孤立性肺结节的64层螺旋CT灌注成像技术及其应用价值

目的 探讨64层螺旋CT灌注成像技术在孤立性肺结节(SPN)诊断和鉴别诊断中的应用价值.方法 前瞻性利用Sie-mens SOMATOM sensation 64层螺旋cT机对35例SPN进行灌注扫描,经随机软件syngo Body PCT测定SPN的灌注参数,包括血容量(blood volume,BV)、血流量(blood flow,BF)、渗透性(permeability,P)的数值以及时间-密度曲线(time-density curve,TDC).并在时间-密度曲线的基础上,测量SPN的强化值、结节和动脉强化值比.结果 恶性肺结节的灌注参数BV值、P值、强化值以及结节和动脉强化值比均高于良性结节,有显著性差异(P值均<0.05),BF值无显著性差异(P>0.05).炎性结节的强化值以及结节和动脉强化值比与恶性结节无显著性差异(P>0.05).恶性结节、炎性结节、良性结节的TDC形态不同.结论 多排螺旋CT灌注成像对良恶性SPN鉴别诊断具有重要意义.     

DCE-MRI对孤立性肺结节良恶性诊断价值的Meta分析

目的 采用Meta分析方法评价动态增强磁共振成像(DCE-MRI)对孤立性肺结节(SPN)良恶性的鉴别诊断价值.方法 计算机检索PubMed、EBSCO、Cochrane Library、Ovid、CBM、VIP、万方和CNKI数据库,检索关于DCE-MRI用来诊断SPN的中英文文献.按照Cochrane协作网推荐的诊断试验纳入标准筛选文献,提取纳入研究文献的特征信息.文献评价采用诊断研究评价工具QUADAS-2.数据采用Stata 12.0和Meta-Disc 1.4软件进行Meta分析,检验异质性和发表偏倚,根据异质性的结果选择相应效应量,计算汇总敏感度、特异度、阳性似然比、阴性似然比以及诊断比值比,绘制汇总受试者工作特征(SROC)曲线并计算曲线下面积(AUC).结果 共纳入17篇文献,包含了1255个病灶,Meta分析结果显示:DCE-MRI对SPN良恶性的诊断价值的汇总灵敏度、特异度、阳性似然比、阴性似然比和诊断比值比分别为0.95、0.81、4.9、0.06、85.SROC曲线AUC为0.97.结论 DCE-MRI对SPN良恶性的鉴别诊断具有较高的灵敏度和特异度,是一种诊断效能较高的影像学检查方法.     

DKI全域直方图参数鉴别孤立性肺结节良恶性的价值

目的 探讨扩散峰度成像(DKI)全域直方图参数鉴别孤立性肺结节(SPN)良恶性的诊断价值。方法 回顾性搜集71例CT难以鉴别的SPN患者纳入研究，所有患者均行磁共振常规及DKI序列扫描。根据病理结果将SPN分为良性组和恶性组，采用两独立样本t检验(正态分布)或Mann-Whitney U检验(非正态分布)比较良、恶性SPN组DKI(D值、K值)和ADC值全域直方图参数的差异；采用受试者工作特征曲线评估直方图参数的诊断效能，并用DeLong检验比较各直方图参数的曲线下面积(AUC);采用Spearman秩相关分析直方图参数与恶性SPN的相关性。结果 恶性SPN的D值mean、std、10Percentile、90Percentile、InterquartileRange、Max、Median、Min、Range、Energy、Entropy、Variance均显著低于良性SPN,而Uniformity显著高于良性SPN;恶性SPN的K值std、90Percentile、InterquartileRange、Range、Variance均显著高于良性SPN,而10Percentile、Mi...     

