宝石能谱CT在肝癌TACE术后残留病灶供血动脉显示及活性乏血供病灶诊断中的应用
发布时间：2019-04-10 13:39
【摘要】：目的评价宝石能谱CT(GSI)最佳单能量血管成像对显示肝癌经皮肝动脉化疗栓塞(TACE)术后残留病灶供血动脉的价值;评价GSI在肝癌TACE术后乏血供活性病灶诊断中的价值。方法收集2013年2月至2016年2月绵阳市中心医院肝癌TACE术后患者进行回顾性分析。所有患者均在术后4~6周行GSI扫描,一次GSI扫描后,通过原始数据重建获得混合能量(QC)图像及能谱图像,图像后处理采用ADW4.6工作站和GSI-viewer软件。本研究分为以下两部分:第一部分:按纳入、排除标准将42例患者纳入研究。运用后处理软件中的对比噪声比(CNR)曲线,在能谱图像中得出动脉期腹主动脉与肝组织间最大CNR时所对应的显示残留病灶供血动脉的最佳单能量图像。在2名从事腹部影像工作的副主任医师指导下,分别在QC图像及最佳单能量图像上重建残留病灶供血动脉,并对上述两种方法重建的动脉进行分级评分,运用配对样本t检验比较两种方法对残留病灶供血动脉显示的评分结果。第二部分:按纳入、排除标准将36例患者纳入研究。运用CNR曲线,分别得出动脉期、门脉期乏血供病灶与周围正常肝组织间最大CNR时所对应的最佳单能量图像,记录QC图与最佳单能量图像中病灶的CNR值,比较动脉期、门脉期的QC图及最佳单能量图像CNR值的差异。采用A、B两种方法观察肝癌TACE术后肝脏乏血供病灶,A法通过观察QC图平扫、动脉期及门静脉期图像进行诊断;B法采用最佳单能量图、基物质图、能谱工具进行观察、诊断。由2名从事腹部影像的副主任医师在不知情的情况下分别在后处理工作站上对乏血供病灶性质进行判断,诊断结果与DSA及后续随访结果对照,采用2c检验比较A、B两种方法诊断肝癌TACE术后活性(残留、复发、转移)乏血供病灶的差异。结果第一部分:CT共检出残留病灶供血动脉52支,显示供血动脉的最佳单能量值在61-65Ke V间。QC图供血动脉图像评分为1.86±0.68,最佳单能量图像供血动脉图像评分为2.60±0.54,两种方法在评价肝癌TACE术后残留病灶供血动脉血管显示中存在显著差异(t=8.15,P0.001),GSI最佳单能量图像对肝癌TACE术后残留病灶供血动脉的显示优于QC图像。第二部分:36例TACE术后复查患者CT检查共检出乏血供病灶82个。动脉期QC图与最佳单能量图像中乏血供病灶CNR值分别为3.18±1.20、3.85±1.31;门脉期QC图与最佳单能量图像中乏血供病灶CNR值分别为3.85±1.52、4.50±1.48;上述两组数据差异均有统计学意义。A法敏感性为72.00%,特异性为81.30%;B法敏感性为94.00%,特异性为90.60%,两种方法敏感性及特异性差异均有统计学意义(2?=9.09,2?=5.14,P0.05)。结论与常规混合能量CT比较,GSI最佳单能量成像可以更好的显示肝癌TACE术后残留病灶供血动脉,GSI能更清晰的显示肝癌TACE术后肝脏乏血供病灶,并能根据能谱分析图的不同特征,有效地鉴别肝脏活性乏血供病灶与其他病变,可为后续治疗提供更为全面的信息。
[Abstract]:Objective to evaluate the value of best single energy angiography (CT (GSI) with gemstone energy spectrum in the diagnosis of residual foci after percutaneous transhepatic arterial chemoembolization (TACE) in hepatocellular carcinoma (HCC) and to evaluate the value of GSI in the diagnosis of hepatic carcinoma after TACE. Methods from Feb.2013 to Feb.2016, the patients with hepatocarcinoma TACE in Mianyang Central Hospital were retrospectively analyzed. All patients underwent GSI scan at 4-6 weeks after operation. After one GSI scan, mixed-energy (QC) images and energy spectrum images were obtained by raw data reconstruction. ADW4.6 workstation and GSI-viewer software were used in the post-processing of the images. This study is divided into two parts: part one: 42 patients were included in the study according to the criteria of inclusion and exclusion. By using the (CNR) curve of the contrast noise ratio in the post-processing software, the optimal single-energy image for displaying the residual focus supplying artery was obtained in the energy spectrum image when the maximum CNR between the abdominal aorta and the liver tissue was obtained during the arterial phase. Under the guidance of two deputy chief doctors engaged in abdominal imaging, the residual foci supplying arteries were reconstructed on the QC images and the best single energy images respectively, and the reconstructed arteries were graded according to the above two methods. The t-test of paired samples was used to compare the results of the two methods on the display of the blood supply artery of the residual lesion. Part two: 36 patients were included in the study according to the criteria of