双源CT双能量技术在腮腺占位中的临床应用研究

发布时间：2018-04-24 02:41

本文选题：腮腺 + 体层摄影术　；参考：《昆明医科大学》2017年硕士论文

【摘要】：第一部分腮腺占位病变中双源CT双能量虚拟平扫的可行性研究[目的]探讨腮腺占位病变中双源CT双能量虚拟平扫代替常规平扫的可行性。[资料方法]回顾性分析在我院行双源CT检查并经外科手术取得病理证实的腮腺病变共54例(腮腺良性占位38例,其中良性肿瘤34例,其他良性占位4例;恶性肿瘤12例;炎性病变4例)。所有患者均进行常规平扫(truenon-contrast,TNC)及双能量增强扫描。利用Liver VNC软件处理分别得到动脉期及静脉期虚拟平扫(virtualnon-contrast,VNC)图像,比较常规平扫与动静脉期虚拟平扫图像上显示腮腺占位能力的一致性,分别计算两组图像对腮腺良、恶性肿瘤及炎性病变诊断的敏感度、特异度及准确度;常规平扫及两组虚拟平扫正常腮腺组织、病灶区、颌下腺、胸锁乳突肌、下颌骨平均CT值、信号噪声比(signal-to-noiseratio,SNR)、对比噪声比(contrast-to-noiseratio,CNR)、图像质量评分、辐射剂量。[结果]①常规平扫及虚拟平扫均能显示病灶,常规平扫及动脉期虚拟平扫图像对于诊断腮腺良、恶性肿瘤、炎性病变诊断准确率一致性好(Kappa值分别为0.96、0.93、0.73);真实平扫对良性肿瘤、恶性肿瘤、炎性病变诊断的敏感度、特异度和符合率分别为 89.5%、81.7%、88.5%,70%、95.2%、90.4%,50%、97.9%、94.2%;动脉期虚拟平扫对三者诊断的敏感度、特异度和符合率分别为86.8%、85.7%、86.5%,70%、97.6%、92.3%,75%、95.8%、94.2%。②常规平扫、VNCA、VNCv主观图像质量评分分别为4.31±0.76、4.19±0.82、4.21±0.78,三者间差异无统计学意义(P0.05)。③53例腮腺占位患者平扫下颌角层面胸锁乳突肌、颌下腺平均CT值均无统计学意义(P0.05),腮腺占位灶、下颌骨、正常腮腺平均CT值差异有统计学意义(P0.05);两组VNC图所有组织SNR均大于真实平扫,差异有统计学意义(P0.05)。三组图CNR差异无统计学意义(P0.05)。④双能量双期扫描有效剂量低于常规三期扫描,差异有统计学意义(P0.05),降低辐射剂量约38.6%。[结论]腮腺占位双源CT双能量虚拟平扫能保证图像质量及诊断准确性,能替代真实平扫,从而降低受检者接受的辐射剂量。第二部分腮腺多形性腺瘤、腺淋巴瘤及腮腺恶性肿瘤的双能量能谱分析[目的]分析腮腺多形性腺瘤、腺淋巴瘤及恶性肿瘤能谱曲线特征,探讨双源CT双能量成像技术在三类腮腺肿瘤诊断及鉴别诊断中的应用价值。[资料与方法]收集经手术病理证实且具有完整资料的腮腺肿瘤患者共46例,52个病灶。剔除基底细胞腺瘤及转移瘤各1例后,共44例,50个病灶,其中腮腺多形性腺瘤19例,腺淋巴瘤14例(20个病灶),恶性肿瘤11例。均行双源CT双能量扫描后,分别将动脉期、静脉期100 kVp及Sn140 kVp两组薄层图像调入双能量工具软件中,选取“Mono Energetic”模式处理得到40-160kev单能谱图像,观察能谱曲线变化趋势,比较腮腺多形性腺瘤、腺淋巴瘤及恶性肿瘤实质区动脉期能谱曲线斜率。[结果]腮腺多形性腺瘤、腺淋巴瘤及恶性肿瘤对比,在40-160keV范围内,随着单能KeV值的升高,动脉期肿瘤实质CT值逐渐递减,且随keV值越高,CT值降低的幅度越小,其能谱曲线在40-160keV下均呈“下降型”。动脉期腮腺腺淋巴瘤能谱曲线斜率在40KeV-160KeV范围内均位于最上方,恶性肿瘤居中,多形性腺瘤位于最下方,三组间在40-160KeVCT值差异有统计学意义(P0.05);腮腺多形性腺瘤、腺淋巴瘤及恶性肿瘤实质区动脉期能谱曲线斜率分别为1.22±0.99、2.36±1.02,1.55±0.83三组间差异具均有统计学意义(P0.05),两两比较示腮腺多形性腺瘤及腺淋巴瘤间差异具有统计学差异(P0.05),而恶性肿瘤与多形性腺瘤及腺淋巴瘤间斜率存在部分重叠,差异无统计学差异。去除不同性质腮腺肿瘤之间重叠部分,我们初步得出,动脉期腮腺肿瘤实质区能谱曲线斜率(K)的范围如下:若1.68K≥0.82,可能是多形性腺瘤;若2.87≥K2.0,可能是腺淋巴瘤。[结论]双源CT动脉期能谱分析对腮腺多形性腺瘤、腺淋巴瘤及恶性肿瘤影像鉴别诊断有一定的参考价值。第三部分双能量CT碘浓度及形态学分析在腮腺多形性腺瘤、腺淋巴瘤及恶性肿瘤诊断中的价值[目的]探讨双源CT双能量扫描所获碘图碘浓度及常规形态学方法对腮腺多形性腺瘤、腺淋巴瘤、恶性肿瘤诊断及鉴别诊断价值。[资料与方法]临床资料及扫描方法同第二部分。①分析及记录腮腺三类腮腺肿瘤常规形态学特点(包括部位、象限、形态、边界、有无囊变、有无肿大淋巴结),分组为腮腺多形性腺瘤组、腺淋巴瘤组、恶性肿瘤组,进行x~2检验及Logistic回归区分主要征象及次要征象。②将动、静脉期100 kVp及Sn140 kVp两组薄层图像调入双能量工具软件中,利用后处理软件“Liver VNC”,分别测量腮腺多形性腺瘤、腺淋巴瘤及恶性肿瘤实性部分的动、静脉两期的碘浓度(iodineconcentration,IC)及标准化碘浓度(normalizedconcentration,NIC),计算动静脉期碘值差值(ICD=静脉期碘浓度-动脉期碘浓度)。采用方差分析,以P0.05为差异具有统计学意义;比较三组之间的差异,并对其敏感度、特异度及受试者工作特性曲线(ROC)进行分析。[结果]腮腺多形性腺瘤组、腺淋巴瘤组与恶性肿瘤组动脉期碘浓度、标准化碘浓度分别为0.93±0.79mg/ml、1.94±0.74mg/ml、1.33±0.72mg/ml 及0.09±0.09、0.23±0.11、0.17±0.11,其差异具有统计学意义(F值分别为8.755、8.648,P均0.05)。进一步进行两两之间对比,腮腺多形性腺瘤组与腺淋巴瘤组之间碘浓度及标准化碘浓度差异具有统计学意义(P0.05),而恶性肿瘤组与多形性腺瘤组、腺淋巴瘤组间差异不具有统计学意义(P0.05)。静脉期与动脉期碘浓度差值分别为0.83±0.52mg/ml、0.72±0.93mg/ml及0.45 ±0.77mg/ml,其差异具有统计学意义(F=21.352,P=0.000),两两之间对比,腺淋巴瘤与多形性腺瘤、恶性肿瘤静脉-动脉碘浓度差值之间差异具有统计学意义(P0.05),而多形性腺瘤与恶性肿瘤动静脉期碘浓度差值之间差异不具有统计学意义(P0.05)。利用静脉期碘值诊断多形性腺瘤时,敏感度为63.2%,特异度为72.7%,AUC(ROC曲线下面积)为0.671;利用动脉期碘值诊断腺淋巴瘤时,敏感度为90%,特异度为68.7%,AUC为0.795,动脉期标准化碘浓度诊断腺淋巴瘤时,敏感度为95%,特异度为65.6%,AUC为0.798;而利用碘浓度诊断恶性肿瘤的敏感性及特异性均不高。对腮腺肿瘤发生部位、象限、形态、边界、有无囊变、有无肿大淋巴结等形态指标进行多因素回归分析,发现腮腺深浅叶均受累、边界不清、形态不规则、有肿大淋巴结为诊断腮腺恶性肿瘤有价值的形态学指标。[结论]能谱CT碘值在腮腺多形性腺瘤、腺淋巴瘤及恶性肿瘤间的鉴别有一定价值,但恶性肿瘤与多形性腺瘤及腺淋巴瘤间碘浓度存在部分重叠,结合常规形态学特点,有助于正确诊断及鉴别三类肿瘤性病变,其敏感性及特异度较高。
