螺旋CT灌注显像技术在胰腺癌综合诊疗体系中的作用

【作者】 黄振华；

【导师】 金征宇；

【作者基本信息】 北京协和医学院 ， 临床医学， 2009， 博士

【摘要】 目的：对比研究最大斜率法和去卷积法两种不同算法模型在胰腺灌注扫描中是否有差异,获得正常胰腺的灌注参数参考值。材料与方法：选取我院行普通CT增强扫描+胰腺灌注检查的31名患者,其中15例无胰腺疾病,16例病理或临床诊断为胰岛细胞瘤。胰腺灌注扫描图像数据分别用Siemens Body-perfusion软件和TERARECOM公司Aquarius工作站的TDA(Time Density Analysis)软件进行分析计算,首先比较正常胰腺与胰岛细胞瘤正常胰腺实质的各灌注参数,做独立样本t检验(置信区间95%)；若无显著差异可将胰岛细胞瘤正常胰腺实质测得的灌注参数归入正常胰腺组统一计算,这样就加大正常胰腺的样本量。对比分析最大斜率法和去卷积法两种不同算法模型得到的相同灌注参数血流量(BF)、血容量(BV)和达峰时间(TTP)在胰腺灌注扫描中是否有差异,采用成组配对t检验。对正常胰腺实质样本各灌注参数值取平均值,获得正常胰腺的灌注参考值。结果：两种算法正常胰腺与胰岛细胞瘤组正常胰腺实质的灌注参数BF、BV和TTP均无明显统计学差异(p>0.05),遂将16例胰岛细胞瘤患者正常胰腺实质的数据+15例正常胰腺患者的数据作为正常胰腺组样本数据；最大斜率法和去卷积法的灌注参数BF.BV和TTP均差异非常显著(p<0.001)；正常胰腺(样本量n=31)的最大斜率法灌注参考值：血流量(BF)135.21±24.92ml·100ml-1min-1,血容量(BV)19.88±3.43ml.100ml-1,灌注起始时间(TTS)2.92±0.98s,达峰时间(TTP)14.01±1.68s.渗透性(PM)42.83±14.530.5ml.100ml-1·min-1;正常胰腺(样本量n=31)的去卷积法灌注参考值：血容量(BF)159.92±24.72m1.100g-1·min-1,血容量(BV)28.96±7.67ml·100g-1,平均通过时间(MTT)9.52±2.11s,达峰时间(TTP)11.63±2.19s。结论：最大斜率法和去卷积法在胰腺灌注扫描中结果差异非常显著,不具备比较性。本实验得到的正常胰腺灌注参考值与国内外各个研究的结果比较接近,但是有一定偏差。目的：评价螺旋CT灌注技术中的各项指标对胰腺肿块鉴别诊断的价值。材料与方法：选取我院行普通CT增强扫描+胰腺灌注检查的患者,其中15例为无胰腺疾病的正常患者,16例病理或临床诊断为胰腺癌,7例病理或临床诊断为胰腺囊性肿瘤,16例病理或临床诊断为胰岛细胞瘤。