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目的利用选层重组的方法改善孤立性肺结节(SPN)CT动态增强扫描各延时像测量层面的一致性,并探讨其临床应用价值。方法(1)对3种均质液体行CT螺旋扫描并在Z轴方向同层厚任意多平面重组,比较其原始扫描图像及重组图像密度测量值的差异。(2)对72例SPN患者行螺旋CT动态增强扫描,运用一定的选层重组的方法保证各延时像测量层面的一致性。并对其中46例经病理及临床证实的SPN的CT动态增强特点进行评价,评估其增强前后的CT值、强化峰值、SPN与主动脉的强化值比。结果(1)不同密度的均质液体同层厚的原始扫描图像及重组图像间密度测量值差异无统计学意义(F=1.544,P>0.05);(2)67例SPN选层重组前、后各延时像测量层面一致率分别为20.98%(14/67)和97.01%(65/67),其差异有统计学意义(χ2=80.22,P=0.00)。多层螺旋CT对5例SPN的选层重组全部成功。(3)SPN的CT动态增强各延时像测量层面一致性优化以后,恶性结节与炎性结节强化峰值[(38.48±14.32)、(42.48±11.55)HU]和结节与主动脉强化值比[(19.64±9.52)、(21.14±7.77)%]均明显高于良性结节[(9.52±3.78)HU、(3.41±1.86)%];P值均<0.01。炎性结节的强化峰值、结节与主动脉强化值比[(42.48±11.55)HU、(21.14±7.77)%]与恶性结节[(38.48±14.32)HU、(19.64±9.52)%]间的差异无统计学意义(P值均>0.05)。CT动态增强选层重组保证各延时像测量层面一致性后,使其对SPN定性的准确率由78%提升至80%。结论螺旋CT扫描Z轴方向同层厚任意重组对均质物质的密度值的测量无明显影响。CT动态增强扫描各延时像测量层面一致性的优化可进一步客观反映SPN的动态增强情况,有利于其形态学的比较及CT值的测量,有望提高其对孤立性肺结节鉴别诊断的能力。
Objective To improve the consistency of various delay time images in CT scan of solitary pulmonary nodules (SPNs) by using the method of layer selection and reorganization, and to explore its clinical value. Methods (1) CT helical scanning was performed on three kinds of homogeneous liquid and reconstructed in any plane with the same thickness in the Z-axis direction. The differences between the original scan images and the reconstructed image densities were compared. (2) 72 cases of SPN patients underwent spiral CT dynamic contrast-enhanced scan, the use of a certain method of layer selection and reassignment to ensure that the consistency of the delay-like measurement level. Forty-six cases of pathologically and clinically confirmed SPN CT dynamic enhancement characteristics were evaluated before and after the enhancement CT value, strengthen the peak SPN and aortic enhancement ratio. Results (1) There was no significant difference between the original scan images and the density of reconstructed images in the same layer with different density (F = 1.544, P> 0.05); (2) Before the 67 SPN layers were reorganized, The coincidence rate of each delay time was 20.98% (14/67) and 97.01% (65/67), respectively. The difference was statistically significant (χ2 = 80.22, P = 0.00). Multi-slice spiral CT in 5 cases of SPN selection and reorganization all successful. (3) CT dynamic enhancement of SPN After the consistency of measurement level was optimized, the enhancement peak of malignant nodules and inflammatory nodules [(38.48 ± 14.32), (42.48 ± 11.55) HU] and nodules and aorta enhancement (19.64 ± 9.52) and (21.14 ± 7.77)%, respectively, were significantly higher than those in benign nodules [(9.52 ± 3.78) HU, (3.41 ± 1.86)%]; P values were all lower than 0.01. (42.48 ± 11.55 HU, (21.14 ± 7.77)%] and malignant nodules [(38.48 ± 14.32) HU, (19.64 ± 9.52)%] were significantly higher in the nodules than in the aorta There was no significant difference between the two groups (P> 0.05). CT dynamic enhancement layer selection reorganization to ensure that the delay as measured after the level of consistency, so that its qualitative SPN accuracy increased from 78% to 80%. Conclusion There is no significant effect on the measurement of the density of homogeneous materials by arbitrary recombination in the Z-axis direction with the same layer thickness. The optimization of the consistency of the CT dynamic contrast-enhanced tomography can further objectively reflect the dynamic enhancement of SPN, which is in favor of its morphological comparison and CT value measurement and is expected to improve its ability to differentiate solitary pulmonary nodules .