[Abstract]:The feasibility study of double source CT double energy virtual plain scan in parotid space occupying lesions [Objective] to explore the feasibility of double source CT double energy virtual scan in parotid space occupying lesion instead of routine plain scan. [data method] Retrospective analysis of 54 cases of parotid disease confirmed by double source CT examination in our hospital and pathologically confirmed by surgery (Sai Xianliang There were 38 cases of sexual occupying, including 34 cases of benign tumor, 4 cases of other benign space occupying sites, 12 cases of malignant tumor and 4 cases of inflammatory disease. All patients were performed routine plain scan (truenon-contrast, TNC) and double energy enhanced scan. The images of virtualnon-contrast (VNC) of arterial and venous phase (virtualnon-contrast, VNC) were obtained by Liver VNC software, and the normal level was compared. The sensitivity, specificity and accuracy of the two groups of images on parotid benign, malignant and inflammatory lesions were calculated respectively. The average CT value of the lesion area, the submandibular gland, the sternocleidomastoid muscle and the mandible, and the signal noise of the two groups of normal plain scan and the normal plain scan were calculated respectively. Signal-to-noiseratio (SNR), contrast noise ratio (contrast-to-noiseratio, CNR), image quality score, radiation dose. [result] 1. Routine plain scan and virtual plain scan were all able to show the focus. The accuracy of diagnosis of benign parotid, malignant and inflammatory lesions was consistent with routine plain scan and arterial phase (Kappa value, respectively). 0.96,0.93,0.73); the sensitivity, specificity and coincidence rate of true plain scan for benign tumor, malignant tumor, and inflammatory disease were 89.5%, 81.7%, 88.5%, 70%, 95.2%, 90.4%, 50%, 97.9%, 94.2%. The sensitivity, specificity and coincidence rate of virtual plain scan to the three were 86.8%, 85.7%, 86.5%, 70% The subjective image quality score of the routine plain scan, VNCA and VNCv was 4.31 + 0.76,4.19 + 0.82,4.21 + 0.78 respectively, and there was no significant difference between the three groups (P0.05). (3) 53 cases of parotid gland occupying patients had no statistical significance (P0.05), the average CT value of the submandibular gland was not statistically significant (P0.05), the parotid gland space, the mandible, and the normal parotid gland average CT value difference. The difference was statistically significant (P0.05); the SNR of all tissues in the two group of VNC was greater than that of the true plain scan (P0.05). There was no statistical significance (P0.05) in the difference of CNR in the three group diagram. (4) the effective dose of double energy biphasic scan was lower than that of the conventional three phase scan, and the difference was statistically significant (P0.05), and the radiation dose reduced about 38.6%.