胰腺灌注扫描图像数据分别用Siemens Bodyperfusion软件和TERARECOM公司Aquarius工作站的TDA(Time Density Analysis)软件进行分析计算,分别测量得到正常胰腺、胰腺癌、胰腺囊性肿瘤和胰岛细胞瘤的最大斜率法灌注参数平均值(BF、BV、TTS、TTP和PM)和去卷积法灌注参数平均值(BF、BV、MTT和TTP),分别比较胰腺癌组与正常胰腺组、胰腺囊性肿瘤组、胰岛细胞瘤组的各灌注参数均值,采用独立样本t检验分析(置信区间95%)。结果：最大斜率法：胰腺癌组的BF、BV均明显低于正常胰腺组,差异均有统计意义(P<0.05)；胰腺癌组的TTP大于正常胰腺组,差异均有统计意义(P<0.05)：TTS、PM在胰腺癌组和正常胰腺组间没有统计学差异(P>0.05)。胰腺癌和胰腺囊性肿瘤的各灌注参数值均无统计学差异(P>0.05)。胰腺癌组的BF、BV明显小于胰岛细胞瘤组,差异非常显著；胰腺癌组的TTP大于胰岛细胞瘤组,差异具有统计学意义(P<0.05)；TTS、PM在胰腺癌组和胰岛细胞瘤组间无统计学差异。去卷积法：胰腺癌组的BF、BV均明显低于正常胰腺组,差异均有统计意义(P<0.05)；胰腺癌组的TTP大于正常胰腺组,差异均有统计意义(P<0.05)；MTT在两组样本间没有统计学差异(P>0.05)。胰腺癌和胰腺囊性肿瘤的各灌注参数值均无统计学差异(P>0.05)。胰腺癌组的BF、BV明显小于胰岛细胞瘤组,差异非常显著；胰腺癌组的MTT、TTP大于胰岛细胞瘤组,差异具有统计学意义(P<0.05)。结论：CT灌注技术能够对胰腺癌与正常胰腺、胰岛细胞瘤进行鉴别诊断,而无法鉴别胰腺癌与胰腺囊性肿瘤。目的：研究胰腺CT灌注技术在评估胰腺癌治疗效果中的价值。材料与方法：入组病例为临床确诊胰腺癌、不能手术切除、拟行化疗的患者,行腹部增强CT和胰腺灌注扫描,经过数次化疗后再次行腹部增强CT和胰腺灌注检查,在两个随访点同时测定血清肿瘤标志物(CA19-9, CA242, CA50, CEA)、评价患者体力状况和腹痛程度。将胰腺灌注结果与肿瘤标志物、体力状况、疼痛评分的变化进行比较。结果：夏XX胰腺灌注变化与CA19-9变化情况反映的情况一致,说明患者病情恶化,体力状况评分不变、疼痛评分变化不明显；沈XX胰腺灌注结果与CA19-9、疼痛变化、体力变化反应的情况一致,均说明患者病情进一步恶化；任XX的胰腺灌注结果与CA19-9、疼痛变化、体力变化反应的情况一致说明患者病情无变化。结论：CT灌注检查可用于胰腺癌化疗疗效的评估。更多还原

