能谱CT对TACE治疗原发性肝癌疗效的评估价值与常规CT的对比研究

发布时间：2018-05-01 08:30

本文选题：能谱CT + 碘基图像　；参考：《石河子大学》2017年硕士论文

【摘要】：目的:探讨能谱CT对原发性肝癌(Primary Hepatic Carcinoma,PHC)经导管动脉化疗栓塞术(Transcatheter Arterial Chemoembolization,TACE)治疗后早期疗效评估应用价值的准确性与常规CT的对比。材料与方法:1.收集2015年11月至2016年11月就诊于新疆石河子大学医学院第一附属医院被确诊为原发性肝癌并准备再次行TACE治疗的患者39例,所有患者均签署知情同意书同意进行TACE治疗,并且术前1~3天均进行能谱CT及常规CT检查,然后又经数字减影血管造影(Digital subtraction angiography,DSA)复查证实;男性35例(89.7%),女性4例(10.3%),年龄42~79岁,平均(55.4±11.1)岁。2.扫描设备采用美国GE公司生产的Discovery HD 750 CT扫描仪及GSI Liver扫描序列。3.将采集到的常规CT图像(即混合能量图像)及能谱CT图像传至GE adw4.6工作站,并重建出1.25mm层厚平扫及3期(动脉期、门脉期、延迟期)碘基图像;在每一时相栓塞瘤体不同的层面图像上选定5个感兴趣区(region of interest,ROI),瘤区选择ROI时应尽量包括整个病变区域,非瘤区(瘤周正常肝实质区)选取ROI时应尽量避开血管、胆道、伪影处。然后分别测量各期瘤区、非瘤区碘基图像上碘浓度含量,及常规CT图像上CT值;瘤区碘浓度含量即IC病灶为3期增强扫描病灶测量的碘浓度含量—平扫病灶测量的碘浓度含量,非瘤区碘浓度含量即IC肝脏为各期周围正常肝组织的碘浓度含量。4.采用SPSS 17.0统计软件进行分析,所用统计方法为诊断试验,通过能谱CT及常规CT与金标准DSA的比较,得到真阳性、假阳性、真阴性、假阴性的例数,分别计算两种方法的灵敏度、特异度、漏诊率、误诊率、诊断指数,绘制ROC曲线,通过曲线下面积来比较二者的检验效能。结果:1.39例PHC患者均获得较满意的常规CT、能谱CT及DSA图像。2.能谱CT判断结果分析:以DSA作为“金标准”,能谱CT判断是否有肿瘤残留或复发的灵敏度为96.77%,特异度为100.0%,误诊率为0.0%,漏诊率为3.23%,诊断指数为196.77%。3.常规CT判断结果分析:以DSA作为“金标准”,常规CT判断是否有肿瘤残留或复发的灵敏度为67.74%,特异度为100.0%,误诊率为0.0%,漏诊率为32.26%,诊断指数为167.74%。4.绘制ROC曲线显示,能谱CT的曲线下面积为0.984,常规CT的曲线下面积为0.839。结论:1.能谱CT碘基图的碘含量变化对检出肝内病灶的敏感性较高,对评价TACE术后疗效具有重要参考价值。2.能谱CT及常规CT和DSA相比,二者均可通过判断是否有肿瘤残留或复发来对TACE治疗原发性肝癌的疗效进行评估,但能谱CT的评估准确性较常规CT高。3.能谱CT的多参数成像对TACE治疗原发性肝癌疗效的评估及指导再次介入手术的时机选择可以提供更详细、更准确、更全面的影像资料,是一种更为可靠的评估方法;对临床医生在后续治疗方案的制定及判断预后也有一定的指导作用。
[Abstract]:Objective: to evaluate the value of energy dispersive CT (EDS) in evaluating the early efficacy of transcatheter arterial chemoembolization (TACE) for primary Hepatic carcinoma (PHC) and to compare with conventional CT in evaluating the early efficacy of transcatheter arterial chemoembolization (TACE). Materials and methods: 1. From November 2015 to November 2016, 39 patients who were diagnosed with primary liver cancer at the first affiliated Hospital of Medical College of Shihezi University of Xinjiang and were ready to receive TACE treatment again were collected. All the patients signed informed consent to TACE treatment. EDS and conventional CT were performed on 1 day and 3 days before operation, and then were confirmed by digital subtraction angiography (DSA). 35 cases of male and 4 cases of female were confirmed by digital subtraction angiography (35 cases) and 10.3% (mean age: 55.4 卤11.1) years old (mean, 55.4 卤11.1) years. The scanning equipment uses Discovery HD 750 CT scanner and GSI Liver scan sequence produced by GE Company in USA. The conventional CT images (mixed energy images) and energy dispersive CT images were transferred to GE adw4.6 workstation, and then the 1.25mm slice thick plain scan and 3 phases (arterial phase, portal phase, delayed phase) were reconstructed. Five regions of interest were selected on different plane images of each transient embolization tumor. The tumor area should include the whole lesion area when selecting ROI, and the non-tumor area (normal hepatic parenchyma around the tumor) should avoid blood vessels and bile duct as far as possible. The artifact. Then the iodine concentration in each stage of tumor area and non-tumor area was measured respectively, and the CT value on conventional CT image was also measured, and the iodine concentration in the tumor area was measured by phase 3 enhancement scan and the iodine concentration measured by plain scan. The iodine concentration in the non-tumor area is the iodine concentration of the normal liver tissue around each phase of IC liver. The statistical software SPSS 17.0 was used to analyze. The statistical method was diagnostic test. By comparing the spectral CT and conventional CT with gold standard DSA, the cases of true positive, false positive, true negative and false negative were obtained, and the sensitivity of the two methods were calculated respectively. Specificity, missed diagnosis rate, misdiagnosis rate, diagnostic index, ROC curve were drawn. Results 1.39 patients with PHC obtained satisfactory routine CTS, EDS CT and DSA images. Analysis of the results of energy dispersive CT: with DSA as the "gold standard", the sensitivity, specificity, misdiagnosis rate, missed diagnosis rate and diagnostic index were 96.777.77, 100.0, 0.010, 3.23g and 196.77.3respectively. Analysis of the results of conventional CT: with DSA as the "gold standard", the sensitivity of conventional CT in judging whether there was tumor residue or recurrence was 67.74, the specificity was 100.00.The misdiagnosis rate was 0.00.The missed diagnosis rate was 32.26, and the diagnostic index was 167.74.4. The area under the curve of energy dispersive CT is 0.984, and that of conventional CT is 0.839. Conclusion 1. The changes of iodine content in EDS were highly sensitive to the detection of intrahepatic lesions, which had important reference value for evaluating the curative effect of TACE. Compared with conventional CT and DSA, energy dispersive CT and conventional CT can be used to evaluate the efficacy of TACE in the treatment of primary liver cancer by judging whether there is tumor residue or recurrence, but the accuracy of EDS is higher than that of conventional CT. Multiparameter imaging of energy dispersive CT can provide more detailed, accurate and comprehensive imaging data for evaluating the efficacy of TACE in the treatment of primary liver cancer and guiding the timing of re-interventional surgery. It is a more reliable evaluation method. It is also helpful for clinicians to make treatment plan and judge prognosis.
【学位授予单位】：石河子大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.7

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