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胃部肿瘤定性主要依靠胃镜及活检病理结果,但胃镜对于肿瘤大小、局部侵犯范围、区域淋巴结转移及远处转移情况往往不能作出准确的判断,难以在治疗前全面评估肿瘤分期及指导诊疗。功能影像与解剖影像相结合的PET/CT是填补这一不足的重要的无创性检查手段,但由于设备昂贵、检查费用高,在临床上常常难以大规模地开展。我院采用18F-FDG SPECT/CT,为带有低剂量定位CT和SPECT的复合体,其在肿瘤的定位、定性诊断及疗效评价方面的性能优良[1-2],但图像分辨率不佳,对于病灶大小及侵犯范围的显示较模糊,对区域淋巴结及远处转移灶显示欠佳。我们将18F-FDG SPECT/CT与64排螺旋CT进行异机融合,以此弥补上述不足,更好地为患者提供诊断及治疗。
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56枚病灶异机融合与同机融合的图像质量分级对比见表 1。在显示胃局部病灶的T组中,同机融合后图像质量为1、2、3级的病灶数量分别为8、14、6枚,异机融合分别为25、3、0枚,两者间差异有统计学意义(χ2=21.875,P<0.05);在显示转移淋巴结病灶的N组中,同机融合后图像质量为1、2、3级的病灶数量分别为7、5、7枚,异机融合分别为17、2、0枚,两者间差异有统计学意义(χ2=12.452,P<0.05);在显示远处脏器转移的M组中,同机融合后图像质量为1、2、3级的病灶数量分别为0、3、6枚,异机融合分别为8、1、0枚,两者间差异有统计学意义(χ2=15.000,P<0.05)。异机融合后病灶在代表图像质量优等的1级分类中的个数明显多于同机融合。异机融合后的图像质量明显优于同机融合,可提供更好的诊断依据(图 1、图 2)。
组别 图像融合方式 1级 2级 3级 χ2值 P值 T组 同机融合 8 14 6 21.875 <0.05 异机融合 25 3 0 N组 同机融合 7 5 7 12.452 <0.05 异机融合 17 2 0 M组 同机融合 0 3 6 15.000 <0.05 异机融合 8 1 0 注:表中,T组:胃部原发肿瘤病灶组;N组:淋巴结转移病灶组;M组:远处转移病灶组。 表 1 56枚胃癌病灶在不同分组中的同机融合与异机融合图像质量的分级对比(个)
Table 1. Comparison of image quality of 56 gastric cancer lesions among the three groups of T, N and M stages in the same and different machine fusions
18F-FDG SPECT/CT显像与64排螺旋CT异机融合技术在胃癌诊断中的应用
Benefits of using 18F-FDG SPECT/CT combined with the 64-multislice spiral CT in gastric cancer diagnosis
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摘要:
目的通过对比分析18F-FDG SPECT/CT与64排螺旋CT异机融合的图像质量,探讨异机融合在胃癌诊断中的优势。 方法收集一周内分别行18F-FDG SPECT/CT和64排螺旋CT扫描的符合入选标准的35例胃癌患者,共计56枚病灶,其中包含胃部肿瘤病灶28枚、转移淋巴结病灶19枚和远处转移病灶9枚,并依此进行分组,同组中同机融合的图像与异机融合的图像进行图像质量对比,分别从病灶的大小、边界是否清晰、是否有伪影等方面进行主观综合评价、分级。两组间计数资料比较采用卡方检验。 结果在胃部肿瘤病灶组中,28枚病灶同机融合后图像质量为1、2、3级的病灶数量分别为8、14、6枚,异机融合分别为25、3、0枚;在转移淋巴结病灶组中,19枚病灶同机融合后图像质量为1、2、3级的病灶数量分别为7、5、7枚,异机融合分别为17、2、0枚;在远处转移病灶组中,9枚病灶同机融合后图像质量为1、2、3级的病灶数量分别为0、3、6枚,异机融合分别为8、1、0枚。3组中同机融合与异机融合图像质量比较差异均有统计学意义(χ2=21.875、12.452和15.000,均P < 0.05),异机融合后的图像质量优于同机融合。 结论18F-FDG SPECT/CT与64排螺旋CT异机融合的图像质量明显优于同机融合,在胃癌诊断中能提供更好的诊断依据,值得临床推广应用。 -
关键词:
- 胃肿瘤 /
- 氟脱氧葡萄糖F18 /
- 体层摄影术,发射型计算机,单光子 /
- 体层摄影术,X线计算机 /
- 体层摄影术,螺旋计算机
Abstract:ObjectiveTo explore the advantages of heterogeneous fusion in diagnosing gastric cancer by comparing the images obtained from 18F-FDG SPECT/CT and 64-multislice spiral CT heterogeneous fusion. MethodsClinical and radiological image data were collected from 35 patients examined by both 18F-FDG SPECT/CT and 64-multislice spiral CT. All the 35 patients suffered from gastric cancer. These patients showed a total of 56 masses, which were grouped into three types, namely, gastric tumor, metastatic lymph node, and distant metastasis. The images processed by homogeneous and heterogeneous technologies were compared in terms of size, mass boundary, and image artifacts. Chi-square test was used to compare the enumeration data between the two groups. ResultsThe gastric cancer group comprised a total of 28 cases. The number of cases with image quality of grades 1, 2, and 3 after homogeneous fusion technology was 8, 14, and 6 and that after heterogeneous fusion technology was 25, 3, and 0, respectively. The metastatic lymph node group comprised a total of 19 cases. The number of cases with image quality of grades 1, 2, and 3 after homogeneous fusion technology was 7, 5, and 7, and that after heterogeneous fusion technology was 17, 2, and 0, respectively. The distant metastasis group comprised a total of 9 cases. The number of cases with image quality of grades 1, 2, and 3 after homogeneous fusion technology was 0, 3, and 6 and that after heterogeneous fusion technology was 8, 1, and 0, respectively. Significant differences were noted between the images obtained from homogenous and heterogeneous fusion technologies, and the images obtained from the latter were better than those of the former (χ2=21.875, 12.452, and 15.000, all P < 0.05). ConclusionThe heterogeneous fusion technology of 18F-FDG SPECT/CT and the 64-slice spiral CT can compensate for the deficiencies of the homogeneous fusion technology of 18F-FDG SPECT/CT in terms of display, evaluation, and metastatic detection of gastric cancer. -
表 1 56枚胃癌病灶在不同分组中的同机融合与异机融合图像质量的分级对比(个)
Table 1. Comparison of image quality of 56 gastric cancer lesions among the three groups of T, N and M stages in the same and different machine fusions
组别 图像融合方式 1级 2级 3级 χ2值 P值 T组 同机融合 8 14 6 21.875 <0.05 异机融合 25 3 0 N组 同机融合 7 5 7 12.452 <0.05 异机融合 17 2 0 M组 同机融合 0 3 6 15.000 <0.05 异机融合 8 1 0 注:表中,T组:胃部原发肿瘤病灶组;N组:淋巴结转移病灶组;M组:远处转移病灶组。 -
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