多层螺旋CT灌注成像在孤立性肺结节中的诊断价值

目的 探讨多层螺旋CT灌注成像在诊断孤立性肺结节(SPN)中的应用价值.方法 对经手术病理证实的42例SPN患者采用GE Lightspeed 16排螺旋CT机行灌注成像,应用GE ADW 4.3工作站的Perfusion3-body tumor软件对结节进行分析,对所获得参数包括血流量(BF)、血容量(BV)、平均通过时间(MTT)、表面通透性(PS)的数值及时间-密度曲线(TDC)进行统计分析,计算有统计学意义的参数诊断良恶性SPN的敏感性、特异性、阳性预测值及阴性预测值.结果 恶性SPN的灌注参数BV及PS值均高于良性SPN,有显著性差异(P＜0.05),BF及MTT值无显著性差异(P＞0.05).恶性结节和炎性结节的BF、BV和PS值均明显高于良性结节,有显著性差异(P＜0.05),恶性结节与炎性结节之间的灌注值则无显著性差异(P＞0.05).以BV≥5 mL/100 g为诊断恶性阈值,其敏感性、特异性、阳性预测值、阴性预测值分别为87.5％(21/24)、72.2％(13/18)、80.7％(21/26)、81.3％(13/16).PS≥15 mL·min-1·100 g-1为诊断恶性阈值,其敏感性、特异性、阳性预测值、阴性预测值分别为91.8％(22/24)、66.7％(12/18)、78.6％(22/29)、85.7％(12/14).BV≥5 mL/100 g且PS≥15 mL· min-1·100 g-1为诊断恶性阈值,其敏感性、特异性、阳性预测值、阴性预测值分别为95.8％(23/24)、83.3％(15/18)、88.5％(23/26)、93.8％(15/16).恶性、炎性与良性结节的平均TDC形态不同,恶性结节主要表现为Ⅰ型曲线,炎性结节主要表现为Ⅱ型曲线,良性结节表现为Ⅲ型曲线.结论 多层螺旋CT灌注成像灌注参数对良恶性的鉴别有一定的价值,但对恶性及炎性SPN鉴别缺乏特异性.     

一站式能谱及灌注成像鉴别诊断孤立性肺结节

目的：探讨一站式能谱及灌注成像在孤立性肺结节(SPN)鉴别诊断中的应用价值。方法47例接受一站式能谱及灌注成像且经病理证实为 SPN 患者分为恶性组(28例)、良性组(19例),分别测量肺内病灶的血容量(BV)、血流量(BF)、平均通过时间(MTT)、表面通透性(PS)数值及动、静脉期的碘浓度(IC)、标准碘浓度(NIC)、能谱曲线斜率(40~100 keV)。采用独立样本 t 检验的方法,比较2组各参数间的差异。结果恶性结节的灌注参数 BF、BV、PS 值高于良性结节,有显著性差异(P <0.05),恶性结节 MTT 与良性结节无显著性差异(P>0.05);肺恶性结节动、静脉期 IC、NIC、能谱曲线斜率均高于良性结节,有显著性差异(P<0.05)。结论一站式能谱及灌注成像技术具有实现能谱及灌注成像同时完成的优势,可提供更多参数,在 SPN 鉴别诊断中具有一定应用价值。     

IVIM-DWI全域直方图参数鉴别孤立性肺结节良恶性的价值

【摘要】目的：探讨体素内不相干运动扩散加权成像（IVIM-DWI）全域直方图参数对良、恶性孤立性肺结节（SPN）的鉴别诊断价值。方法：回顾性将CT难以明确诊断而进一步行MRI检查的90例SPN患者纳入研究。根据病理结果将SPN分为良性组（30例）和恶性组（60例）。采用两独立样本t检验（正态分布）或Mann-Whitney U检验（非正态分布）比较良、恶性组的ADC和IVIM-DWI参数（D、D*、f）的全域直方图参数值的差异；采用受试者工作特征（ROC）曲线评估直方图参数的诊断效能并确定最佳阈值，采用DeLong法比较各直方图参数AUC的差异；采用Spearman秩相关检验分析全域直方图参数与恶性SPN的相关性。结果：恶性SPN组的D值和ADC值的多项全域直方图参数（均值、标准差、P10、P90、四分位间距、最大值、中位数、最小值、范围、能量、熵、均匀性和异质性）的测量值均显著低于良性SPN组（P<0.05）；且这些直方图参数均与恶性SPN呈负相关（P<0.05）。D和ADC的直方图参数均能有效鉴别SPN的良恶性，且各项直方图参数AUC的差异无统计学意义（P＞0.05）。以D值的多项全域直方图参数建立的联合模型预测恶性SPN的效能最高，AUC为0.966、敏感度为88.3%、特异度为96.7%。结论：IVIM-DWI参数中D值的全域直方图参数可有效鉴别良、恶性SPN，且诊断效能优于ADC值的直方图参数，D值多项全域直方图参数构建的联合模型的诊断效能高于单一参数。     

双能CT对孤立性肺结节的诊断价值

目的:探讨双能CT对孤立性肺结节(SPN)的诊断价值.方法:采用双能CT(管电压为80和140kVp)对水模、体模、47例平扫CT无明显钙化的SPN(恶性31例,良性16例)进行扫描,测量其CT值变化,计算病灶内钙质含量,比较良恶性SPN的CT值变化及钙质含量.结果:良性SPN的CT值变化中位数为5HU,恶性SPN为4...     

