双源CT灌注扫描对胰腺癌诊断的应用价值.pdf

中国医科大学硕士学位论文双源CT灌注扫描对胰腺癌诊断的应用价值姓名:柴瑞梅申请学位级别:硕士专业:影像医学与核医学指导教师:任克 20090401 ·中文结构式摘要· 双源CT灌注扫描对胰腺癌诊断的应用价值目的利用CT灌注方法,分析胰腺癌血流动力学变化,比较分析肿瘤组织与周围正常组织间各参数值的差异,探讨CT灌注对胰腺癌诊断的应用价值。实验材料与方法 l、研究对象对48例临床疑似胰腺癌或经其它检查方法发现胰腺占位性病变者进行CT灌注扫描,所有患者灌注检查前后一周内均接受了常规CT增强检查,其中22例经病理证实为胰腺癌,余26例经随访及临床检查证实。在22例经病理证实的胰腺癌中,有7例为高分化腺癌,5例为中分化腺癌,3例为中低分化腺癌,4例为低分化腺癌,3例查到瘤细胞但病理未确定分型。按其分化程度分成3组:A组高分化腺癌7例,B组中分化腺癌5例,C组中低分化及低分化腺癌7例。 2、仪器与方法采用Siemens双源CT扫描仪,先进行胰腺平扫,确定病变最大层面后,对此层面行CT灌注扫描。灌注图像传至Syngo CT工作站,利用Body Perfusion软件对灌注图像进行后处理,得到灌注血流量(Flow)图,血容量(blood volume BV)图,达峰时间(time topeak,TTP)图,通透性(permeability,per)图及 Patlak血容量(patlak blood volume,pBV)图等。分别测量病变组织与周围正常组织间的各项灌注值。 3、,全部计量资料以i±s表示,对胰腺癌组织与周围正常组织间各灌注测量值行配对t检验,对不同组别之间的参数比较采用单因素方差分析,P<。对于22例有手术病理的患者,分析比较常规CT方法及其与灌注CT相结合对胰腺癌诊断的准确率。实验结果 l、胰腺癌组织的灌注参数值Flow,BV,TTP,per及pBV均较周围正常胰腺组织低,其中Flow,BVgtpBV具有统计学意义(P<),同时病变组织的上竺 1915V 值显著高于周围正常组织。 2、A组、B组及C组间的Flow值及BV值具有明显差异(P<),而W瞪, per,pBV昌值无统计学差异。 3、CT灌注方法结合常规CT检查可提高胰腺癌诊断的准确率。结论胰腺CT灌注方法能够定量反映胰腺癌低血供的特点,并能提示肿瘤的病理分化程度,尤其对于形态学改变不典型的胰腺癌更具有优势。关键词胰腺癌;体层摄影术,X线计算机:灌注;双源CT 2 ·英文结构式摘要· InitialStudy ofCT Perfusion Using DSCT inDiagnosis ofPancreatic Cancer obj ective To analyze the hemodynamics ofpancreatic pare theparameters between tulTIortissueandnormaltissue,and discuss thevalue puted tomography (CD indiagnosis ofpancreatic cancer. Materials andMethods object Perfusion CT wasperformed in48 patients who were suspected aspancreatic cancer,22 wereconfirmed histopathologically and 26wereconfirmed byfollow-up. Allthepatients had received aroutine enhancement CT within the 22 histopathologically confirmed pancreatic cancer,7 were highly differentiated adenocarcinoma,5 were middle differentiated,3 were differentiated,4 were low differentiatedand 3were tothe differentiation degree,the histopathologicallyconfirmed ones were divided into3groups:A group included the7highlydifferentiated,Bgroup included the5middledifferentiated,and Cgroup