CT能谱成像的临床应用课件.ppt

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Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系本人改正。,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系本人改正。,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系本人改正。,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系本人改正。,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系本人改正。,文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系本人改正。,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系本人改正。,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系本人改正。,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系本人改正。,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系本人改正。,Click to edit Master title style,文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系本人改正。,Click to edit Master title style,文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系本人改正。,Click to edit Master title style,文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系本人改正。,Click to edit Master title style,文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系本人改正。,Click to edit Master title style,文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系本人改正。,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系本人改正。,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系本人改正。,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系本人改正。,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系本人改正。,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系本人改正。,常规,CT,混合能量衰减成像,能谱,CT,多参数成像,能,谱,CT,物质密度成像,单能量衰减成像,有效原子序数成像,单能量图像及能谱曲线,基物质图像及浓度测定,有效原子序数,多参数诊断,CT,能谱成像,血管性病变,医源性植入物成像,肿瘤综合诊断,临床应用范畴,功能及代谢性疾病,1.,血管性病变,女性，,24,岁，,右额部头皮血管畸形可能,QC,65keV,40keV,颈动脉能谱,CTA,单能量图像,碘（钙）基图像,颈动脉斑块能谱,CT,研究,能谱,CT,不同能量水平单能量图像测量动脉钙化斑块定量结果不同,80keV,单能量图像测量颈动脉钙化斑块最为准确（与组织学标本比较）,Mannelli l,Mitsumori LM,Ferguson M et al.Changes in measured size of atherosclerotic plaque calcifications in dual-energy CT of ex vivo carotid endarterectomy specimens:effect of monochromatic keV image reconstructions.Eur Radiol.DOI 10.1007/s00330-012-2623-y(University of Washington,USA),心肺,肺动脉栓塞,同时提供形态学诊断（单能量,CTPA,图像）和功能诊断及定量分析（物质分离技术）,能谱,CT,碘基图像能够反应肺实质的灌注状态,碘定量分析有助于肺动脉栓塞的诊断及严重性评估,Wu HW,Cheng JJ,Li JY,et al.Pulmonary Embolism Detection and Characterization Through Quantitative Iodine-Based Material Decomposition Images With Spectral Computed Tomography Imaging.Invest Radiol.2012;47:8591.,Geyera LL,Scherra M,Krnera M,et al.Imaging of acute pulmonary embolism using a dual energy