CTE结合能谱成像在常见小肠恶性肿瘤中的应用价值

发布时间：2018-05-27 15:16

本文选题：小肠 + CT小肠造影　；参考：《皖南医学院》2017年硕士论文

【摘要】：目的:总结口服等渗甘露醇后正常小肠的MSCT表现及能谱曲线特点,为小肠疾病的诊断提供对比依据。方法:本研究搜集我院自2015年2月-2016年12月期间经临床确诊的无消化系统疾病的患者31例,其中男性14例,女性17例。所有病例均在口服等渗甘露醇后行CT检查,其中6例行双源CT双能量扫描,本研究将小肠分为十二指肠、空肠及回肠三组,观察并分析三组肠管肠腔充盈宽度、肠壁厚度、肠壁分层、肠壁平扫及增强双期CT值、肠系膜脂肪密度及40-160keV单能量CT值。对各组段小肠肠腔充盈宽度、肠壁厚度、平扫及增强双期CT值等指标进行单因素方差分析,方差一致时,采用One-way ANOVA检验,用LSD进行两两比较;方差不一致时,采用Brown-Forsythe进行检验,用Tamhane,s检验进行多重比较,P0.05说明具有统计学意义。结果:1.正常小肠肠壁平均厚度为(2.00±0.16)mm,十二指肠、空肠及回肠肠壁平均厚度分别为(2.01±0.17)、(2.00±0.15)、(1.99±0.15)mm,各组间差异无统计学意义;2.正常小肠平均充盈宽度为(23.24±3.23)mm,十二指肠、空肠及回肠平均充盈宽度分别为(25.31±3.03)、(23.53±2.33)、(20.89±2.62)mm,各组间差异有统计学意义;3.正常小肠肠壁分层较少见,本组数据显示6.5%的十二指肠肠壁分层,余肠段肠壁均以单层为主;4.小肠各组段平扫CT值差异无统计学意义。同组段小肠增强双期CT值差异具有统计学意义,各组段小肠门静脉期CT值均高于动脉期。而同一期相各组段小肠CT值差异具有统计学意义,各组段小肠CT值由近及远逐渐减低;5.正常小肠肠系膜脂肪密度平均CT值为-96.11HU,标准差为14.35HU,最高值为-67HU,最低值为-131HU。6.平扫小肠各组段在40-160keV单能量的CT值差异均无统计学意义。动脉期,小肠各组段在40-100keV单能量的CT值差异具有统计学意义,在110-160keV单能量的CT值差异无统计学意义。静脉期,小肠各组段在40-80keV单能量的CT值差异具有统计学意义,在90-160keV单能量的CT值差异无统计学意义。结论:正确认识正常小肠CTE表现及能谱曲线特点有助于小肠病变的诊断。目的:探讨口服大剂量等渗甘露醇CT小肠造影结合能谱成像在常见小肠恶性肿瘤诊断中的临床应用价值。方法:收集我院2015年2月-2016年12月期间经手术病理证实的常见小肠恶性肿瘤患者的影像学资料及临床资料,共51例,其中间质瘤29例,腺癌13例,淋巴瘤9例。所有病例均在口服等渗甘露醇后行CT检查,其中18例行双源CT双能量扫描。观察并分析三种常见小肠恶性肿瘤的CTE影像学特征及能谱曲线特点,CTE影像特征包括肿瘤(腺癌、间质瘤及淋巴瘤)的发病部位、形态、大小、生长方式、强化方式、邻近区域淋巴结有无肿大、邻近脏器受侵及转移等。对腺癌、间质瘤及淋巴瘤三组患者的性别及不同危险度间质瘤的MSCTE影像学指标(肿瘤形态、最大径、生长方式、边界及强化程度等)采用卡方检验,对腺癌、间质瘤及淋巴瘤三组肿瘤的发病年龄、40-160ke V单能量CT值进行方差齐性检验和单因素方差分析,三组间均数不同时,两两之间比较采用LSD法。P0.05为差异具有统计学意义。结果:1.本组13例腺癌,位于回肠6例,十二指肠4例,空肠3例。8例病变肠管呈环形增厚、管壁僵硬,5例呈肠管内软组织肿块;9例边界不清,4例边界清楚;8例密度均匀,5例密度不均,其中2例病灶内可见液化坏死区;增强扫描多呈较明显不均匀强化;本组4例可见肠系膜根部或腹膜后肿大淋巴结,1例出现肝脏转移。2.本组29例间质瘤,位于空肠12例,回肠9例,十二指肠8例,6.90%(2/29)经病理证实为极低度危险性间质瘤,37.93%(11/29)为低度危险性间质瘤,6.90%(2/29)为中度危险性间质瘤,48.28%(14/29)为高度危险性间质瘤,经统计学分析,不同危险度间质瘤的形态、最大径、生长方式、密度、边界、肿瘤血管及转移的差异具有统计学意义,而强化程度差异无统计学意义。本研究结果显示,肿瘤最大径5cm、边界不清、密度不均、增强扫描呈明显不均匀强化、邻近组织器官侵犯及远处转移等征象高度提示高度危险性间质瘤。3.本组9例淋巴瘤,位于回肠7例、十二指肠2例。6例小肠肠壁不均匀增厚,病变累及范围较广,其中5例病变肠腔呈动脉瘤样扩张,3例呈肠腔内息肉样软组织肿块,其中1例合并肠套叠;平扫7例密度均匀、2例密度不均;增强后病灶呈轻中度延迟强化;5例合并肠系膜或腹膜后淋巴结肿大,其中3例可见“汉堡包征”。4.常见小肠恶性肿瘤强化特点及能谱曲线特点:小肠淋巴瘤多呈轻中度延迟强化;间质瘤多呈“快进慢出”型强化;腺癌多呈“快进快出”型强化。本研究结果显示增强双期,腺癌、淋巴瘤及间质瘤三组肿瘤在40-60ke V单能量的CT值差异具有统计学意义,且腺癌组和间质瘤组的单能量CT值均大于淋巴瘤组,而三组肿瘤在70-160ke V单能量的CT值差异无统计学意义。但两两检验的结果显示静脉期腺癌组和间质瘤组在40-60ke V单能量的CT值差异无统计学意义。结论:小肠CT造影能反映常见小肠恶性肿瘤的形态学特征;而通过能谱曲线可对其进行定量分析。小肠CT造影结合能谱曲线特点为小肠肿瘤的诊断提供了新的思路和方法,具有较高的临床应用价值。
[Abstract]:Objective: To sum up the characteristics of MSCT and spectral curves of normal small intestine after oral isotonic mannitol, and to provide a comparative basis for the diagnosis of small intestinal diseases. Methods: This study collected 31 patients who had been clinically confirmed without digestive system diseases during the period of December February 2015, 14 of them and 17 in women. All cases were taken orally. CT examination was performed in 6 cases with double source CT scanning. The small intestine was divided into three groups of duodenum, jejunum and ileum, and three groups of intestinal cavity filling width, intestinal wall thickness, intestinal wall stratification, intestinal wall plain scan and enhanced double phase CT value, mesenteric fat density and 40-160keV single energy CT value were observed. The width of the cavity, the thickness of the intestinal wall, the plain scan and the enhancement of the two phase CT value were analyzed with single factor variance. When the variance was consistent, the One-way ANOVA test was used and the LSD was used for 22 comparison. When the variance was not consistent, Brown-Forsythe was used to test, and Tamhane, s test was used for multiple comparison. P0.05 showed statistical significance. Results: 1. normal small. The average thickness of intestinal wall was (2 + 0.16) mm, the average thickness of duodenum, jejunum and ileum was (2.01 + 0.17), (2 + 0.15) and (1.99 + 0.15) mm, and there was no statistical difference between each group. 