[Conclusion] parotid occupying double Source CT dual energy virtual scan can ensure image quality and diagnostic accuracy, and can replace true plain scan, thus reducing the radiation dose accepted by the subjects. Second partial parotid pleomorphic adenomas, adenomas and parotid malignancies are analyzed by dual energy spectrum analysis [Objective] to analyze the spectral curves of pleomorphic adenomas, adenomas and malignant tumors of the parotid gland. Characteristics, the application value of dual source CT dual energy imaging technique in the diagnosis and differential diagnosis of three types of parotid tumors. [data and methods] 46 cases of parotid tumors confirmed by operation and pathology were collected and 52 lesions were found in 1 cases of basal cell adenoma and metastasis, including 44 cases and 50 lesions, including parotid pleomorphic. 19 cases of adenoma, 14 cases of adenoma lymphoma (20 focus) and 11 cases of malignant tumor. After double source CT double energy scanning, the thin layer images of the arterial phase, the venous phase 100 kVp and the Sn140 kVp two were transferred to the dual energy tool software, and the "Mono Energetic" mode was selected to obtain the 40-160kev single energy spectrum image, and the variation trend of the energy spectrum curve was observed and the gills were compared. Adenoma of adenoma, adenoma, and the arterial phase in the parenchyma of the tumor were slope. [results] the parotid pleomorphic adenoma, adenoma and malignant tumor were compared. In the range of 40-160keV, the CT value of the arterial phase decreased gradually with the increase of the KeV value of the single energy, and the lower the CT value decreased with the higher the keV value, the energy spectrum curve In the 40-160keV, the slope of the parotid gland lymphoma was located at the top of the 40KeV-160KeV range, the malignant tumor was middle, and the pleomorphic adenoma was located at the bottom. The difference between the three groups was statistically significant (P0.05); the parotid gland multiform adenoma, adenoma and the malignant tumor parenchyma artery The difference of the slope of the period energy spectrum curve was 1.22 + 0.99,2.36 + 1.02,1.55 + 0.83 respectively (P0.05). 22 compared with the parotid pleomorphic adenoma and adenoma (P0.05), but there was a partial overlap between the malignant tumor and the pleomorphic adenoma and adenoma, and there was no statistical difference. In order to remove the overlapping parts of different parotid tumors, we preliminarily conclude that the range of K is as follows: if 1.68K > 0.82, it may be a pleomorphic adenoma; if 2.87 or more K2.0, it may be adenoma. [Conclusion] the dual source CT arterial phase can be analyzed for parotid pleomorphic adenoma, adenoma and malignant swelling The value of third partial CT iodine concentration and morphological analysis in the diagnosis of parotid pleomorphic adenoma, adenoma and malignant tumor. [Objective] to explore the iodine concentration of double source CT double energy scan and the conventional morphological method for parotid pleomorphic adenoma, adenoma and malignant tumor. Diagnostic and differential diagnostic value. [data and methods] clinical data and scanning methods are the same as second parts. (1) analysis and record the conventional morphological features of parotid gland tumors (including location, quadrant, shape, boundary, cyst, lymph node), parotid pleomorphic adenoma group, adenoma group, malignant tumor group, x~2 Test and Logistic regression were used to distinguish the main signs and secondary signs. 