CN114795267A - 基于第二代双源光子ct对肺内实性结节良恶性鉴别方法 - Google Patents
基于第二代双源光子ct对肺内实性结节良恶性鉴别方法 Download PDFInfo
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Abstract
本发明公开了一种基于第二代双源光子CT对肺内实性结节良恶性鉴别方法,该方法包括以下步骤:均经病理证实的肺结节患者,并按病理类型,将患者分组;所有患者行双期双能CT扫描;所有图像导入工作站,利用各个模块,分析病例的各项测量参数。本发明通过CT影像特征结合双能量CT多发参数诊断肺内结节,为肺内良、恶性结节的诊断提供了全新的思路,通过碘图、标准化碘浓度、虚拟单能谱图、能谱曲线斜率等量化指标数据分析,可以提高对肺内实性结节良恶性鉴别的准确率,是常规CT的有效补充手段。
Description
技术领域
本发明涉及医疗设备相关领域,具体是一种基于第二代双源光子CT对肺内实性结节良恶性鉴别方法。
背景技术
肺癌是全球发病率和死亡率最高的恶性肿瘤之一,且发病率和死亡率呈明显上升趋势,多数肺癌表现为肺内结节或肿块,早期对肺结节的良恶性的检出对降低肺癌的死亡率尤为重要且意义重大。
目前肺部病变诊断最主要的检查手段是依靠影像学检查,如X线、CT、MRI、PET-CT等可用来发现、描述和诊断肺癌;基于其良好的密度分辨率以及拥有含气肺组织天然对比度,目前传统CT平扫及增强检查仍然是肺结节诊断与鉴别诊断的首选方法;但由于病变的多样性及复杂性,良恶性病变在强化程度与形态学上有一定的重叠,存在“同影异病”或“同病异影”的不确定性,所以常规CT在诊断上具有一定的限制;例如,在对肺癌的有效鉴别、淋巴结转移情况、术后疗效的诊断及评估等上面仍然具有很大的挑战。
发明内容
因此,为了解决上述不足,本发明在此提供一种基于第二代双源光子CT对肺内实性结节良恶性鉴别方法。
本发明是这样实现的,构造一种基于第二代双源光子CT对肺内实性结节良恶性鉴别方法,该方法包括以下步骤:
1、均经病理证实的肺结节患者,并按病理类型,将患者分组;
2、所有患者行双期双能CT扫描;
3、所有图像导入工作站,利用各个模块,分析病例的各项测量参数;
4、分析出各组双期病例碘图、各组双期病例单能谱图像、各组双期病例能谱曲线斜率;
5、结合各项参数及统计学对肺结节良恶性鉴别的诊断效能。
优选的,所述患者分组的纳入标准为(1)病灶为大于1cm,小于3cm的实性结节,行双能量CT检查前未接受肺结节相关治疗;(2)所有病例均经过病理学证实,并分为非小细胞肺癌、结核、炎性结节三组。
优选的,CT检查采用Siemens Somatom DefinitionFlash双源CT扫描,先行平扫,再行双期双能量增强扫描,具有两套互相独立的X线球管及探测器,两个球管分别产生高低两者X线能量,独立采集数据,进行双能量成像,在一次双能量扫描下可得到两组高低不同能量的数据图像,并通过物质在高低能量下不同的衰减值来进行物质的鉴别。
优选的,所有图像上传PACS系统后,在CT平扫及增强上观察、记录病灶的影像学特征,包括结节的部位、结节边缘、磨玻璃影、血管受累、病灶钙化、淋巴结增大、强化特点。
优选的,对上传的图像进行后处理,重建后得到1组80kv图像、1组140kv图像及1组融合图像(M=0.6)。