2. normal small intestine filling width was (23.24 + 3.23) mm, and the average filling width of duodenum, jejunum and ileum was respectively (25.31 + 3.03), and the average filling width of duodenum, jejunum and ileum was respectively (25.31 + 3.03). 33) (20.89 + 2.62) mm, the difference between each group was statistically significant; 3. the intestinal wall stratification of normal small intestine was rare. The data of the duodenum wall in this group showed that 6.5% of the duodenum wall was stratified and the intestinal wall of the remaining intestine was the single layer. The difference of the CT value of the small intestinal segments was not statistically significant. The difference of the CT value of the two stages of the small intestine enhancement in the same group was statistically significant, and the segments were small in each group. The CT value of the enteric portal vein was higher than that of the arterial phase, but the difference in the CT value of small intestine in each stage of the same phase was statistically significant, and the CT value of small intestine in each group decreased gradually, and the average CT value of 5. normal intestinal mesentery was -96.11HU, the standard deviation was 14.35HU, the highest was -67HU, the lowest value was -131HU.6. flat small small intestine segments in 40-160keV. There was no statistically significant difference in the CT value of single energy. In the arterial phase, the difference in the CT value of the single energy of the small intestine in the single energy of the small intestine was statistically significant, and there was no statistical significance in the CT value of the single energy of the 110-160keV. In the venous phase, the difference in the CT value of the single energy of the small intestine at the CT value of the single energy of the small intestine was statistically significant, and the CT difference in the single energy of 90-160keV was different. No statistical significance. Conclusion: a correct understanding of the characteristics of normal small intestinal CTE and spectral curves is helpful for the diagnosis of small intestinal lesions. Objective: To explore the clinical value of oral large dose isosotic mannitol CT small bowel angiography combined with energy spectrum imaging in the diagnosis of common small intestinal malignant tumors. Methods: our hospital was collected during the period of December -2016 February 2015. The imaging data and clinical data of the patients with common intestinal malignant tumor confirmed by pathology were 51 cases, including 29 cases of stromal tumors, 13 cases of adenocarcinoma and 9 cases of lymphoma. All cases were examined by CT after oral administration of mannitol, of which 18 cases were treated with double source CT double energy scan. The CTE imaging features of three common small intestinal malignant tumors were observed and analyzed. Characteristics of the spectrum curve, CTE image features include the site of the tumor (adenocarcinoma, stromal tumor and lymphoma), morphology, size, growth mode, strengthening mode, lymph node enlargement in adjacent area, invasion and metastasis of adjacent viscera, and the MSCTE imaging index of sex and different risk of stromal tumors in three groups of adenocarcinoma, stromal tumor and lymphoma (tumor