MSCT对回盲部良恶性病变的诊断分析

发布时间：2018-03-22 08:06

本文选题：MSCT　切入点：回盲部　出处：《山西医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:通过对临床病理证实了的回盲部良性及恶性病变CT征象的分析,总结出有助于对回盲部病变进行良、恶性鉴别的有意义CT表现,加深对回盲部病变影像特征的理解,进而提高该部位病变影像诊断的准确率。方法:选取2016年1月-2017年1月期间于山西医科大学第一医院医学影像科行全腹部CT扫描的75例回盲部病变患者的CT图象进行分析,再进行病例随访获得其手术病理或肠镜活组织检查等临床资料证实病变的性质。其中男性患者41例,女性患者34例,年龄分布19-86岁,中位年龄56岁。使用我院GE 64排Light VCT螺旋CT机扫描,扫描范围从膈下到盆腔水平。扫描结束后图像信息传输至AW4.6工作站,运用MPR进行图像后处理,并由2名高年资医师参与盲法阅片,意见不统一时经讨论达到一致。根据病理结果将所有病例分为:良性病例组,恶性病例组,观测指标包括:1.病变肠管长度;2.病变肠管壁厚度;3.病变肠管与正常管壁的分界情况;4.病变肠管壁的分层情况;5.末段回肠是否受累;6.肠周浑浊程度。将收集到的数据进行统计学分析,总结并归纳出相关的CT诊断结论。结果:共收集到75例符合条件的病例,所有病例均经过手术病理或者肠镜活组织检查得出最后诊断,结果显示良性病例40例,恶性病例35例。所观测的6组观测指标中,病变肠管长度良性组为97.50±68.75mm,恶性组为75.00±34.00mm,结果显示差异无统计学意义;病变肠管壁厚度良性组为10.55±5.73mm,恶性组22.00±20.30mm,结果显示差异有统计学意义;病变肠管与正常肠管分界的比较中,结果显示差异有统计学意义,即恶性病变组较良性病变组,病变肠管与正常肠管分界明显;管壁“分层样”改变,在两组病例中的检出率差异存在统计学意义,说明良性病变更易出现管壁分层样改变;末段回肠受累情况在两组病变中的检出率差异存在统计学意义,即良性病变更易侵犯末段回肠;肠周“浑浊征”在两组病变中的检出率差异存在统计学意义,即良性病变肠周浑浊较恶性病变严重。结论:1.病变肠管壁厚度、病变肠管与正常肠管分界、病变肠管壁分层及末段回肠是否受累、肠周“浑浊征”的差异等征象对回盲部良恶性病变的鉴别有重要意义。2.病变肠管壁长度的差异对回盲部良恶性鉴别有一定意义,但由于阑尾病变对周围结构的影响,其参考价值在本研究中并不可靠。3.对于回盲部病变良恶性鉴别诊断须结合多个征象进行综合分析评价。
[Abstract]:Objective: to analyze the CT features of benign and malignant ileocecal lesions confirmed by clinical pathology, and to summarize the significant CT findings which are helpful in differentiating benign and malignant ileocecal lesions, and to deepen the understanding of the imaging features of ileocecal lesions. Methods: from January 2016 to January 2017, 75 patients with ileocecal lesions underwent total abdominal CT scanning in the Department of Medical Imaging of the first Hospital of Shanxi Medical University. The patients were followed up to obtain clinical data, such as surgical pathology or biopsy, to confirm the nature of the lesions, including 41 male patients and 34 female patients, aged 19-86 years. The median age was 56 years old. GE 64 Light VCT spiral CT scan was used in our hospital. The scanning range was from subphrenic to pelvic level. After scanning, the image information was transmitted to AW4.6 workstation, and the image was processed by MPR. According to the pathological results, all cases were divided into benign case group and malignant case group. The observed indexes include: 1. The length of the diseased intestine 2. The thickness of the diseased intestinal wall 3. The boundary between the diseased intestinal wall and the normal wall 4. The stratification of the diseased intestinal wall 5. Whether the ileum in the last segment is involved or not 6. The degree of periintestinal turbidity. The number of cases to be collected. According to statistical analysis, Results: a total of 75 eligible cases were collected. All the cases were finally diagnosed by pathology or biopsy. The results showed that 40 cases were benign. 35 cases of malignant cases were observed. In the 6 groups, the length of the lesion intestine was 97.50 卤68.75 mm in benign group and 75.00 卤34.00 mm in malignant group, the difference was not statistically significant, the thickness of intestinal wall was 10.55 卤5.73 mm in benign group and 22.00 卤20.30 mm in malignant group. In the comparison of the boundary between the diseased and normal intestinal duct, the difference was statistically significant, that is, the boundary between the diseased intestinal duct and the normal intestinal canal was obvious in the malignant lesion group than in the benign lesion group, and the "stratification" of the wall of the lesion was observed. The difference of detection rate between the two groups was statistically significant, which indicated that the benign lesions were more prone to the stratification of the tube wall, and the incidence of ileal involvement at the end of the two groups was significantly different between the two groups. That is, benign lesions are more likely to invade the terminal ileum, and there is a significant difference in the detection rate of periintestinal turbid sign between the two groups, that is, benign lesions are more serious than malignant ones. Conclusion 1. The boundary between the diseased intestine and the normal intestine, the stratification of the diseased intestinal wall and the involvement of the ileum at the end of the lesion, The difference of periintestinal "turbidity" signs is of great significance for the differential diagnosis of benign and malignant ileocecal lesions. 2. The differences in the length of intestinal wall of ileocecal lesions have a certain significance for differentiating benign and malignant ileocecal lesions, but due to the influence of appendicitis on the surrounding structures, Its reference value is not reliable in this study. The differential diagnosis of benign and malignant ileocecal lesions should be combined with multiple signs for comprehensive analysis and evaluation.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.3;R730.44

【参考文献】