CT能谱成像对腮腺肿瘤鉴别诊断价值的初步研究
发布时间：2018-07-17 03:41
【摘要】：背景和目的:腮腺肿瘤是口腔颌面部常见的肿瘤之一,病理类型较为复杂,不同类型的肿瘤在临床表现,影像学表现,治疗及预后等方面均不相同。如何获得准确的术前诊断,是广大口腔颌面外科医生亟待解决的问题。随着CT设备和技术的不断发展,宝石能谱成像(gemstone spectral imaging,GSI)作为一种新的影像学检查方法,具有高清成像和低剂量成像的特点,在肿瘤良恶性的鉴别,肿瘤组织的定性及分级,判定组织的特异性等方面均已取得了一定的研究进展,将该技术应用于腮腺肿瘤的术前诊断,通过对肿瘤多参数的分析,有望为腮腺肿瘤性质的诊断提供一种新的方法。本研究目的是探究CT能谱分析在腮腺肿瘤诊断及鉴别中的应用价值,为腮腺肿瘤的早期诊断和鉴别诊断及治疗方案的选择提供更多的参考依据。方法:选取2015.1-2017.1间于郑州大学第一附属医院就诊并经手术后病理证实的腮腺肿瘤患者64例。其中多形性腺瘤24例,沃辛瘤15例,基底细胞腺瘤7例,腮腺恶性肿瘤18例。所有病例均采用美国GE Discovery 750HD CT机行颌面部平扫和双期增强扫描。扫描完成后采用标准算法重建成单能量图像,对平扫和增强扫描的能量图像进行分析与测量。测量感兴趣区(region of interest,ROI)的动脉期和静脉期各单能水平的CT值(HU),获得ROI的CT能谱曲线,并计算能谱曲线的斜率。分别测量ROI与颈内动、静脉的动脉期与静脉期碘浓度值,计算出标准碘浓度及动、静脉期碘浓度的差值,应用ROC曲线(receiver operating characteristics curve)分析比较能谱参数鉴别腮腺良恶性肿瘤的诊断价值。所有数据统计学分析均采用SPSS21.0统计学软件进行分析,结果以P0.05表示差异具有统计学意义。结果:1.腮腺各型肿瘤CT值比较:多形性腺瘤静脉期CT值(123.44±48.46HU)较动脉期(54.15±25.12HU)显著增高;而沃辛瘤静脉期CT值(110.95±47.65HU)较动脉期(143.01±27.39HU)减低;基底细胞腺瘤静脉期CT值(178.52±67.62HU)较动脉期(125.89±35.43HU)轻度增高;而腮腺恶性肿瘤静脉期CT值(171.76±59.33HU)较动脉期(92.25±24.00HU)显著增高,差异具有统计学意义(P0.01)。2.腮腺各型肿瘤40-70ke V的能谱曲线斜率比较:动脉期,多形性腺瘤能谱曲线斜率最低(0.53±0.51),沃辛瘤最高(2.11±0.58);静脉期,基底细胞腺瘤的能谱曲线斜率最高(3.24±0.52),沃辛瘤最低(1.49±1.17),且较动脉期明显下降,差异均具有统计学意义(P0.01)。3.腮腺各型肿瘤的碘浓度比较:动脉期,多形性腺瘤碘浓度最低(2.14±4.18mg/ml),沃辛瘤为9.83±4.19mg/ml,基底细胞腺瘤为9.19±5.25mg/ml,而恶性肿瘤最高(13.69±7.57mg/ml)。静脉期,多形性腺瘤碘浓度升高(10.99±5.93mg/ml),沃辛瘤较动脉期降低(7.86±6.24mg/ml),基底细胞腺瘤较动脉期显著增高(17.09±7.50mg/ml),而恶性肿瘤则轻度增高(16.45±7.49mg/ml),差异具有统计学意义(P0.01)。4.为排除个体的差异,将腮腺良、恶性肿瘤的标准碘浓度进行比较,与上述碘浓度比较的统计结果相一致。5.不同能谱参数诊断腮腺良、恶性肿瘤的ROC曲线分析:动脉期,碘浓度的ROC曲线下面积(area under curve,AUC)为0.801,标准碘浓度的AUC为0.792。静脉期,碘浓度的AUC为0.732,标准碘浓度的AUC为0.784。动脉期碘浓度诊断腮腺良恶性中的诊断效能最高,当诊断阈值为11.89时,灵敏度为66.7%,特异度为87.0%。结论:1.CT能谱成像能提供较多的诊断信息,有良好的临床应用前景。2.腮腺各型肿瘤的CT值,能谱衰减曲线及碘浓度等指标均有其独特的特点。3.CT能谱成像对不同性质腮腺肿瘤的鉴别诊断具有指导意义。
[Abstract]:Background and purpose: parotid tumor is one of the common tumors in the oral and maxillofacial region. The pathological types are more complex. Different types of tumors are different in clinical manifestations, imaging manifestations, treatment and prognosis. How to obtain accurate preoperative diagnosis is an urgent problem for the general oral and maxillofacial surgeons. With CT equipment and technology As a new method of imaging examination, gemstone spectral imaging (GSI) has been developed. It has the characteristics of high definition imaging and low dose imaging. It has made certain research progress in the identification of benign and malignant tumors, the qualitative and classification of tumor tissue, and the specificity of the tissue. The preoperative diagnosis of parotid tumors is expected to provide a new method for the diagnosis of parotid tumors by analyzing the multiple parameters of the tumor. The purpose of this study is to explore the application value of CT spectroscopy in the diagnosis and identification of parotid tumors, and to provide more references for the early diagnosis and differential diagnosis of parotid tumors and the choice of treatment options. Methods: 64 cases of parotid tumor confirmed by 2015.1-2017.1 in the First Affiliated Hospital of Zhengzhou University and confirmed by pathology after operation were selected, including 24 cases of pleomorphic adenoma, 15 cases of avatin tumor, 7 basal cell adenomas and 18 parotid malignant tumors. All cases were performed plain and double phase scan of maxillofacial region by American GE Discovery 750HD CT machine. Enhanced scan. After the scan completed, the standard algorithm was used to reconstruct the single energy image. The energy images of plain and enhanced scan were analyzed and measured. The CT values of each single energy level in the region of interest (ROI) were measured and the CT values of each single energy level (HU) were measured. The CT spectrum curve of ROI was obtained and the slope of the energy spectrum curve was calculated. ROI was measured respectively. The value of iodine concentration in the arterial and venous phase of the jugular vein was calculated. The difference between the standard iodine concentration and the iodine concentration in the venous phase was calculated. The diagnostic value of the ROC curve (receiver operating characteristics curve) was applied to the identification of the parotid benign and malignant tumors. The data statistics analysis used the SPSS21.0 statistics software. The results showed that the difference was statistically significant with P0.05. Results: the CT values of 1. parotid tumors were compared: the CT value of the pleomorphic adenoma (123.44 + 48.46HU) was significantly higher than that of the arterial phase (54.15 + 25.12HU), and the CT value of the venous phase of the aneurysm (110.95 + 47.65HU) was lower than that of the arterial phase (143.01 + 27.39HU), and the CT value of the basal cell adenoma venous phase. 