优选的,将重建后薄层图像导入Syngo Dual Energy工作站中,在“Monoenergetic”模块,点击能谱信息,选择病灶感兴趣区,将ROI放在病灶及同层面胸主动脉,ROI的圈画选取病灶最大以及强化最不均匀的层面,避开病灶囊变坏死、空洞、血管、肺不张及钙化区域,测量时保持各期ROI的位置、大小、形态一致。
优选的,测量后计算的数据包括:标准化碘浓度(NIC),NIC=IC病灶/IC胸主,IC病灶为病灶碘浓度,IC胸主为同层面胸主动脉碘浓度,包括动脉期NIC(NICAP)及静脉期NIC(NICVP),为确保数据一致性,所有ROI的测量均在连续的3个层面上测量,并取其平均值。
优选的,利用能谱分析软件,分别获得动、静脉期相应的能量衰减曲线,并计算能谱曲线斜率K40-100keV=(CT40keV-CT100keV)/(100-40),CT40keV、CT100keV分别为40、100keV单能量水平下病灶内ROI的CT值。
优选的,使用统计软件(SPSS 22.0)进行分析,结节的部位、结节边缘、血管受累、病灶钙化、淋巴结增大、强化特点征象等非计量指标的组间比较采用x2检验,双能量CT扫描相关定量参数(标准化碘浓度及能谱曲线斜率)经正态性及方差齐性检验,3组差异比较采用单因素方差分析。
优选的,采用多项式logistic回归分析CT影像形态学特征与CT影像特征结合双能量相关定量参数对肺实性结节诊断的准确性;p值小于0.05被认为是统计上存在差异。
优选的,双源CT系统采用的stellar光子探测器、自动球管电流调制技术(CAREDose4D)、能谱纯化技术降低了自身的电子噪声和信号串扰,提高了图像的信噪比和空间分辨率,达到辐射剂量最优化,从而使双能扫描技术的临床诊断和物质鉴别更为准确。
本发明具有如下优点:本发明通过改进在此提供一种基于第二代双源光子CT对肺内实性结节良恶性鉴别方法,与同类型设备相比,具有如下改进:
优点1:本发明所述一种基于第二代双源光子CT对肺内实性结节良恶性鉴别方法,采用第二代双源双能量扫描技术,其具有两套互相独立的X线球管及探测器,两个球管分别产生高低两者X线能量,独立采集数据,进行双能量成像,在一次双能量扫描下可得到两组高低不同能量的数据图像,并通过物质在高低能量下不同的衰减值来进行物质的鉴别。
优点2:本发明所述一种基于第二代双源光子CT对肺内实性结节良恶性鉴别方法,双源CT通过一次扫描能够提供多参数信息,比如虚拟平扫、碘图、虚拟单能谱图、能谱曲线等,利用这些参数信息对病灶进行综合评估,评价各个参数对肺内实性结节诊断的价值,并结合统计学得出相关数据。
优点3:本发明所述一种基于第二代双源光子CT对肺内实性结节良恶性鉴别方法,双源CT系统采用的stellar光子探测器、自动球管电流调制技术(CARE Dose4D)、能谱纯化技术降低了自身的电子噪声和信号串扰,提高了图像的信噪比和空间分辨率,达到辐射剂量最优化,从而使双能扫描技术的临床诊断和物质鉴别更为准确。
优点4:本发明所述一种基于第二代双源光子CT对肺内实性结节良恶性鉴别方法,双源CT多发参数诊断肺内结节,为肺内良、恶性结节的诊断提供了全新的思路,通过碘图、标准化碘浓度、虚拟单能谱图、能谱曲线斜率等量化指标,可以提高其诊断率,是常规CT的有效补充手段。
附图说明
图1是本发明的技术路线框图。
具体实施方式
下面将结合附图1对本发明进行详细说明,对本发明实施例中的技术方案进行清楚、完整地描述,显然,所描述的实施例仅仅是本发明一部分实施例,而不是全部的实施例。基于本发明中的实施例,本领域普通技术人员在没有做出创造性劳动前提下所获得的所有其他实施例,都属于本发明保护的范围。