inclusion and exclusion. Using CNR curve, the best single energy images corresponding to the maximum CNR between arterial phase, portal phase and surrounding normal liver tissue were obtained, and the CNR values of lesions in QC and optimal single energy images were recorded, and the arterial phase was compared. Difference of CNR value between portal phase QC diagram and optimal single energy image. Methods A and B methods were used to observe hepatic hypovascular lesions after TACE. Plain scan of QC images, arterial phase and portal phase images of A method were used for diagnosis. B method used the best single energy diagram, base material diagram, energy spectrum tools to observe and diagnose. Two deputy chief doctors who were engaged in abdominal imaging were used to judge the nature of ischemic lesions on post-processing workstations without their knowledge. The diagnosis results were compared with DSA and follow-up results, and the results were compared with those of DSA and follow-up with 2c test A, and the results were compared with those of follow-up by 2c test. B the difference of activity (residual, recurrence and metastasis) in diagnosis of hepatocellular carcinoma (HCC) after TACE. Results in the first part, 52 residual feeding arteries were detected by CT. The best single energy value of the feeding arteries was between 61-65Ke V. the image score of QC map was 1.86 卤0.68, The best single-energy image was 2.60 卤0.54. There was significant difference between the two methods in the evaluation of residual blood supply arteries after TACE (t = 8.15, P0.001), and there was a significant difference between the two methods in the evaluation of residual lesions of HCC after operation (t = 8.15, P0.001). The best single energy image of GSI was superior to QC image in displaying the feeding artery of residual foci after TACE for hepatocellular carcinoma (HCC). In the second part, 82 lesions were detected by CT in 36 patients with TACE. The CNR values in arterial phase QC and optimal single energy images were 3.18 卤1.20,3.85 卤1.31, 3.85 卤1.52 and 4.50 卤1.48 in portal phase QC and optimal single energy images, respectively, and the CNR values in arterial phase and optimal single energy images were 3.18 卤1.20,3.85 卤1.31, 3.85 卤1.52 and 4.50 卤1.48respectively. The sensitivity and specificity of A method were 72.0% and 81.30% respectively. The sensitivity and specificity of method B were 94.00% and 90.60% respectively. There was a significant difference in sensitivity and specificity between the two methods (2 / 9.09, 2 / 5.14, P0.05). Conclusion compared with conventional mixed-energy CT, the best single-energy imaging of GSI can better display the residual lesion feeding arteries after TACE, and GSI can more clearly show the hepatic hypovascular lesions after TACE. According to the different characteristics of the energy spectrum analysis map, we can effectively distinguish the liver active ischemic lesions from other lesions, which can provide more comprehensive information for the follow-up treatment.
