恶性骨肿瘤髓内浸润：能谱CT与病理对照实验研究

发布时间：2018-06-21 00:00

本文选题：恶性骨肿瘤 + 微观浸润　；参考：《青岛大学》2013年硕士论文

【摘要】：目的和意义：通过兔VX2恶性骨肿瘤模型的能谱CT与病理对照,探讨能谱曲线鉴别恶性骨肿瘤髓内微观浸润和骨髓水肿方面的应用价值。材料和方法：新西兰大白兔34只,月龄为2个月左右,性别不限,体重为2、0～3、0kg。对其右侧胫骨近端钻孔,将1mm×1mm大小肿瘤组织块肿瘤块送入髓腔内,骨蜡封口。4周左右进行常规CT和能谱CT扫描。处死模型兔,将标本进行固定、脱钙,切成连续3mm矢状断面,取胫骨最大矢状断面进行分区,制备成病理切片。分别将常规CT和能谱CT图像进行矢状位重建,选取与病理切片一致的图像观察。在单能量图像上选取最佳keV。依据病理切片,分别在肿瘤区域(A)、移行区域(B)及正常髓腔区域(C)放置感兴趣区(ROIs),观察每组能谱曲线特点,计算每组斜率值。移行区在病理上为肿瘤微观浸润或骨髓腔单纯水肿。分别计算出肿瘤微观浸润区(B1)和单纯水肿区(B2)斜率值。能谱曲线斜率计算公式为：斜率=(HU40keV-HU70keV)/(70-40)。结果：(1)成功制备模型兔并进行CT扫描和病理学检查23例。(2)23例常规CT图像均不能显示髓腔内肿瘤边界。能谱CTl40key为显示恶性骨肿瘤最佳单能量。23例140keV单能量图像中,7例显示肿瘤边缘清楚,16例边缘欠清,22例图像中可见位置及CT值均介于肿瘤与正常髓腔两者之间的移行区。(3)依据病理切片,移行区为肿瘤微观浸润7例,单纯骨髓水肿15例,其中1例能谱CT图像无显示移行区病理结果为单纯骨髓水肿。(4)肿瘤区域、移行区域和正常骨髓腔能谱CT曲线随着单能量增加,其CT值降低,在40keV-70keV之间CT值下降迅速,大于70keV曲线近于平直。(5)移行区斜率(B)斜率(为7.78±3.40)大于肿瘤大致浸润区(A)ROIs斜率(3.7l±2.15)小于正常髓腔(C)斜率(12.88±4.12)(P0.001)。微观浸润区(B1)的斜率(10.874±2.69)大于单纯骨髓水肿区(B2)斜率(5·838±2.11)(P0.001)。结论：(1)能谱CT图像质量优于常规CT,能够显示恶性骨肿瘤边缘移行区,能谱曲线证实移行区斜率区别于肿瘤组织和正常骨髓腔。(2)运用能谱曲线可以鉴别肿瘤微观浸润及单纯骨髓水肿,肿瘤微观浸润斜率大于单纯骨髓水肿。
[Abstract]:Objective and significance: to explore the application value of energy dispersive CT (EDS) in differentiating intramedullary microscopic infiltration and bone marrow edema from malignant bone tumor by means of energy dispersive computed tomography (EDS) and pathology in rabbit VX2 malignant bone tumor model. Materials and methods: 34 New Zealand white rabbits were aged about 2 months. At the proximal end of the right tibia, the tumor mass of 1mm 脳 1mm tumor was injected into the medullary cavity, and the bone wax was sealed for about 4 weeks for routine CT and energy dispersive CT scanning. The model rabbits were sacrificed, the specimens were fixed, decalcified, and cut into continuous 3mm sagittal sections. The tibia was divided into the largest sagittal sections and the pathological sections were prepared. Sagittal reconstruction of conventional CT and energy dispersive CT images were performed respectively. The best Kev is selected on the single energy image. According to the pathological section, the region of interest (ROIsa) was placed in the tumor area (An), the transitional area (B) and the normal medullary cavity (C) respectively. The characteristics of each group's energy spectrum curve were observed and the slope values of each group were calculated. The transitional areas were microinfiltrated tumor or simple edema of medullary cavity pathologically. The slope values of B _ 1 and B _ 2 were calculated respectively. The formula for calculating the slope of the energy spectrum curve is as follows: the slope of HU40keV-HU70keV / U / 70keV / 70 / 40g. Results (1) the model rabbits were successfully made and CT scan and pathological examination were performed in 23 cases. The conventional CT images of 23 cases could not show the margin of intramedullary tumor. Energy spectrum CTl40key is the best single energy for displaying malignant bone tumor. In the 140keV single energy image of 23 cases, 7 cases showed clear margin of the tumor and 16 cases with unclear margin. In 22 cases, the visible position and CT value were between the tumor and the normal medullary cavity. Area 3) according to pathological section, There were 7 cases of microscopic tumor infiltration and 15 cases of simple bone marrow edema in the transitional area. In one case, the pathological results of the transitional area were simple bone marrow edema. The CT curve of the transitional area and the normal medullary cavity increased with the increase of single energy. The CT value decreased rapidly between 40kev and 70keV, and the slope (7.78 卤3.40) was larger than that of the normal medullary cavity (12.88 卤4.12P0.001), and the slope of the transition area (7.78 卤3.40) was larger than that of the normal medullary cavity (12.88 卤4.12p0. 001), which was higher than that of the normal medullary cavity (3.71 卤2.15), which was higher than that of the normal medullary cavities (7.78 卤3.40) and larger than that of the normal medullary cavities (3.71 卤2.15). The slope of microinfiltrating area B1 (10.874 卤2.69) was higher than that of bone marrow edema (5838 卤2.11P0.001). Conclusion the image quality of spectral CT is superior to that of conventional CT, and it can display the marginal transitional area of malignant bone tumor. Energy spectrum showed that the slope of transitional area was different from that of tumor tissue and normal medullary cavity. (2) the microcosmic invasion of tumor and simple bone marrow edema could be distinguished by energy spectrum curve. The slope of microscopic invasion of tumor was higher than that of simple bone marrow edema.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R738.1;R730.44

【参考文献】