178.52 + 67.62HU) was slightly higher than that of the arterial phase (125.89 + 35.43HU), while the CT value (171.76 + 59.33HU) of the parotid malignant tumor (171.76 + 59.33HU) was significantly higher than that of the arterial phase (92.25 + 24.00HU). The difference was statistically significant (P0.01) in the.2. parotid gland tumor 40-70ke V spectral curves of 40-70ke V: the lowest (0.53 +) in the arterial phase. 0.51) the highest (2.11 + 0.58) of the tumor was the highest (3.24 + 0.52) of the basal cell adenoma in venous phase (3.24 + 0.52), and the lowest (1.49 + 1.17) of the aneurysm (1.49 + 1.17), and compared with the arterial phase. The difference was statistically significant (P0.01) the iodine concentration of each type of parotid gland tumor: arterial phase, the lowest (2.14 + 4.18mg/ml) of pleomorphic adenoma (2.14 + 4.18mg/ml). The tumor was 9.83 + 4.19mg/ml, the basal cell adenoma was 9.19 + 5.25mg/ml, and the malignant tumor was the highest (13.69 + 7.57mg/ml). The iodine concentration in the pleomorphic adenoma increased (10.99 + 5.93mg/ml) in the venous phase. The aneurysm tumor was lower than the arterial phase (7.86 + 6.24mg/ml). The basal cell adenoma was significantly higher than the arterial phase (17.09 + 7.50mg/ml), and the malignant tumor was slightly higher (16.4). 5 + 7.49mg/ml), the difference was statistically significant (P0.01).4. for the exclusion of individual differences, the standard iodine concentration of parotid benign and malignant tumors was compared, consistent with the statistical results compared with the above iodine concentration,.5. different spectrum parameters were used to diagnose parotid benign and malignant tumor ROC curve analysis: arterial phase, iodine concentration under the ROC curve area (area under). Curve, AUC) is 0.801, AUC of standard iodine concentration is 0.792. venous phase, AUC of iodine concentration is 0.732, AUC of standard iodine concentration is the highest in diagnosis of benign and malignant parotid gland with 0.784. arterial phase iodine concentration, when diagnostic threshold is 11.89, sensitivity is 66.7%, specificity is 87%. Conclusion: 1.CT spectrum imaging can provide more diagnostic information, there are more information. The CT value of.2. parotid tumor, energy spectrum attenuation curve and iodine concentration have its unique characteristics. The.3.CT spectrum imaging is of guiding significance for the differential diagnosis of different parotid tumors.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R739.8
本文编号：2128845
[Abstract]:Background and purpose: parotid tumor is one of the common tumors in the oral and maxillofacial region. The pathological types are more complex. Different types of tumors are different in clinical manifestations, imaging manifestations, treatment and prognosis. How to obtain accurate preoperative diagnosis is an urgent problem for the general oral and maxillofacial surgeons. With CT equipment and technology As a new method of imaging examination, gemstone spectral imaging (GSI) has been developed. It has the characteristics of high definition imaging and low dose imaging. It has made certain research progress in the identification of benign and malignant tumors, the qualitative and classification of tumor tissue, and the specificity of the tissue. The preoperative diagnosis of parotid tumors is expected to provide a new method for the diagnosis of parotid tumors by analyzing the multiple parameters of the tumor. The purpose of this study is to explore the application value of CT spectroscopy in the diagnosis and identification of parotid tumors, and to provide more references for the early diagnosis and differential diagnosis of parotid tumors and the choice of treatment options. Methods: 64 cases of parotid tumor confirmed by 2015.1-2017.1 in the First Affiliated