CT system with rapid kVp switching:Initial results.EurJRadiol(2011),doi:10.1016/j.ejrad.2011.02.043(University of Munich,Germany),能谱,CT,门静脉成像,能谱,CT,门静脉成像研究,51keV,为门静脉成像的最佳单能量图像,51keV,图像与常规,CT,图像（,140kVp,）图像相比,CNR,增加,100,，噪声增加,30,51keV,图像质量主观评分高于常规,CT,图像,门静脉癌栓碘浓度高于门静脉血栓,Zhao lq,et al.,Improving image quality in portal venography with spectral CT imaging.Eur J Radiol(2011),doi:10.1016/j.ejrad.2011.02.063,Qian lj et al.Differentiation of neoplastic from bland macroscopic portal vein thrombi using dual-energy spectral CT imaging:a pilot study.Eur RadiolDOI 10.1007/s00330-012-2477-3,40keV,51keV,66keV,2.,医源性植入物成像,骨与关节,医源性植入物,成像,血管性,医源性植入物,成像,关节假体及金属固定物,GSI,MARs,重建能够明显降低金属伪影,图像质量与假体位置、,DFOV,、,keV,水平有关,金属材料及大小是假体成像时需要考虑的相关因素,Lee YH,Park KK,Song HT,et al.Metal artefact reduction in gemstone spectral imaging dual-energy CT with and without metal artefact reduction software.Eur Radiol.(2012)22:13311340 DOI 10.1007/s00330-011-2370-5.(Yonsei University,Seoul,Republic of Korea),3.,功能及代谢性疾病成像与诊断,正常甲状腺,桥本氏甲状腺炎,钙基,碘基,有效原子序数融合图像,能谱,CT,代谢性疾病,成像,-,肾结石,能谱,CT,代谢性疾病,成像,痛风,尿酸基融合图像,钙基融合图像,能谱,CT,代谢性疾病,成像,脂肪肝,能谱,CT,代谢性疾病,成像,脂肪肝,能谱,CT,代谢性疾病,成像,脂肪肝,脂肪肝能谱,CT,研究,65keV,单能量,CT,值与甘油三酯含量相关系数,r,2,0.89,65keV,与,MRI,FF,间相关系数,r,2,0.86,65keV,单能量,CT,值、,MRI,FF,均与组织学结果有很好的相关性,脂肪（水）浓度、有效原子序数与甘油三酯含量相关系数,r,2,0.57,Artz NS,Hines CDG,Brunner ST,et al.Quantification of Hepatic Steatosis With Dual-Energy Computed Tomography Comparison With Tissue Reference Standards and Quantitative Magnetic Resonance Imaging in the ob/ob Mouse.Invest Radiol.2012;47:603-610.,（,University of Wisconsin,USA,）,肝硬化的血流动力学研究,肝硬化门脉期碘浓度,B,级和,A,级,正常肝脏肝动脉指数,AIF,小于肝硬化组,随着,CHILD,分级升高，,AIF,升高,Lv PJ,et al.Spectral CT:Preliminary Studies in the Liver Cirrhosis.Korean J Radiol 2012;13(4):434-442,Zhao LQ,et al.The evaluation of haemodynamics in cirrhotic patients with spectral CT.Br J Radiol.2013 Aug;86(1028):20130228.,4.,肿瘤综合诊断,右肝,sHCC,III,级,能谱,CT,肿瘤定位诊断,右肝,HCC,III,级,能谱,CT,肿瘤定位诊断,小肝癌的检测,病灶,CNR,动脉期,50keV,、,70keV,，门脉期,70keV,最高,图像噪声,70keV,最低,Lv p,et al.,Spectral CT in patients with small HCC:investigation,of image quality and diagnostic accuracy.Eur Radiol DOI 10.1007/s00330-012-2485-3,最佳单能量,碘基图像,51,岁，女性，反复发作性意识障碍,2,年,XZ Lin et al.Dual energy spectral CT imaging of insulinoma-Value in preoperative diagnosis compared with conventional multi-detector CT.European Journal of Radiology.2012;81(10):2487-94,CT,能,谱,成像在胰,岛细,胞瘤,检测,中的价,值,CT,能谱成像检测胰岛细胞瘤的敏感度较常规,64,排,CT,高（,95.7%vs 