morphology, maximum diameter, growth mode, boundary and intensification degree, etc.) by chi square test, the onset age of three groups of adenocarcinoma, stromal tumor and lymphoma, 40-160ke V single energy CT value was tested by variance homogeneity test and single factor variance analysis, the number of three groups was different, and 22 compared with LSD.P0.05 as the difference was statistically significant Results: 1. the 13 cases of adenocarcinoma in the group, 6 cases in the ileum, 4 cases in the duodenum, 3 cases of.8 in the jejunum, the thickening of the intestinal tube, the rigid tube wall, the 5 cases of the soft tissue mass in the intestinal canal, 9 cases with unclear boundary and the clear boundary in 4 cases, 8 cases with uniform density and 5 cases of density uneven, among which 2 cases showed liquefied necrotic area in the lesion, and the enhanced scan showed more obvious uneven. There were 4 cases of mesenteric root or retroperitoneal lymphadenoma in 4 cases, 1 cases of liver metastases in 29 cases of interstitial tumor, 12 cases in jejunum, 9 ileum, 8 duodenum, 6.90% (2/29) proved to be extremely low risk stromal tumor, 37.93% (11/29) as low risk stromal tumor, 6.90% (2/29) as moderate risk stromal tumor, 4 8.28% (14/29) was a highly dangerous stromal tumor. Statistical analysis showed that the morphology, maximum diameter, growth mode, density, boundary, tumor blood vessel and metastasis of different risk were statistically significant, but there was no significant difference in the degree of enhancement. The results of this study showed that the maximum diameter of the tumor was 5cm, the boundary was unclear, density was uneven, enhanced scan. There were 9 cases of high risk interstitial tumor.3. in this group, 7 cases in ileum, 2 cases in duodenum and 2 cases of.6 in the duodenum, with a wide range of intestinal lesions, 5 of which were aneurysm like dilation in the intestinal cavity and 3 cases of polyposis in the intestinal cavity. Tissue mass, including 1 cases of intussusception, 7 cases with uniform density, 2 cases of uneven density, enhanced light and moderate delayed enhancement, 5 cases of mesenteric or retroperitoneal lymph node enlargement, and 3 cases of "Hamburg package".4. common small intestinal malignant tumor enhancement characteristics and characteristics: small and moderate delay in small intestinal lymphoma The results showed that the difference of CT value of the single energy of 40-60ke V in the three groups of enhanced double stage, adenocarcinoma, lymphoma and stromal tumor was statistically significant, and the single energy CT value of the adenocarcinoma group and the stromal tumor group was greater than that of the Lymphoma Group, and the three groups were swollen. There was no significant difference in the CT value of the single energy of 70-160ke V, but the results of 22 test showed that there was no statistical difference in the CT value of the single energy of 40-60ke V in the venous phase of the adenocarcinoma group and the stromal tumor group. Conclusion: the small intestinal CT contrast can reflect the morphological characteristics of the common malignant tumor of the small intestine, but the quantitative analysis can be done by the spectrum curve. The characteristics of small bowel CT angiography combined with energy spectrum curve provide new ideas and methods for the diagnosis of small intestinal tumors and have high clinical application value.
【学位授予单位】：皖南医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R730.44;R735.32

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