Hospital of Zhengzhou University and confirmed by pathology after operation were selected, including 24 cases of pleomorphic adenoma, 15 cases of avatin tumor, 7 basal cell adenomas and 18 parotid malignant tumors. All cases were performed plain and double phase scan of maxillofacial region by American GE Discovery 750HD CT machine. Enhanced scan. After the scan completed, the standard algorithm was used to reconstruct the single energy image. The energy images of plain and enhanced scan were analyzed and measured. The CT values of each single energy level in the region of interest (ROI) were measured and the CT values of each single energy level (HU) were measured. The CT spectrum curve of ROI was obtained and the slope of the energy spectrum curve was calculated. ROI was measured respectively. The value of iodine concentration in the arterial and venous phase of the jugular vein was calculated. The difference between the standard iodine concentration and the iodine concentration in the venous phase was calculated. The diagnostic value of the ROC curve (receiver operating characteristics curve) was applied to the identification of the parotid benign and malignant tumors. The data statistics analysis used the SPSS21.0 statistics software. The results showed that the difference was statistically significant with P0.05. Results: the CT values of 1. parotid tumors were compared: the CT value of the pleomorphic adenoma (123.44 + 48.46HU) was significantly higher than that of the arterial phase (54.15 + 25.12HU), and the CT value of the venous phase of the aneurysm (110.95 + 47.65HU) was lower than that of the arterial phase (143.01 + 27.39HU), and the CT value of the basal cell adenoma venous phase. 178.52 + 67.62HU) was slightly higher than that of the arterial phase (125.89 + 35.43HU), while the CT value (171.76 + 59.33HU) of the parotid malignant tumor (171.76 + 59.33HU) was significantly higher than that of the arterial phase (92.25 + 24.00HU). The difference was statistically significant (P0.01) in the.2. parotid gland tumor 40-70ke V spectral curves of 40-70ke V: the lowest (0.53 +) in the arterial phase. 0.51) the highest (2.11 + 0.58) of the tumor was the highest (3.24 + 0.52) of the basal cell adenoma in venous phase (3.24 + 0.52), and the lowest (1.49 + 1.17) of the aneurysm (1.49 + 1.17), and compared with the arterial phase. The difference was statistically significant (P0.01) the iodine concentration of each type of parotid gland tumor: arterial phase, the lowest (2.14 + 4.18mg/ml) of pleomorphic adenoma (2.14 + 4.18mg/ml). The tumor was 9.83 + 4.19mg/ml, the basal cell adenoma was 9.19 + 5.25mg/ml, and the malignant tumor was the highest (13.69 + 7.57mg/ml). The iodine concentration in the pleomorphic adenoma increased (10.99 + 5.93mg/ml) in the venous phase. The aneurysm tumor was lower than the arterial phase (7.86 + 6.24mg/ml). The basal cell adenoma was significantly higher than the arterial phase (17.09 + 7.50mg/ml), and the malignant tumor was slightly higher (16.4). 5 + 7.49mg/ml), the difference was statistically significant (P0.01).4. for the exclusion of individual differences, the standard iodine concentration of parotid benign and malignant tumors was compared, consistent with the statistical results compared with the above iodine concentration,.5. different spectrum parameters were used to diagnose parotid benign and malignant tumor ROC curve analysis: arterial phase, iodine concentration under the ROC curve area (area under). Curve, AUC) is 0.801, AUC of standard iodine concentration is 0.792. venous phase, AUC of iodine concentration is 0.732, AUC of standard iodine concentration is the highest in diagnosis of benign and malignant parotid gland with 0.784. arterial phase iodine concentration, when diagnostic threshold is 11.89, sensitivity is 66.7%, specificity is 87%. Conclusion: 1.CT spectrum imaging can provide more diagnostic information, there are more information. The CT value of.2. parotid tumor, energy spectrum attenuation curve and iodine concentration have its unique characteristics. The.3.CT spectrum imaging is of guiding significance for the differential diagnosis of different parotid tumors.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R739.8
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