本发明的一种基于第二代双源光子CT对肺内实性结节良恶性鉴别方法,该方法包括以下步骤:
1、均经病理证实的肺结节患者,并按病理类型,将患者分组;
2、所有患者行双期双能CT扫描;
3、所有图像导入工作站,利用各个模块,分析病例的各项测量参数;
4、分析出各组双期病例碘图、各组双期病例单能谱图像、各组双期病例能谱曲线斜率;
5、结合各项参数及统计学对肺结节良恶性鉴别的诊断效能。
患者入组:在普通X线,CT体检或常规检查发现肺内实性结节患者,患者分组的纳入标准为(1)病灶为大于1cm,小于3cm的实性结节,行双能量CT检查前未接受肺结节相关治疗;(2)所有患者签署知情同意书,无对比剂过敏;(3)所有病例均经过病理学证实,并分为非小细胞肺癌、结核、炎性结节三组。
检查方法:CT检查采用Siemens Somatom Definition Flash双源CT扫描;先行平扫,再行双期增强扫描,均采用双能扫描模式;A、B球管的管电压分别为80、140kV(加锡板过滤),管电流开启实时动态曝光剂量调节自动衰减管电流,X线转速0.28s,螺距1.0,准直器宽度64×0.6mm;图像重组层厚为1mm,间距为1mm;每次扫描可见同时获得分别为140kV、80kV以及融合系数为0.6的线性融合图像。
图像后处理及分析:1名住院医师对图像进行后处理,将重建后薄层图像导入Syngo Dual Energy工作站中,在“Lung Nodules”模块中调整CT与碘对比剂融合比率至100%得到碘分布图;在“Monoenergetic”模块,点击能谱信息,选择病灶感兴趣区,将ROI放在病灶及同层面胸主动脉,ROI的圈画选取病灶最大以及强化最不均匀的层面,避开病灶囊变坏死、空洞、血管、肺不张及钙化区域,测量时保持各期ROI的位置、大小、形态一致;测量后计算的数据包括:标准化碘浓度(NIC),NIC=IC病灶/IC胸主,IC病灶为病灶碘浓度,IC胸主为同层面胸主动脉碘浓度,包括动脉期NIC(NICAP)及静脉期NIC(NICVP),为确保数据一致性,所有ROI的测量均在连续的3个层面上测量,并取其平均值;再利用能谱分析软件,分别获得动、静脉期相应的能量衰减曲线,并计算能谱曲线斜率K40-100keV=(CT40keV-CT100keV)/(100-40),CT40keV、CT100keV分别为40、100keV单能量水平下病灶内ROI的CT值,记录不同keV对应的单能量图像下的CT值及双期能量衰减曲线;
由两名中高级职称放射科医师对图像进行分析,将所有病例分组,计算各组病例两期的各种测量参数,包括碘图、标准化碘含量(NIC)、单能谱图像CT值、能谱曲线斜率等,分析各项参数对肺结节良恶性鉴别的诊断效能,评价各个参数对肺内实性结节诊断的价值,并结合统计学得出相关数据。
统计学方法:使用统计软件(SPSS 22.0)进行分析,结节的部位、结节边缘、血管受累、病灶钙化、淋巴结增大、强化特点征象等非计量指标的组间比较采用x2检验,双能量CT扫描相关定量参数(标准化碘浓度及能谱曲线斜率)经正态性及方差齐性检验,3组差异比较采用单因素方差分析;采用多项式logistic回归分析CT影像形态学特征与CT影像特征结合双能量相关定量参数对肺实性结节诊断的准确性;