体素内不相干运动中D值鉴别乳腺良恶性病变的Meta分析

目的 采用Meta分析方法,评价体素内不相干运动(IVIM)中D值鉴别乳腺良恶性病变的诊断价值.方法 检索Pubmed、Embase、CBM、CNKI、万方数据库建库至2015年11月间收录的应用IVIM D值鉴别乳腺良恶性病变的中英文文献,按照Cochrane协作网推荐的诊断试验纳入标准筛选文献及进行质量评价,提取纳入研究的特征信息,采用Stata 12.0软件对纳入文献进行Meta分析.结果 共纳入文献10篇,研究病灶共计710个.D值鉴别乳腺良恶性病变的汇总敏感性、特异性、阳性似然比、阴性似然比和SROC曲线下面积分别为:90％(95％CI 0.87 ～0.93)、85％ (95％CI 0.75 ～0.91)、5.9(95％CI 3.4～ 10.1)、0.12(95％ CI 0.08 ～0.17)、0.92(95％CI 0.90～0.94).D值提示恶性的乳腺病变验后恶性率为90％,D值提示良性的乳腺病变验后恶性率为15％.经Deeks线性回归分析,纳入文献无发表偏倚.结论 IVIM D值有助于乳腺良恶性病变的鉴别.     

孤立性肺结节CT灌注成像与微血管构成的相关性研究

目的:探讨孤立性肺结节(SPN)CT容积灌注(CTVP)成像参数与其微血管构成的相关性。方法:38例SPN(恶性32例,良性6例)患者行首过法CTVP成像,并进行CD34及α-平滑肌免疫组织化学染色。通过完全随机t检验或Wilcoxon法非参数秩和检验比较良、恶性结节间灌注参数及血管参数间的差异,采用Pearson或Spearman相关分析探讨SPN的CTVP参数与微血管参数,包括有腔血管面积(LVA)、有腔血管周长(LVP)及有腔血管数目(LVN)的相关性。结果:恶性与良性结节组的血流量(BF)分别为(101.98±43.14)和(59.65±31.25)ml/(100g.min),血容量(BV)分别为(4.56±1.51)和(2.60±1.60)ml/100g,表面通透性(PS)分别为(16.97±7.35)和(6.81±6.65)ml/(100g.min),LVA分别为(423.12±183.24)和(165.29±127.31)μm2/视野、LVP分别为(299.08±138.29)和(134.37±88.24)μm/视野,LVN分别为(16.15±9.62)和(9.08±6.59)条/视野;差异均有统计学意义(P均<0.05)。SPN的BV值与MVD有相关性(r=0.483,P<0.05),BF值与LVA、LVP及LVN有相关性(r值分别为0.547、0.507和0.404),BV值与LVA、LVP有相关性(r值为0.714、0.504),PS值与LVA、LVP、LVN有相关性(r值分别为0.507、0.541、0.473,P均<0.05)。结论:SPN的CTVP成像参数与有腔血管参数的相关性好于与MVD的相关性;与血管生成相比较,CTVP成像更多地反映SPN的微血管构成。     

CT容积灌注诊断孤立性肺结节良恶性的临床应用评价

目的评价常规胸部CT结合CT容积灌注(CTVP)诊断孤立性肺结节(SPN)良、恶性的临床应用价值。资料与方法搜集行首过法CTVP的SPN65例,其中恶性43例,良性22例。先通过受试者工作特征(ROC)曲线明确CTVP参数诊断阈值,并通过四格表行2项参数的联合试验。由两名低年资和两名高年资医师回顾性盲法阅常规胸部CT图像,做出诊断(方法A);再阅常规胸部CT及CTVP资料,作出诊断(方法B)。采用ROC曲线比较每名医师采用诊断方法A与B的准确性有无统计学差异。通过组内相关系数(ICC)评价诊断方法A及B的一致性。结果当BF=50ml.100g-1.min-1、BV=3ml/100g、PS=10ml.100g-1.min-1时,CTVP诊断SPN良、恶性的敏感性分别为93%、86%及86%,特异性分别为59%、68%及77%。BF+PS及BV+PS的序列实验联合特异性均为82%。联合运用常规胸部CT和CTVP,四名医师诊断SPN良、恶性的敏感性分别为91%、95%、95%及95%;特异性分别为86%、91%、95%及82%。四名医师方法B的ROC曲线下面积均大于方法A(P均<0.05)。四名医师方法A的ICC=...     