68.8%,）,CT,能谱成像单能量图像与碘基图像相结合能够提高胰岛细胞瘤的检测敏感度,能谱,CT,肿瘤定性诊断,异病同影,“,右肝,”,肝细胞肝癌,III,级，结节性肝硬化,肝,脏,富血供,肿,瘤的,鉴别诊,断,肝脏血管瘤碘浓度,HCC,FNH,碘浓度,HCC,AML,碘浓度,HCC,Lv pj,et al.Spectral CT Differentiation of Hemangioma and Hepatocellular Carcinoma:Recently Introduced Spectral CT Method.,Radiology,2011,259(3):720-729,Yu yx,et al.Hepatocellular carcinoma and focal nodular hyperplasia of the liver:differentiation with CT spectral imagingEur Radiol DOI 10.1007/s00330-012-2747-0,Yu yx,et al.Differentiating hepatocellular carcinoma from angiomyolipoma of the liver with CT spectral imaging:A preliminary study.Clinical Radiology 68(2013)e491,e,e497,肝脏富血供肿瘤的鉴别诊断,HCC,FNH,AML,HH,男性，,56,岁，体检发现,AFP,升高三周余,“,右肝肿块,”,：肝细胞癌,II,级，周围肝组织结节性肝硬化。,胰腺囊腺瘤,能谱,CT,肿瘤定性诊断,异病同影,林晓珠，等。,CT,能谱成像在鉴别胰腺寡囊型浆液性囊腺瘤与黏液性囊性肿瘤中的价值。中华放射学杂志,。,2011;8(45):713-717,CT,能,谱,成像在胰腺寡囊型,浆,液性囊腺瘤与粘液性囊性,肿,瘤中的价,值,胰腺寡囊型浆液性囊腺瘤与粘液性囊性肿瘤在,CT,能谱特征方面存在差异。,CT,能谱成像多参数联合诊断能够提高胰腺寡囊型浆液性囊腺瘤与粘液性囊性肿瘤鉴别诊断准确率。,男性，,41,岁,，上腹部疼痛二十余天,男性，,59,岁，体检发现胰头占位一周,女性，,48,岁，体检发现甲状腺结节,10,日,右甲状腺乳头状癌,左甲状腺结节性甲状腺肿,甲状腺结节鉴别,甲状腺癌标本碘浓度低于甲状腺腺瘤及结节性甲状腺肿,甲状腺癌标本能谱曲线斜率与甲状腺腺瘤及结节性甲状腺肿不同,甲状腺癌标本有效原子序数低于甲状腺腺瘤及结节性甲状腺肿,Li M,Zheng X,Li J,et al.Dual-Energy Computed Tomography Imaging of Thyroid Nodule Specimens Comparison With Pathologic Findings.Invest Radiol.2012;47:5864.,能谱,CT,肿瘤定性诊断,追根溯源,？,男，,64,岁，多饮多尿,1,月，厌食伴恶心,1,周,“,左侧部分肾上腺及后腹膜,”,嗜铬细胞瘤，生物学行为不定,“,第,IV,肝段,”,肝细胞癌,III,级，伴结节性肝硬化,能谱,CT,肿瘤综合诊断,肿瘤,T,分期,单能量,碘基融合图像,最佳单能量,动脉期,门脉期,能谱,CT,肿瘤综合诊断,肿瘤与血管,男性，,66,岁,体检发现胰头占位,2,日,术中发现肿块与门静脉粘连，沿肿块周边,1cm,游离肿块，去除标本及侵犯的门静脉。,“,胰颈部,”,导管腺癌,II,级，侵犯神经。,“,第,7,、,8,、,9,组淋巴结,”,2,枚未见癌转移,男，,42,岁，体检发现胰腺占位,2,日,68keV,40keV,术中见肿瘤部分侵犯肠系膜上静脉右侧壁，无法分离，遂决定行肠系膜上静脉部分切除重建。,“胰十二指肠切除标本”胰腺导管腺癌,-,级，胰腺切缘、胆总管切缘、胃切缘、十二指肠切缘未见肿瘤侵犯，胰周淋巴结,2,枚未见肿瘤转移。胃周淋巴结,14,枚未见肿瘤转移。,腺癌,II,级（平坦型），浸润至粘膜下层,+,+,+,+,胃体粘液腺癌（溃疡型），浸润至浆膜外纤维脂肪组织,能谱,CT,肿瘤综合诊断,肿瘤区域淋巴结,胃癌淋巴结,能,谱,曲,线,阴性,-,阳性比,较,印戒细胞癌在门脉期的碘浓度高于管状腺癌,腺癌的转移淋巴结和非转移淋巴结标准化碘浓度在动脉期有差异,印戒细胞癌的转移淋巴结和非转移淋巴结在动脉期和门静脉期的标准化碘浓度均有差异。,庞丽芳，张欢，宋立涛等。宝石,CT,能谱成像在胃癌诊断中的初步应用研究。外科学理论与实践，,2011,，,3,：,244-247,胃癌的能谱研究,食道癌淋巴结转移的鉴别,女性，,67,岁，发现皮肤颜色变黄,20,天,胰头导管腺癌,II,III,级，浸润至胰周纤维脂肪组织，淋巴管内见癌栓，侵犯神经，累及十二指肠壁。找到胃周淋巴结,2,枚、找到胰周淋巴结,2,枚、另送“第,8,组淋巴结”,6,枚均未见肿瘤。,女，,54,岁，腰腹部不适,8,月,胰腺导管腺癌,III,级，部分腺鳞癌，浸润胰周脂肪组织、神经及血管壁，肿块旁淋巴结,1/1,枚见癌累及；脾门淋巴结,5,枚未见癌转移,能谱,CT,肿瘤综合诊断,肿瘤转移,粒子植入后第二次,CT,，动脉期碘浓度,0.90mg/cc,粒子植入后第一次,CT,，动脉期碘浓度,1.43mg/cc,能谱,CT,肿瘤综合诊断,疗效评估,粒子植入后第二次,CT,，门脉期碘浓度,0.94mg/cc,粒子植入后第一次,CT,，门脉期碘浓度,2.57mg/cc,空肠,GIST,术后,5,年,格列卫治疗后,1,月,格列卫治疗后,6,月,女性，,55,岁,CT,能谱成像,肿瘤综合诊断,血管成像,组织灌注,代谢异常,谢,谢！,