三组结节的CT影像评估中,结节边缘、血管受累、病灶钙化、淋巴结增大、强化特点征象存在统计学差异(P<0.05),结核的部位多位于两肺上叶,与肺癌组及炎性结节组不同,但差异没有统计学意义(P>0.05),肺癌组边缘多为毛刺/分叶征,结核组的病灶多不光整,而炎性结节多为边缘光整,三者均存在统计学差异(P<0.05),血管受累及淋巴结增大多发生于肺癌,较少发生于结核及炎性结节,以上两个征象均存在统计学差异,部分结核组可发生纵膈及肺门淋巴结的肿大,结核与炎症组两两对比不存在统计学差异(P>0.05);结核组的病灶内钙化高达54.5%,高于肺癌及炎性结节组;强化特点上炎性结节组呈明显均匀强化,与肺癌组不均匀强化,存在统计学差异;p值小于0.05被认为是统计上存在差异。
本发明通过改进提供一种基于第二代双源光子CT对肺内实性结节良恶性鉴别方法,采用第二代双源双能量扫描技术,其具有两套互相独立的X线球管及探测器,两个球管分别产生高低两者X线能量,独立采集数据,进行双能量成像,在一次双能量扫描下可得到两组高低不同能量的数据图像,并通过物质在高低能量下不同的衰减值来进行物质的鉴别;双源CT通过一次扫描能够提供多参数信息,比如虚拟平扫、碘图、虚拟单能谱图、能谱曲线等,利用这些参数信息对病灶进行综合评估,评价各个参数对肺内实性结节诊断的价值,并结合统计学得出相关数据;双源CT系统采用的stellar光子探测器、自动球管电流调制技术(CARE Dose4D)、能谱纯化技术降低了自身的电子噪声和信号串扰,提高了图像的信噪比和空间分辨率,达到辐射剂量最优化,从而使双能扫描技术的临床诊断和物质鉴别更为准确;双源CT多发参数诊断肺内结节,为肺内良、恶性结节的诊断提供了全新的思路,通过碘图、标准化碘浓度、虚拟单能谱图、能谱曲线斜率等量化指标,可以提高其诊断率,是常规CT的有效补充手段。
以上显示和描述了本发明的基本原理和主要特征和本发明的优点,并且本发明使用到的标准零件均可以从市场上购买,异形件根据说明书的和附图的记载均可以进行订制,各个零件的具体连接方式均采用现有技术中成熟的螺栓铆钉、焊接等常规手段,机械、零件和设备均采用现有技术中,常规的型号,加上电路连接采用现有技术中常规的连接方式,在此不再详述。
对所公开的实施例的上述说明,使本领域专业技术人员能够实现或使用本发明。对这些实施例的多种修改对本领域的专业技术人员来说将是显而易见的,本文中所定义的一般原理可以在不脱离本发明的精神或范围的情况下,在其它实施例中实现。因此,本发明将不会被限制于本文所示的这些实施例,而是要符合与本文所公开的原理和新颖特点相一致的最宽的范围。
Claims (10)
1.一种基于第二代双源光子CT对肺内实性结节良恶性鉴别方法,其特征在于,该方法包括以下步骤:
S1、均经病理证实的肺结节患者,并按病理类型,将患者分组;
S2、所有患者行双期双能CT扫描;
S3、所有图像导入工作站,利用各个模块,分析病例的各项测量参数;
S4、分析出各组双期病例碘图、各组双期病例单能谱图像、各组双期病例能谱曲线斜率;
S5、结合各项参数及统计学对肺结节良恶性鉴别的诊断效能。
2.根据权利要求1所述一种基于第二代双源光子CT对肺内实性结节良恶性鉴别方法,其特征在于:所述患者分组的纳入标准为(1)病灶为大于1cm,小于3cm的实性结节,行双能量CT检查前未接受肺结节相关治疗;(2)所有病例均经过病理学证实,并分为非小细胞肺癌、结核、炎性结节三组。
3.根据权利要求1所述一种基于第二代双源光子CT对肺内实性结节良恶性鉴别方法,其特征在于:CT检查采用双源CT扫描,先行平扫,再行双期双能量增强扫描,具有两套互相独立的X线球管及探测器,两个球管分别产生高低两者X线能量,独立采集数据,进行双能量成像,在一次双能量扫描下可得到两组高低不同能量的虚拟平扫、碘图、虚拟单能谱图、能谱曲线数据图像,并通过物质在高低能量下不同的衰减值来进行物质的鉴别,为肺内实性结节的诊断和鉴别诊断提供更多信息。