Differentiation of benign and malignant parotid tumors using deconvolution-based perfusion CT imaging: feasibility of the method and initial results

AIM: We evaluated the feasibility of perfusion CT (CTP) of the parotid gland and attempted to differentiate benign from malignant tumors. MATERIALS AND METHODS: CTP was performed in 17 patients with benign tumors and 10 patients with malignant parotid tumors. Data were postprocessed by using deconvolution-based perfusion analysis. Postprocessing-generated maps showed blood flow (BF), blood volume (BV), mean transit time (MTT), and capillary permeability surface product (PS). Regions of interest were placed through the tumor site and the contralateral healthy parotid tissue. Ratios of the perfusion values between the tumors and the contralateral healthy structures were also calculated. Pearson correlation coefficients were determined to compare the agreement between the two readers. RESULTS: Perfusion maps of all tumors were successfully obtained. High Pearson correlation coefficients comparing the two readers' visually measured abnormalities were observed (r=0.79-0.86, P=0.001) for all perfusion maps, The MTT and PS values between malignant and benign tumors were not significantly different. The BF and BV values were statistically significant different between the benign and malignant tumors (0.00相似文献   

Differential diagnosis between malignant and benign hepatic tumors using apparent diffusion coefficient on 1.5-T MR imaging: a meta analysis

This meta-analysis evaluates the diagnostic accuracy of diffusion-weighted MR imaging with ADC values for differentiation between malignant and benign hepatic focal lesions. From retrieved articles, we selected 7 sets of data in 6 articles, which met all the included criteria, for meta-analysis. The pooled sensitivity and specificity were 86% (95% CI, 0.83-0.90) and 84% (95% CI, 0.78-0.88), respectively. However, notable heterogeneity between studies was noted and no covariate evaluated can explain the cause. Only b factor correlated with the mean ADC values of malignant and benign hepatic tumors. In conclusion, ADC value was useful for differentiation between malignant and benign hepatic focal lesions. But, significant heterogeneity between studies underlines the need for further efforts to optimize standardization and reproducibility of the utilized techniques and methods.     

~(18)F-FDG PET-CT和双源CT的LungCare软件在评估孤立性肺结节中的比较研究

目的 探讨18-氟-脱氧葡萄糖(~(18)F-FDG)PET/CT显像及Siemens双源CT的LungCare软件对孤立性肺结节(SPN)的辅助诊断能力及适用范围.方法 回顾分析经病理证实的24例SPN患者的PET-CT图像资料,并与利用双源CT的LungCare软件分析SPN进行比较研究.用χ~2检验对2种检查方法的评价结果进行统计学分析,以P<0.05作为差异有显著意义.结果 在24例SPN中,恶性结节15例,良性结节9例.LungCare软件评估其良恶性的准确性、敏感性、特异性、阳性预测值、阴性预测值分别为83.3%、80.0%、88.8%、92.3%、72.7%,PET-CT评估其良恶性的准确性、敏感性、特异性、阳性预测值、阴性预测值分别为87.5%、93.3%、77.7%,87.5%、87.5%.LungCare软件和PET/CT定性SPN的准确性相当,两者之间并不存在明显的差异(P>0.05).PET/CT的敏感性、阴性预测值明显高于LungCare软件,但其特异性、阳性预测值明显低于LungCare软件(P<0.05).结论 ~(18)F-FDG PET-CT对肺结节的诊断有一定辅助作用,适用于对孤立性肺结节的良恶性鉴别诊断.PET/CT密切结合LungCare软件,可进一步提高诊断正确率.     

