动态增强ct检查对肾上腺腺瘤和非腺瘤的鉴别诊断价值探讨 (1)

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1、华中科技大学同济医学院二00六届硕士学位论文中文摘要目的探讨动态增强CF检查技术对肾上腺腺瘤与非腺瘤的鉴别诊断价值，并优先选出有意义的参数，以进一步明确两者的鉴别诊断标准。方法选取41例共43个肾上腺肿瘤(腺瘤22个，非腺瘤21个)，均行CT平扫及延时lmin、3min、5min、7min动态增强扫描。所有病例均经手术病理证实或动态随访观察得以确诊。测量各时间点肿肿瘤实质平均cT值，绘制成时问一密度(T-D)曲线并归类，A、C型为廓清迅速组，B、D、E为廓清缓慢组。计算各延时时间点的绝对廓清率(Washa)和相对廓清率(Washr)。采用受试者工作特性(ROC)曲线分析并确定鉴

2、别肾上腺腺瘤与非腺瘤的最佳延时时间点及廓清阈值。采用SPSSl2．0统计软件包对上述数据进行卡方检验和t检验，P<0．05有统计学意义。结果肾上腺腺瘤与非腺瘤的T—D曲线类型分布存在统计学差异(P=0．000)。肾上腺腺瘤多表现为A、C型曲线，非腺瘤表现为B、D、E型。延时5min腺瘤与非腺瘤的廓清率存在统计学差异(P<0．05)。以Washr为32％或Washa为26％为阈值诊断价值最高。肿瘤Washr≥32％或Washa≥26％提示为肾上腺腺瘤，反之为非腺瘤。以T—D曲线和肿瘤廓清率作为联合标准，对肾上腺腺瘤的诊断灵敏度、特异都有较大提高，分别达到96％、95％。结论肾上腺

3、肿瘤的T—D曲线类型及延时5min以Washr>，32％或Washa，>26％为阈值对肾上腺腺瘤与非腺瘤都具有鉴别诊断价值。以T-D曲线及肿瘤廓清率为联合诊断标准，能提高腺瘤的诊断符合率。关键词体层摄影术，x计算机：动态增强：肾上腺肿瘤华中科技大学同济医学院二oo六届硕士学位论文ABSTRACTobjective：TOevaluatedynamicenhancedCTindifferentiatingadrenaladenomasfromnon—adenomas，todeterminetheoptimalscanningparametersandtoestablishthedi

4、fferentiationcriteria．Methods：Forty—onepatientswith43adrenaltumors(22adenomasand21non—adenomas)wereenrolledintothisstudy,．NonenhancedCTwasfollowedbydynamiccontrast—enhancedCTatlmin、3min、5minand7minlater．35tumorswereprovedbysurgicallyandpathologicallyand6caseswith8metastaseswereprovedbythedyn

5、amicobservationinthreemonths．TheCTattenuationvalueWasmeasuredinalltumorsatdifferentscanningtimeandacquiredthetime-density(T-D)curves．ThetypeofAandCbelongtotheGroupfasterWashandthetypeofB、D、EbelongtotheGroupslowerWash．Theabsolutewashoutpercentage(Washa)andrelativewashoutpercentage(Washr)atdif

6、ferenttimeweremeasuredandidentifythebestdelayedtimeandthewashoutpercentagetodistinguishadenomasfromnon—adenomasbyROCCurve．ThedatawereanalyzedwithT-testandX—testbySPSSl2．0statisticalsoftware，andP<0．05wasconsideredtobesignificant．Results：ThetypesofT．DCurveshavesignificantdifferencesbetweenaden

7、omasandnon—adenomas．TheadenomasappearedwiththetypeofAandC．Thenon—adenomasappearedwiththetypeofB、C、E．5min—delayedwashpercentagehavesignificantdifferencesbetweenadenomasandnon．adenomas．Washr≥32％orWasha=26％wasthecuetoadenomas，otherwiseWasnon·adenomas．