CT能譜成像對(duì)腮腺腫瘤鑒別診斷價(jià)值的初步研究
發(fā)布時(shí)間：2018-07-17 03:41
【摘要】：背景和目的:腮腺腫瘤是口腔頜面部常見(jiàn)的腫瘤之一,病理類型較為復(fù)雜,不同類型的腫瘤在臨床表現(xiàn),影像學(xué)表現(xiàn),治療及預(yù)后等方面均不相同。如何獲得準(zhǔn)確的術(shù)前診斷,是廣大口腔頜面外科醫(yī)生亟待解決的問(wèn)題。隨著CT設(shè)備和技術(shù)的不斷發(fā)展,寶石能譜成像(gemstone spectral imaging,GSI)作為一種新的影像學(xué)檢查方法,具有高清成像和低劑量成像的特點(diǎn),在腫瘤良惡性的鑒別,腫瘤組織的定性及分級(jí),判定組織的特異性等方面均已取得了一定的研究進(jìn)展,將該技術(shù)應(yīng)用于腮腺腫瘤的術(shù)前診斷,通過(guò)對(duì)腫瘤多參數(shù)的分析,有望為腮腺腫瘤性質(zhì)的診斷提供一種新的方法。本研究目的是探究CT能譜分析在腮腺腫瘤診斷及鑒別中的應(yīng)用價(jià)值,為腮腺腫瘤的早期診斷和鑒別診斷及治療方案的選擇提供更多的參考依據(jù)。方法:選取2015.1-2017.1間于鄭州大學(xué)第一附屬醫(yī)院就診并經(jīng)手術(shù)后病理證實(shí)的腮腺腫瘤患者64例。其中多形性腺瘤24例,沃辛瘤15例,基底細(xì)胞腺瘤7例,腮腺惡性腫瘤18例。所有病例均采用美國(guó)GE Discovery 750HD CT機(jī)行頜面部平掃和雙期增強(qiáng)掃描。掃描完成后采用標(biāo)準(zhǔn)算法重建成單能量圖像,對(duì)平掃和增強(qiáng)掃描的能量圖像進(jìn)行分析與測(cè)量。測(cè)量感興趣區(qū)(region of interest,ROI)的動(dòng)脈期和靜脈期各單能水平的CT值(HU),獲得ROI的CT能譜曲線,并計(jì)算能譜曲線的斜率。分別測(cè)量ROI與頸內(nèi)動(dòng)、靜脈的動(dòng)脈期與靜脈期碘濃度值,計(jì)算出標(biāo)準(zhǔn)碘濃度及動(dòng)、靜脈期碘濃度的差值,應(yīng)用ROC曲線(receiver operating characteristics curve)分析比較能譜參數(shù)鑒別腮腺良惡性腫瘤的診斷價(jià)值。所有數(shù)據(jù)統(tǒng)計(jì)學(xué)分析均采用SPSS21.0統(tǒng)計(jì)學(xué)軟件進(jìn)行分析,結(jié)果以P0.05表示差異具有統(tǒng)計(jì)學(xué)意義。結(jié)果:1.腮腺各型腫瘤CT值比較:多形性腺瘤靜脈期CT值(123.44±48.46HU)較動(dòng)脈期(54.15±25.12HU)顯著增高;而沃辛瘤靜脈期CT值(110.95±47.65HU)較動(dòng)脈期(143.01±27.39HU)減低;基底細(xì)胞腺瘤靜脈期CT值(178.52±67.62HU)較動(dòng)脈期(125.89±35.43HU)輕度增高;而腮腺惡性腫瘤靜脈期CT值(171.76±59.33HU)較動(dòng)脈期(92.25±24.00HU)顯著增高,差異具有統(tǒng)計(jì)學(xué)意義(P0.01)。2.腮腺各型腫瘤40-70ke V的能譜曲線斜率比較:動(dòng)脈期,多形性腺瘤能譜曲線斜率最低(0.53±0.51),沃辛瘤最高(2.11±0.58);靜脈期,基底細(xì)胞腺瘤的能譜曲線斜率最高(3.24±0.52),沃辛瘤最低(1.49±1.17),且較動(dòng)脈期明顯下降,差異均具有統(tǒng)計(jì)學(xué)意義(P0.01)。3.腮腺各型腫瘤的碘濃度比較:動(dòng)脈期,多形性腺瘤碘濃度最低(2.14±4.18mg/ml),沃辛瘤為9.83±4.19mg/ml,基底細(xì)胞腺瘤為9.19±5.25mg/ml,而惡性腫瘤最高(13.69±7.57mg/ml)。靜脈期,多形性腺瘤碘濃度升高(10.99±5.93mg/ml),沃辛瘤較動(dòng)脈期降低(7.86±6.24mg/ml),基底細(xì)胞腺瘤較動(dòng)脈期顯著增高(17.09±7.50mg/ml),而惡性腫瘤則輕度增高(16.45±7.49mg/ml),差異具有統(tǒng)計(jì)學(xué)意義(P0.01)。4.為排除個(gè)體的差異,將腮腺良、惡性腫瘤的標(biāo)準(zhǔn)碘濃度進(jìn)行比較,與上述碘濃度比較的統(tǒng)計(jì)結(jié)果相一致。5.不同能譜參數(shù)診斷腮腺良、惡性腫瘤的ROC曲線分析:動(dòng)脈期,碘濃度的ROC曲線下面積(area under curve,AUC)為0.801,標(biāo)準(zhǔn)碘濃度的AUC為0.792。靜脈期,碘濃度的AUC為0.732,標(biāo)準(zhǔn)碘濃度的AUC為0.784。動(dòng)脈期碘濃度診斷腮腺良惡性中的診斷效能最高,當(dāng)診斷閾值為11.89時(shí),靈敏度為66.7%,特異度為87.0%。結(jié)論:1.CT能譜成像能提供較多的診斷信息,有良好的臨床應(yīng)用前景。2.腮腺各型腫瘤的CT值,能譜衰減曲線及碘濃度等指標(biāo)均有其獨(dú)特的特點(diǎn)。3.CT能譜成像對(duì)不同性質(zhì)腮腺腫瘤的鑒別診斷具有指導(dǎo)意義。
[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.
【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R739.8
本文編號(hào)：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.
【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R739.8
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