4.根据权利要求3所述一种基于第二代双源光子CT对肺内实性结节良恶性鉴别方法,其特征在于:所有图像上传PACS系统后,在CT平扫及增强上观察、记录病灶的影像学特征,包括结节的部位、结节边缘、磨玻璃影、血管受累、病灶钙化、淋巴结增大、强化特点。
5.根据权利要求4所述一种基于第二代双源光子CT对肺内实性结节良恶性鉴别方法,其特征在于:对上传的图像进行后处理,重建后得到1组80kv图像、1组140kv图像及1组融合图像(M=0.6)。
6.根据权利要求5所述一种基于第二代双源光子CT对肺内实性结节良恶性鉴别方法,其特征在于:将重建后薄层图像导入Syngo Dual Energy工作站中,在“Monoenergetic”模块,点击能谱信息,选择病灶感兴趣区,将ROI放在病灶及同层面胸主动脉,ROI的圈画选取病灶最大以及强化最不均匀的层面,避开病灶囊变坏死、空洞、血管、肺不张及钙化区域,测量时保持各期ROI的位置、大小、形态一致。
7.根据权利要求6所述一种基于第二代双源光子CT对肺内实性结节良恶性鉴别方法,其特征在于:测量后计算的数据包括:标准化碘浓度(NIC),NIC=IC病灶/IC胸主,IC病灶为病灶碘浓度,IC胸主为同层面胸主动脉碘浓度,包括动脉期NIC(NICAP)及静脉期NIC(NICVP),为确保数据一致性,所有ROI的测量均在连续的3个层面上测量,并取其平均值。
8.根据权利要求7所述一种基于第二代双源光子CT对肺内实性结节良恶性鉴别方法,其特征在于:利用能谱分析软件,分别获得动、静脉期相应的能量衰减曲线,并计算能谱曲线斜率K40-100keV=(CT40keV-CT100keV)/(100-40),CT40keV、CT100keV分别为40、100keV单能量水平下病灶内ROI的CT值。
9.根据权利要求8所述一种基于第二代双源光子CT对肺内实性结节良恶性鉴别方法,其特征在于:使用统计软件进行分析,结节的部位、结节边缘、血管受累、病灶钙化、淋巴结增大、强化特点征象等非计量指标的组间比较采用x2检验,双能量CT扫描相关定量参数(标准化碘浓度及能谱曲线斜率)经正态性及方差齐性检验,3组差异比较采用单因素方差分析算式。
10.根据权利要求9所述一种基于第二代双源光子CT对肺内实性结节良恶性鉴别方法,其特征在于:采用多项式logistic回归分析CT影像形态学特征与CT影像特征结合双能量相关定量参数对肺实性结节诊断的准确性;
三组结节的CT影像评估中,结节边缘、血管受累、病灶钙化、淋巴结增大、强化特点征象存在统计学差异(P<0.05),结核的部位多位于两肺上叶,与肺癌组及炎性结节组不同,但差异没有统计学意义(P>0.05),肺癌组边缘多为毛刺/分叶征,结核组的病灶多不光整,而炎性结节多为边缘光整,三者均存在统计学差异(P<0.05),血管受累及淋巴结增大多发生于肺癌,较少发生于结核及炎性结节,以上两个征象均存在统计学差异,部分结核组可发生纵膈及肺门淋巴结的肿大,结核与炎症组两两对比不存在统计学差异(P>0.05);结核组的病灶内钙化高达54.5%,高于肺癌及炎性结节组;强化特点上炎性结节组呈明显均匀强化,与肺癌组不均匀强化,存在统计学差异;
p值小于0.05被认为是统计上存在差异。
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