描,可在原始数据空间层面进行物质解析。我们前期课题研究表明,能谱CT可以区分体外不同类型单一成分的结石及部分混合成分结石,但由于体内环境复杂,能谱CT是否可以区分体内不同成分结石,仍需要进一步的临床研究。目的:以红外光谱结果为诊断标准,初步探讨活体双能量能谱成像区分体内不同泌尿系结石成分的可行性。材料与方法:1)57例泌尿系结石患者共有89枚结石纳入本次研究,患者通过GSI(gemstone spectral imaging)扫描后使用ADW 4.4工作站进行能谱分析,测得GSI扫描模式下图像上结石的有效原子序数(Effective atomic number)、物质分离(Materia Density)的钙水比值(calcium water ratio,CWR)、50ke V(kilo electron voltage)、70ke V单能量CT值,并采用方差分析比较各组结石上述4个指标的差异。以红外光谱分析结果作为参照标准,能谱分析结果与之进行对比,得出能谱诊断纯尿酸结石、纯非尿酸结石、混合成分结石的敏感性、特异性、阳性预测值、阴性预测值。2)回顾性研究术后获得的24例单一成分结石(11枚尿酸结石、9枚草酸钙结石、3磷酸钙结石)以及53例混合成分结石,分别测量各组结石的有效原子序数、CWR、50ke V、70ke V单能量CT值,并采用单因素方差分析比较各组结石上述指标的差异。结果:1)纯尿酸结石、纯非尿酸结石、混合成分结石的有效原子序数、CWR、50ke V单能量CT值、70ke V单能量CT值分别为:纯尿酸类结石组:7.30±0.32、-0.0066±0.0510、493.19±67.64HU、484.67±77.91HU;纯非尿酸结石组:13.32±0.57、0.2673±0.0590、1804.60±388.05HU、1092.20±250.22HU,混合成分结石组:12.49±1.14、0.2185±0.0867、1537.60±530.70HU、953.97±312.35HU。以红外光谱分析结果作为参照标准,双能量能谱CT分析体内纯尿酸结石、纯非尿酸结石、混合成分结石得到灵敏度100.0%、91.7%、97.0%,特异度100.0%、97.4%、95.7%,阳性预测值100.0%、84.6%、98.5%以及阴性预测值100.0%、98.7%、91.7%。2)单一成分尿酸结石、草酸钙结石、磷酸钙结石的有效原子序数、CWR、50ke V单能量CT值、70ke V单能量CT值分别为:纯尿酸结石组:7.30±0.32、-0.0066±0.0510、493.19±67.64HU、484.67±77.91HU;纯草酸钙结石:12.96±0.64,0.2487±0.0568,1731.20±418.41HU,1048.10±272.60HU;纯磷酸钙结石:13.62±0.20,0.3209±0.0198,2016.70±157.27HU,1219.40±96.74HU。3)以红外光谱分析结果进行分组,排除结石最大径1cm以及例数少的混合结石,我们共分为4组,COM+COD+DAH、COM+DAH、COM+UA、STR+DAH的CWR、有效原子序数、50ke V CT值、70ke V CT值数据分别为0.2502±0.0639、12.75±0.65、1671.10±507.32HU、1023.80±321.23HU;0.2389±0.0552、12.84±0.62、1662.60±355.54HU、1010.60±209.77HU;0.1113±0.0686、9.90±0.91、870.06±324.41HU、612.08±214.59HU;0.2614±0.0277、13.09±0.31、1821.20±286.89HU、1127.30±191.08HU。结论:双能量能谱成像可用于体内结石的成分分析,利用有效原子序数、CWR、50keV、70ke V单能量CT值4个指标,可以明显区分体内纯尿酸类结石、草酸钙结石、磷酸钙结石、混合成分结石(COM+COD+DAH、COM+DAH、COM+UA、STR+DAH)。
[Abstract]:Background: urolithiasis is a common disease in the Department of urology. It is a common disease in the Department of urology. The typical symptoms of urolithiasis are colic, hematuria and so on. The long-term untreated urinary calculi may lead to renal function damage, which will seriously affect people's life and health. In clinical treatment, different treatment means are chosen because of the difference in the composition of the stones, of which uric acid stones are treated. There is a clear difference between the treatment and the treatment of other stones. The formation mechanism of uric acid stones is not completely clear now. It is generally considered to be related to the disorder of the purine metabolism and the abnormal mineralization in the body. Most of them can achieve good results through internal medicine treatment. Preventing the occurrence of infection); calcium oxalate stones, calcium phosphate stone stone lithotripsy is often not effective, suitable for laparoscopic barometric ballistic lithotripsy or percutaneous nephrolithotripsy. Therefore, it is helpful to reduce the occurrence of complications by using different treatment methods before the operation. Double energy spectrum CT passes a single ball. Our previous research shows that CT can distinguish stones from different types of single components in vitro and partially mixed stones in vitro, but because of the complex environment in the body, it can distinguish whether CT can distinguish the stones of different components in the body. Further clinical studies are still needed. Objective: using the infrared spectrum as the diagnostic criteria, the feasibility of