【学位授予单位】：西南医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.7;R730.44
本文编号：2455842
[Abstract]:Objective to evaluate the value of best single energy angiography (CT (GSI) with gemstone energy spectrum in the diagnosis of residual foci after percutaneous transhepatic arterial chemoembolization (TACE) in hepatocellular carcinoma (HCC) and to evaluate the value of GSI in the diagnosis of hepatic carcinoma after TACE. Methods from Feb.2013 to Feb.2016, the patients with hepatocarcinoma TACE in Mianyang Central Hospital were retrospectively analyzed. All patients underwent GSI scan at 4-6 weeks after operation. After one GSI scan, mixed-energy (QC) images and energy spectrum images were obtained by raw data reconstruction. ADW4.6 workstation and GSI-viewer software were used in the post-processing of the images. This study is divided into two parts: part one: 42 patients were included in the study according to the criteria of inclusion and exclusion. By using the (CNR) curve of the contrast noise ratio in the post-processing software, the optimal single-energy image for displaying the residual focus supplying artery was obtained in the energy spectrum image when the maximum CNR between the abdominal aorta and the liver tissue was obtained during the arterial phase. Under the guidance of two deputy chief doctors engaged in abdominal imaging, the residual foci supplying arteries were reconstructed on the QC images and the best single energy images respectively, and the reconstructed arteries were graded according to the above two methods. The t-test of paired samples was used to compare the results of the two methods on the display of the blood supply artery of the residual lesion. Part two: 36 patients were included in the study according to the criteria of inclusion and exclusion. Using CNR curve, the best single energy images corresponding to the maximum CNR between arterial phase, portal phase and surrounding normal liver tissue were obtained, and the CNR values of lesions in QC and optimal single energy images were recorded, and the arterial phase was compared. Difference of CNR value between portal phase QC diagram and optimal single energy image. Methods A and B methods were used to observe hepatic hypovascular lesions after TACE. Plain scan of QC images, arterial phase and portal phase images of A method were used for diagnosis. B method used the best single energy diagram, base material diagram, energy spectrum tools to observe and diagnose. Two deputy chief doctors who were engaged in abdominal imaging were used to judge the nature of ischemic lesions on post-processing workstations without their knowledge. The diagnosis results were compared with DSA and follow-up results, and the results were compared with those of DSA and follow-up with 2c test A, and the results were compared with those of follow-up by 2c test. B the difference of activity (residual, recurrence and metastasis) in diagnosis of hepatocellular carcinoma (HCC) after TACE. Results in the first part, 52 residual feeding arteries were detected by CT. The best single energy value of the feeding arteries was between 61-65Ke V. the image score of QC map was 1.86 卤0.68, The best single-energy image was 2.60 卤0.54. There was significant difference between the two methods in the evaluation of residual blood supply arteries after TACE (t = 8.15, P0.001), and there was a significant difference between the two methods in the evaluation of residual lesions of HCC after operation (t = 8.15, P0.001). The best single energy image of GSI was superior to QC image in displaying the feeding artery of residual foci after TACE for hepatocellular carcinoma (HCC). In the second part, 82 lesions were detected by CT in 36 patients with TACE. The CNR values in arterial phase QC and optimal single energy images were 3.18 卤1.20,3.85 卤1.31, 3.85 卤1.52 and 4.50 卤1.48 in portal phase QC and optimal single energy images, respectively, and the CNR values in arterial phase and optimal single energy images were 3.18 卤1.20,3.85 卤1.31, 3.85 卤1.52 and 4.50 卤1.48respectively. The sensitivity and specificity of A method were 72.0% and 81.30% respectively. The sensitivity and specificity of method B were 94.00% and 90.60% respectively. There was a significant difference in sensitivity and specificity between the two methods (2 / 9.09, 2 / 5.14, P0.05). Conclusion compared with conventional mixed-energy CT, the best single-energy imaging of GSI can better display the residual lesion feeding arteries after TACE, and GSI can more clearly show the hepatic hypovascular lesions after TACE. According to the different characteristics of the energy spectrum analysis map, we can effectively distinguish the liver active ischemic lesions from other lesions, which can provide more comprehensive information for the follow-up treatment.
【学位授予单位】：西南医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.7;R730.44
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