双能量CT对肾上腺转移瘤及原发腺瘤鉴别诊断的应用研究

发布时间：2019-04-21 20:05

【摘要】：背景和目的在放射科日常诊断肾上腺病变的工作中,最常遇到的就是肾上腺腺瘤和转移瘤的鉴别诊断,明确的诊断会对肿瘤分期、治疗、预后等产生重要影响。以往的CT是单参数成像,无法提供更多病变信息；而双能量CT是近年来新兴的成像模式,可以通过特殊的能谱成像技术提供病变的组成信息,具有基物质定量分析、能谱分析等功能,目前已经初步应用在肿瘤的鉴别诊断方面。本研究的目的是对肾上腺腺瘤及转移瘤采用常规CT平扫及双能量增强双期扫描,分析肾上腺腺瘤及转移瘤的一般影像学表现,并分析二者的能谱参数特征,以判定能谱成像技术对鉴别肾上腺腺瘤与转移瘤的价值。资料和方法 35例患者(男16例,女19例,年龄范围30-76岁,平均年龄52.2±12.7岁),40个病灶(腺瘤24个,转移瘤16个)入组分析。以平扫CT值10HU为标准将24个腺瘤病灶,分为富脂腺瘤组(14个病灶,CT值≤10HU)和乏脂腺瘤组(10个病灶,CT值10HU),分别与转移瘤进行统计分析,以明确各参数对富脂腺瘤与转移瘤及乏脂腺瘤与转移瘤鉴别诊断的意义。对病变的以下特征：①病人的年龄、肿瘤的大小(最大径线)、肿瘤平扫的CT值、增强CT值、肿瘤与临近组织的分界、是否存在钙化、囊变、坏死等；②碘基值、水基值、脂肪-碘基值进行统计分析。根据受试者工作特征曲线(receive operating characteristic curve, ROC)计算各参数阈值,以确定敏感度、特异度及约登指数。结果 35例患者40个病灶,其中腺瘤24个(富脂腺瘤14个,乏脂腺瘤10个),转移瘤16个。富脂腺瘤、乏脂腺瘤与转移瘤的平均大小、发病年龄及性别组成比等常规参数均没有统计学差异。肾上腺富脂腺瘤组平扫CT值较转移瘤略低,差异存在统计学意义,而乏脂腺瘤CT值较转移瘤略高,差异没有统计学意义。能谱双期增强扫描,富脂腺瘤、乏脂腺瘤的水基值、脂肪-碘基值均低于转移瘤,差异有统计学意义。以ROC曲线分析双期能谱参数结果,动脉期的鉴别意义最大,敏感度和特异度均较高。对比动脉期各能谱参数结果,水基值的敏感度较高,但脂肪-碘基值的特异度较高。结论双能量CT能谱成像可以在增强扫描时提高鉴别肾上腺富脂腺瘤与转移瘤、乏脂腺瘤与转移瘤的诊断敏感度与特异度。其中WCad和FCad对诊断鉴别诊断有帮助较大,能鉴别常规CT平扫和多期增强较难鉴别的肾上腺乏脂腺瘤与转移瘤,并能明显提高乏脂腺瘤与转移瘤鉴别诊断的敏感度和特异度,为指导临床工作提供帮助。
[Abstract]:Background and objective in the routine diagnosis of adrenal lesions in radiology, the differential diagnosis of adrenal adenomas and metastatic tumors is the most common one. Definite diagnosis will have an important impact on the staging, treatment and prognosis of adrenal tumors. In the past, CT was single parameter imaging and could not provide more information of pathological changes. Dual-energy CT is a new imaging mode in recent years. It can provide information about the components of lesions through special energy spectrum imaging technology. It has the functions of quantitative analysis of basic substances and energy spectrum analysis. It has been applied to differential diagnosis of tumors at present. The purpose of this study was to analyze the general imaging features of adrenal adenomas and metastatic tumors by conventional CT plain scan and dual-energy enhanced dual-phase scanning, and to analyze the characteristics of energy spectrum parameters of the two types of adrenal adenomas and metastatic tumors. To determine the value of energy spectrum imaging in differentiating adrenal adenoma from metastatic tumor. Materials and methods 35 patients (M 16, F 19, mean age 52.2 卤12.7 years) with 40 lesions (24 adenomas and 16 metastatic tumors) were analyzed. According to CT value 10HU, 24 adenoma lesions were divided into fat-rich adenomas group (14 lesions, CT value = 10 Hu) and anadiomatous adenomas group (10 lesions, CT value 10HU), and analyzed statistically with metastatic tumors. To determine the significance of each parameter in differential diagnosis between fat-rich adenoma and metastatic tumor and anasteinoma from metastatic tumor. The features of the lesions were as follows: (1) the age of the patient, the size of the tumor (maximum diameter line), the CT value of the plain scan of the tumor, the enhanced CT value, the boundary between the tumor and the adjacent tissue, whether there were calcification, cystic change, necrosis, etc. 2 iodine base value, water base value and fat-iodine base value were analyzed statistically. The threshold values of each parameter were calculated according to the receiver operating characteristic curve (receive operating characteristic curve, ROC) to determine the sensitivity, specificity and Joden index. Results there were 40 lesions in 35 patients, including 24 adenomas (14 fat-rich adenomas, 10 fat-deficient adenomas) and 16 metastatic tumors. There was no statistical difference in the average size, age of onset and sex ratio between fat-rich adenoma, asthenoma and metastatic tumor. The CT value of adrenal sebaceous adenoma group was slightly lower than that of metastatic tumor, and the CT value of anadipose adenoma was slightly higher than that of metastatic tumor, and the difference was not statistically significant. The water base value and fat-iodine base value of fat-rich adenoma and asthenoma were lower than those of metastatic tumor by energy spectrum dual-phase enhanced scanning, and the difference was statistically significant. The biphasic energy spectrum parameters were analyzed by ROC curve, the differentiation of arterial phase was the most significant, and the sensitivity and specificity were higher. The sensitivity of water-based value was higher than that of fat-iodine value, but the specificity of fat-iodine value was higher than that of arterial phase. Conclusion dual-energy CT energy spectrum imaging can improve the sensitivity and specificity of differential diagnosis between adrenal fat-rich adenoma and metastatic adenoma, anadiomatous adenoma and metastatic tumor in contrast-enhanced scanning. Among them, WCad and FCad are of great help in differential diagnosis. They can distinguish adrenal adenoma from metastatic adenoma which is difficult to distinguish by conventional CT plain scan and multi-phase enhancement, and can significantly improve the sensitivity and specificity of differential diagnosis between adipocytic adenoma and metastatic tumor. Provide help to guide clinical work.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R736.6;R730.44

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