identifying different urinary calculi components in vivo by living dual energy spectrum imaging is preliminarily discussed. Materials and methods: 1) 57 cases of urinary calculi with 89 stones were included in this study, and the patients were scanned by GSI (gemstone spectral imaging) scan. After using the ADW 4.4 workstation to perform the energy spectrum analysis, the effective atomic number (Effective atomic number) of the stone in the GSI scanning mode, the calcium / water ratio (calcium water ratio, CWR) of the material separation (calcium water ratio, CWR), and the single energy value were measured, and the above 4 stones were compared by variance analysis. The results were compared with the results of infrared spectrum analysis, and the results of energy spectrum analysis were compared with that of 24 cases of single component stones (11 uric acid nodes) obtained after the diagnosis of pure uric acid stone, pure non uric acid stone, sensitivity, specificity, positive predictive value and negative predictive value.2). Stone, 9 calcium oxalate stones, 3 calcium phosphate stones) and 53 cases of mixed calculus. The effective atomic numbers of the stones were measured, CWR, 50ke V, 70ke V single energy CT, and the difference of the above indexes was compared with the single factor analysis of variance. Results: 1) pure uric acid stone, pure non uric acid stone, and the effective atomic order of mixed ingredients stone. Number, CWR, 50ke V single energy CT value, 70ke V single energy CT value: pure uric acid stone group: 7.30 + 0.32, -0.0066 + 0.0510493.19 + 67.64HU, 484.67 + 77.91HU, pure non uric acid stone group: 13.32 + + 1092.20 + 100%, 91.7%, 97%, specificity 100%, 97.4%, 95.7%, positive predictive value 100%, 84.6%, 98.5% and negative predictive value 100%, 98.7%, 91.7%.2) single component urate acid knot, with the double energy spectrum CT analysis of pure uric acid stone, pure non uric acid stone, and mixed ingredients stone with sensitivity 100%, 91.7%, 97%, specificity 100%, 97.4%, 95.7%. Stone, calcium oxalate stone, effective atomic number of calcium phosphate stone, CWR, 50ke V single energy CT value, 70ke V single energy CT value respectively: pure uric acid stone group: 7.30 + 0.32, -0.0066 + 0.0510493.19 + 67.64HU, 484.67 + 77.91HU, pure calcium oxalate calculus: 12.96 + + + 1048.10 +, pure calcium phosphate stone: 13.62 + 0 .20,0.3209 + 0.01982016.70 + 157.27HU, 1219.40 + 96.74HU.3) was divided into groups by infrared spectrum analysis, excluding the maximum diameter 1cm of stone and mixed calculi with fewer cases. We were divided into 4 groups, COM+COD+DAH, COM+DAH, COM+UA, STR+DAH CWR, effective atomic number, 50ke V value, respectively, 0.2502 + 671.10 + 507.32HU, 1023.80 + 321.23HU, 0.2389 + 0.0552,12.84 + 0.621662.60 + 355.54HU, 1010.60 + 209.77HU, 0.1113 + 0.0686,9.90 + 0.91870.06 + 324.41HU, 612.08 + 214.59HU, 0.2614 + / 0.0277,13.09 + 0.311821.20 + 0.1113 conclusion: double energy spectrum imaging can be used in the composition analysis of stones in vivo. Atomic number, CWR, 50keV, 70ke V single energy CT value of 4 indicators, can clearly distinguish between the body pure uric acid stone, calcium oxalate stone, calcium phosphate stone, mixed composition stone (COM+COD+DAH, COM+DAH, COM+UA, STR+DAH).

【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R691.4;R816.7

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