建立可量化浆膜腔积液成分差异的CT能量学特征参数集的研究

It is significant to guide the treatment and evaluate the prognosis to analyze the difference in compositions of effusion of serous cavity. At present, the radiology imaging and laboratory examination is yet not specific, and the pathological examination is invasive and less sensitive. Therefore, it should be solved as soon as possible how to accurately analyze the in vivo effusion of serous cavity in a non-invasive way. Our early studies showed the correlation between the energetic parameters (e.g. dual-base substance) and some compositions (and their concentration) in effusion. This study planned to achieve the following goal: establish a multi-base substance analytic model for quantizing the difference in concentration of compositions through the data of dual-energy CT for the mixture of standard product; optimize this model by analyzing the effusion specimen and referring to the biochemical examination results of effusion; and establish a set of energetic characteristic parameters by analyzing the in vivo effusion through the optimized model of multi-base substances and considering the energy spectral curve and the data of energy spectral parameters, including effective atomic number monochromatic keV value and variance of iodine concentration between plain and enhanced CT scan. The establishment of this set of energetic parameters will offer an accurate simple effective quantitative method for in vivo analysis of effusion in serous cavity. The model of multi-base substances will bring important academic value in analyzing compositions of tissue and lesions using dual-energy CT. At present, despite a great application prospect, the establishment of this set has not yet been studied at home and abroad.

浆膜腔积液成分差异的分析对指导治疗和评估预后有重要意义，目前影像学和实验室检查尚缺乏特异性，病理检查有创且敏感性低，如何无创准确地在体分析浆膜腔积液是亟需解决的难题。我们的前期研究发现双能量CT的双元基物质等能量参数与积液中的某些物质成分及浓度相关。本课题拟通过标准物质混合样品的双能量CT数据，建立可量化反映物质浓度差异的多元基物质分析模型；对积液样本进行分析，参照生化检查对模型进行优化；应用优化的多元基物质模型对患者进行在体积液分析，结合单keV值、能谱曲线、有效原子序数和增强前后碘浓度等能量参数，建立一个可量化在体浆膜腔积液成分差异的能量学特征参数集。此参数集的建立将为在体分析浆膜腔积液提供准确的简易有效的定量方法，具有广阔的应用前景。多元基物质模型的建立，将为进一步应用双能量CT分析组织及病变的成分奠定理论基础，有很高的学术价值。国内外尚未见相关研究。

浆膜腔积液成分差异的分析对确定诊断、指导治疗有重要意义，目前影像学和实验室检查尚缺乏特异性，病理检查有创且敏感性低，双能量CT的能谱综合分析为物质分离及定量提供了全新的方法。本课题首先对标准液体模GSI扫描及后处理参数进行优化，证明转速0.6s/转，扫描野medium，重建层厚5mm，螺距0.984及275mA为最佳方案，置于中心的小ROI数据更稳定；通过不同材质试管对蒸馏水的CT值有影响，而对GSI的水（碘）浓度值无影响，验证了基物质浓度的可靠性。.对浆膜腔积液的离体标本GSI数据与其生化检查对照，显示不同单keV时，总胆固醇、球蛋白、腺苷脱氨酶、乳酸脱氢酶对CT值均有影响；能谱曲线斜率与甘油三酯、白球比值和腺苷脱氨酶浓度相关；脂（水）值与甘油三酯、球蛋白、总胆固醇的浓度相关。初步证明积液的不同生化指标与能谱后处理参数之间存在的相关性。.对213例浆膜腔积液病人在体能谱扫描研究显示：①不同来源恶性积液（肺癌、卵巢癌及胃癌组）在低keV单能量图像上CT值、能谱曲线斜率、有效原子序数以及钙（水）、脂（水）、水（脂）浓度值均有差异；②不同成因（肝硬化、心力衰竭、结核及炎症组）良性浆膜腔积液，在 40 keV 时各组间CT值均有差异，且对炎性与非炎性组的鉴别效能最高。不同成因组积液的钙（水）、脂（水）浓度间有差异。提示GSI的基物质浓度可以反映不同成因组积液所含相应成分的差异；③良、恶性浆膜腔积液增强扫描的碘浓度（IC）存在差异，恶性积液组增强三期的IC均高于良性者，延迟期IC的AUC最高（0.82）。证明CSI的碘浓度值能更准确地量化浆膜腔积液中碘对比剂的渗出情况。.综上证明CT能谱成像的GSI能量参数：单能量图像、曲线斜率、有效原子序数及基物质浓度等，能有效区分不同成因的良、恶性浆膜腔积液，为浆膜腔积液的鉴别诊断提供安全可行的多参数方法，有很好的临床推广应用前景。相关成果参加国内外会议交流7人次，发表论文16篇，举办全国性能谱CT新技术推广会2次，达到国内领先、国际先进水平。

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