2. TLC images of the 100 kVp and Sn140 kVp two groups were transferred into the two energy tools software, and the postprocessing software "Liver VNC" was used to measure the activity of the parotid pleomorphic adenoma, adenoma and malignant tumor, and the iodine concentration of the two phases of the vein (iodineconcent Ration, IC) and standardized iodine concentration (normalizedconcentration, NIC) were used to calculate the difference of iodized iodine value (iodine concentration in the venous phase - arterial phase iodine concentration in the venous phase of ICD=). The variance analysis was used to analyze the difference between the three groups, and to compare the differences between the two groups, and to analyze the sensitivity, specificity and the working characteristic curve of the subjects (ROC). Results: the iodine concentration in the parotid pleomorphic adenoma group, the adenoma group and the malignant tumor group was 0.93 + 0.79mg/ml, 1.94 + 0.74mg/ml, 1.33 + 0.72mg/ml and 0.09 + 0.09,0.23 + 0.11,0.17 + 0.11 respectively. The difference was statistically significant (F value was 8.755,8.648, P 0.05). Further comparison was carried out between 22, gills. The difference of iodine concentration and standard iodine concentration between the adenoma group and the adenoma group was statistically significant (P0.05), but the difference between the malignant tumor group and the pleomorphic adenoma group and the adenoma group was not statistically significant (P0.05). The difference between the venous and arterial phase iodine concentration was 0.83 + 0.52mg/ml, 0.72 + 0.93mg/ml and 0.45 + 0.77mg/, respectively. Ml, the difference was statistically significant (F=21.352, P=0.000), the difference between adenoma and pleomorphic adenoma, and the difference of iodide concentration between the venous artery and artery of malignant tumor was statistically significant (P0.05), but there was no statistical significance (P0.05) between the difference of iodine concentration between the pleomorphic adenoma and the malignant tumor (P0.05). The sensitivity was 63.2%, the specificity was 72.7%, the AUC (the area under ROC curve) was 0.671, and the sensitivity was 90%, the specificity was 68.7%, and the AUC was 0.795. The sensitivity was 95%, the specificity was 65.6% and the AUC was 0.798, while the iodized iodine value of the arterial phase was 0.798; and iodine was used for iodine. The sensitivity and specificity of concentration diagnosis of malignant tumor were not high. The multiple regression analysis on the location of parotid tumor, quadrant, shape, boundary, no cystic change, or no swelling lymph node, found that the parotid glands were all affected, the boundary was not clear, the shape was irregular, and the lymph nodes were valuable for the diagnosis of parotid malignant tumor. [Conclusion] [Conclusion] the CT iodized value has a certain value in the differentiation of parotid pleomorphic adenoma, adenoma and malignant tumor. However, there are some overlaps in the iodine concentration between malignant tumors and pleomorphic adenomas and adenomas. Combined with the conventional morphological characteristics, it is helpful for Yu Zheng to diagnose and identify three types of tumor, and its sensitivity and specificity. The degree is high.

【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R739.8;R730.44

【参考文献】