双源CT灌注成像在颈部淋巴结病变中的初步研究

目的 探讨双源CT灌注成像技术在颈部淋巴结病变定性诊断中的价值.资料与方法 对40例颈部肿大淋巴结行CT灌注扫描,将其中34例有完整手术病理结果的病例根据其良恶性分为两组,分析良恶性淋巴结的时间密度曲线(TDC)及灌注参数的特点,比较各灌注参数的统计学差异.结果 良性淋巴结组TDC以缓升型为主(87.5%),甲状腺癌转移淋巴结TDC以速升速降型为主(62.5%),淋巴瘤TDC以低平型为主(60%),其他癌(鳞癌、腺癌)转移淋巴结TDC多呈速升缓降型(62.5%);恶性淋巴结组的血流量(BF)、血容量(BV)、Patlak血容量(P-BV)、达峰时间(TTP)及强化值(EV)均高于良性组,其差异有统计学意义(P<0.05).结论 颈部良、恶性淋巴结病变及不同类型恶性淋巴结病变的CT灌注特点不同,CT灌注成像技术对颈部淋巴结病变的定性诊断有重要的应用价值.     

Squamous cell cancer of hypopharynx and larynx - evaluation of metastatic nodal disease based on computed tomography perfusion studies

Background and purpose

In patients with squamous cell cancer metastatic disease in lymph nodes still remains the single most important negative predicting factor and when detected, it reduces overall 5-year survival by 50%.The aim of the study was to evaluate contrast-enhanced computed tomography (CECT) with computed tomography perfusion (CTP) examination in order to differentiate malignant from non-malignant cervical lymph nodes in patients with squamous cell cancer of hypopharynx and larynx.

Material/Methods

This was a prospective three-center study. From November 2007 until March 2010 33 consecutive patients with squamous cell cancer of the hypopharynx and 27 patients with laryngeal cancer underwent computed tomography (CT) examination followed by CTP. During first part of examination 80 ml of contrast was administered, with flow rate 1 ml/s and 100 s delay; standard head and neck examination was performed. Next, perfusion images were acquired with the coverage of 8 cm and different groups of lymph nodes were evaluated – groups II, III, IV and V. Perfusion maps for basic parameters (blood flow [BF], blood volume [BV], mean transit time [MTT] and permeability surface [PS]) were reconstructed for all patients using dedicated software. The long and short axis diameters, the density of the node before and after contrast medium administration and average values of each perfusion parameter were calculated for every node separately. Results were compared with histologic analysis of resected nodes.

Results

Out of the total number of 293 nodes evaluated on CECT and CTP it was possible to correlate 208 resected nodes with histologic findings. 125 of them were proven to be malignant and 83 were benign.Malignant nodes showed remarkably higher density and hyperperfusion, comparing to benign ones. The average density values in Hounsfield units (HU) for cervical nodes were: 91.9 HU for metastatic comparing to 72.3 HU for non-metastatic, but this difference did not show statistical significance. The average value of BF in malignant nodes was 136.4 ml/100 g/min, BV was 7.7 ml/100 g, MTT was 4.4 s and PS was 19.4 ml/100 g/min. The average values for benign nodes were: BF was 80.7 ml/100 g/min, BV was 4.7 ml/100 g, MTT was 5.6 s and PS was 12.8 ml/100 g/min. Comparing to non-malignant nodes, malignant ones showed significantly higher BF, BV and PS values (p < 0.05).

Conclusions

Although CECT findings may draw our attention, pointing at abnormal morphology of the node, CTP seems to provide additional functional information regarding its possible malignancy. CTP may be useful in differentiation between malignant and benign lymph nodes, based on evaluation of the value of BF, BV and PS.     

孤立性肺结节CT形态学征象的Fisher判别

目的:探讨Fisher判别模式对孤立性肺结节(SPN)CT鉴别诊断的应用价值.方法:回顾性分析149例SPN患者的CT资料,按病理及随访结果分为良性组和恶性组,对结节主要CT形态学特征进行评价,以两组间有统计学意义的形态学征象为判别指标并行Fisher判别,采用交叉核实法估计误判概率.结果:孤立性肺结节CT征象的Fis...     

18F-FDG PET-CT双时相显像结合高分辨率CT诊断孤立性肺结节的价值

目的 探讨18F-FDG PET-CT双时相显像结合高分辨率CT (HRCT)对孤立性肺结节(SPN)的鉴别诊断价值。方法 经CT证实符合SPN的病例173例,应用PET-CT技术对SPN病例进行双时相显像及同机HRCT,早期显像于注射18F-FDG后50 ～60min,并行HRCT,延迟显像于注射后2～2.5 h进行...