【Abstract】 Purpose:To study differences of parameters between Maximum-slope model and deconvolution arithmetic in the CT perfusion scanning of pancreas, and calculate the reference values of the parameters of pancreatic perfusion in normal population. Material and method:15normal patients and16patients diagnosed as islet cell tumor pathologically or clinically underwent contrast-enhanced abdominal scanning and pancreatic perfusion scanning. Images were then transferred to workstation and perfusion parameters were calculated using Siemens Body-perfusion software and TD A(Time Density Analysis) in the Aquarius workstation from Terarecom Company. The perfusion parameters of normal people and normal pancreatic tissues of patients were compared by independent-sample t-test(confident interval95%). If there was no statistic significance, the perfusion parameters of normal pancreatic tissue of the patients were taken as data of normal population. The same perfusion parameters of maximum-slope model and deconvolution arithmetic were compared between two arithmetic and performed by paired-sample t-test. Calculate the means of perfusion parameters of normal population sample, and obtain the reference value of parameters of pancreatic perfusion in normal population. Results:There was no statistic significance between perfusion parameters of normal people and normal pancreatic tissues of patients. So the data of normal pancreatic tissue of islet cell tumors was taken as data of normal population sample. The differences of parameters between Maximum-slope model and Deconvolution arithmetic in the CT perfusion scanning of pancreas had statistic significance (p<0.001). The reference value of normal pancreatic tissue in Maximum-slope model were BF(blood flow)135.21±24.92ml·100ml-1·min-1,BV (blood volume)19.88±3.43ml·100ml-1, TTS (time to start)2.92±0.98s, TTP (time to peak)14.01±1.68s, PM (permeability)42.83±14.530.5ml-100ml-1·min-1; The reference value of normal pancreatic tissue in Deconvolution arithmetic were BF(blood flow)159.92±24.72ml·100g-1·min-1,BV (blood volume)28.96±7.67ml·100g-1, MTT (mean transit time)9.52±2.11s,TTP (time to peak)11.63±2.19s。Conclusion:The differences of parameters between Maximum-slope model and deconvolution arithmetic in the CT perfusion scanning of pancreas have statistic signifinance. No comparison between two arithmetic is made. Our reference value of normal pancreatic tissue is very similar to others’ results. But there are still some differences among them. Purpose:To evaluate the use of perfusion imaging with64-slice CT in the differential diagnosis of pancreatic masses. Material and method:15normal patients,16patients diagnosed pancreatic carcinoma pathologically or clinically,7patients diagnosed pancreatic adenoma pathologically or clinically and16patients diagnosed islet cell tumor pathologically or clinically underwent contrast-enhanced abdominal scanning and pancreatic perfusion scanning. Images were then transferred to workstation and perfusion parameters were calculated by using Siemens Body-perfusion software and TDA(Time Density Analysis) in the Aquarius workstation from Terarecom Company. Compare pancreatic carcinoma with normal pancreas, pancreatic adenoma and islet cell tumor separately. They were performed by independent-sample t-test(confident interval95%). Results:With the Maximum-slope model:pancreatic carcinoma had lower BF and BV compared with normal pancreas (P<0.05). Pancreatic carcinoma had higher TTP compared with normal pancreas (P<0.05). There was no statistic significance between pancreatic carcinoma and normal pancreas when comparing TTS and PM (P>0.05). There was no statistic significance between pancreatic carcinoma and pancreatic adenoma in all perfusion parameters. Pancreatic carcinoma had lower BF and BV compared with islet cell tumor (P<0.05). Pancreatic carcinoma had higher TTP compared with islet cell tumor (P<0.05). There was no statistic significance between pancreatic carcinoma and islet cell tumor when comparing TTS and PM (P>0.05). With the Deconvolution arithmetic:pancreatic carcinoma had lower BF and BV compared with normal pancreas (P<0.05). Pancreatic carcinoma had higher TTP compared with normal pancreas (P<0.05). There was no statistic significance between pancreatic carcinoma and normal pancreas when comparing MTT (P>0.05). There was no statistic significance between pancreatic carcinoma and pancreatic adenoma in all perfusion parameters. Pancreatic carcinoma had lower BF and BV compared with islet cell tumor (P<0.05). Pancreatic carcinoma had higher MTT and TTP compared with islet cell tumor(P<0.05). Conclusion:Pancreatic carcinoma can be differentiated from normal pancreas and islet cell tumor by CT perfusion imaging. But CT perfusion imaging has no effect in the differential diagnosis between Pancreatic carcinoma and pancreatic adenoma. Purpose:To study the use of perfusion CT for evaluating the efficacy of chemotherapy in pancreatic carcinoma patients. Material and method:Patients diagnosed as pancreatic carcinoma clinically, can not be resected by surgery and will receive chemotherapy were enrolled in our study. They received contrast-enhanced abdominal scanning and pancreatic perfusion scanning. And then they received the same scan again after several cycles of chemotherapy. At two visit point, we tested the serum tumor makers (CA19-9, CA242, CA50and CEA), evaluated physical condition and bellyache of patients. Compare perfusion parameters with tumor makers, physical condition and ache grades. Results:the changes of perfusion parameters of XIA accorded with the change of CA19-9, which indicated the illness was worse. But there was no change in the physical condition of XIA and the change of ache grades was not obvious. The result of perfusion parameters of SHEN accorded with the change of CA19-9, physical condition and ache grades, which indicated the patients progress. The result of perfusion parameters of SHEN accorded with the chang of CA19-9, physical condition and ache grades. They all indicated the condition of the patient is not change. Conclusion:Perfusion CT can be used to evaluate the efficacy of chemotherapy in pancreatic carcinoma.更多还原