低剂量灌注CT成像诊断胰腺癌的研究进展
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摘要
随着MSCT的不断发展以及检查技术的不断完善,胰腺疾病的诊断率也不断进步。CT可以对胰腺进行普通平扫、多期增强扫描及CT灌注扫描(CTPI)。其中,普通平扫及增强扫描对小的胰腺癌病灶诊断率较低;普通灌注扫描可以通过监测胰腺组织血流动力学评价胰腺功能,对于早期胰腺癌的诊断率较高,但辐射剂量也较高,因此对患者的远期影响较大。因此,在满足对胰腺癌疾病诊断条件的前提下,减少CT扫描对患者的辐射剂量是目前临床研究的热点。灌注扫描通过监测患者血流量(BF)、血容量(BV)对正常胰腺及胰腺癌病灶进行观察,能够在减少辐射剂量的同时获得灌注数据,从而提供更多的诊断信息,进而满足临床诊断的要求。
With the continuous development of MSCT and the continuous improvement of the inspection technology, the diagnostic rate of pancreatic disease also increased. CT can be performed with plain, multi phase and CT perfusion scan(CTPI). Among them, the ordinary scan and enhanced scan in the diagnosis of small pancreatic carcinoma rate is low; the common pancreatic tissue perfusion scan can be detected by monitoring the hemodynamic evaluation of pancreatic function, for the early diagnosis of pancreatic cancer was higher, but the radiation dose is higher, so the impact on patients with long-term large. Therefore, in order to meet the conditions for the diagnosis of pancreatic cancer, it is a hot spot of clinical research to reduce the radiation dose of CT scanning to patients. The blood flow perfusion scan patient monitoring(BF), blood volume(BV) of normal pancreas and pancreatic carcinoma were observed, can reduce the radiation dose and perfusion data, so as to provide more diagnostic information, and meet the demands of clinical diagnosis.
With the continuous development of MSCT and the continuous improvement of the inspection technology, the diagnostic rate of pancreatic disease also increased. CT can be performed with plain, multi phase and CT perfusion scan(CTPI). Among them, the ordinary scan and enhanced scan in the diagnosis of small pancreatic carcinoma rate is low; the common pancreatic tissue perfusion scan can be detected by monitoring the hemodynamic evaluation of pancreatic function, for the early diagnosis of pancreatic cancer was higher, but the radiation dose is higher, so the impact on patients with long-term large. Therefore, in order to meet the conditions for the diagnosis of pancreatic cancer, it is a hot spot of clinical research to reduce the radiation dose of CT scanning to patients. The blood flow perfusion scan patient monitoring(BF), blood volume(BV) of normal pancreas and pancreatic carcinoma were observed, can reduce the radiation dose and perfusion data, so as to provide more diagnostic information, and meet the demands of clinical diagnosis.
引文
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[2]Gomez D,Rahman SH,Wong LF,et al.Characterization of malignant pancreatic cystic lesions in the background of chronic pancreatitis[J].JPO,2012,7(5):465-472
[3]Guo X,Cui Z.Current diagnosis and treatment of pancreatic cancer in China[J].Pancreas,2005,31(1):13-22
[4]Siegel R,Naishadham D,Jemal A.Cancer statistics,2013[J].CA:a cancer journal for clinicians,2013,63(1):11-30
[5]石明国.CT技术发展进入低剂量成像时代[J].中国医疗设备,2012,27(1):39-42,21
[6]叶兴池.临床胰腺癌疾病应用CT与M RI诊断的价值分析[J].中国医学工程,2015,23(8):137
[7]Christopher L,Wolf G,Joseph M,et al.Recent progress in pancreatic cancer[J].CA Cancer J Clin,2013,63(5):318-348
[8]Poruk KE,Firpo MA,Adler DG,et al.Screening for pancreatic cancer:why,how,and who?[J].Ann Surg,2013,257(1):17-26
[9]Bosetti C,Lucenteforte E,Silverman DT,et al.Cigarette smoking and pancreatic cancer:an analysis from the International Pancreatic Cancer Case-Control Consortium(Panc4)[J].Ann Oncol,2012,23:1880-1888
[10]Chari ST,Leibson CL,Rabe KG,Ransom J,de AM,Petersen GM.Probability of pancreatic cancer following diabetes:a populationbased study[J].Gastroenterology,2005,129:504-511
[11]YU ZL,ZHOU GZ,LI ZS,et al.An analytic study on clinical features of small pancreatic adenocarcinoma in Chinese[J].Chin J Clin Oncol,2012,29(11):764-767
[12]Li ZS,Wang LW.Early diagnosis of pancreatic cancer[J].Med JChinese People's Armed Police Forces,2004,15(1):7-10
[13]Yong Li,Hua Z.Research development of ALARA concept and CTlow dose application[J].Chinese Journal of Medical Imaging Technology,2008,(S1):17-20
[14]Mathews JD,Forsythe AV,Brady Z,et al.Cancer risk in 680,000people exposed to computed tomography scans in childhood or adolescence:data linkage study of 11 million Australians[J].BMJ,2013,346(7910):1-18
[15]罗立民,胡轶宁,陈阳,等.低剂量CT成像的研究现状与展望[J].数据采集与处理,2015,30(1):24-34
[16]Yu MH,Lee JM,Yoon JH,Baek JH,Han JK,Choi BI,Flohr TG.Low tube voltage intermediate tube current liver MDCT:sinogramaffirmed iterative reconstruction algorithm for detection of hypervascular hepatocellular carcinoma[J].AJR Am J Roentgenol,2013,201:23-32
[17]Marin D,Choudhury K R,Cupta R T,et al.Clinical impact of an adaptive statistical iterative reconstruction algorithm for detection of hypervascular liver tumours using a low tube voltage,high tube current MDCT technique[J].Eur Radiol,2013,23(12):3325-3335
[18]王威清,熊曾,刘进康,等.低剂量螺旋CT筛查早期肺癌的研究进展[J].国际医学放射学杂志,2011,34(2):146-149
[19]杜广芬,李海亮,韩中山,等.多层螺旋CT低剂量扫描的临床应用现状[J].中国辐射卫生,2012,21(2):246-248
[20]葛虓俊,吴昊,滑炎卿,等.低剂量CT扫描诊断肋骨骨折的临床应用[J].中华放射学杂志,2011,45(5):492-495
[21]Brenner DJ,Hall EJ.Computed tomography-an increasing source of radiation exposure[J].N Engl J Med,2007,357(22):2277-2284
[22]杨乐华,刘震,余纪元,胰腺癌的多层螺旋CT灌注研究探析[J].当代医学,2013,32(19):96-97
[23]Shrimpton P C,Miller H C,Lewis M A,et al.Doses from computed tomography(CT)examinations in the UK-2003 review[R].UK:National Radiological Protection Board,2005
[24]杨瑞,代立梅,李剑颖,等.多层螺旋CT低剂量扫描在眼眶部外伤检查中的应用[J].中华放射学杂志,2010,44(7):731-734
[25]Miles KA.Hayball MP.Dixon AK.Mea surement of human pancreatic perfusion using dynamic computed tomography with perfusion imaging[J].Br J Radio1,1995,68(809):471-475
[26]Xu J,Liang Z,Hao S.et a1.Pancreatic adenocarcinoma:dynamic 64-slice helical CT with perfusion imaging[J].Ahdom Imaging,2009,34(6):759-766
[27]Tsushima Y.Kusano s Age-dependent decline in parenchymal perfusion in the normal human pancreas:measurement by dynamic computed tomography[J].Pancreas,1998,17(2):148-152
[28]TAN ZW,Li XL,Ren K,et al.The primary study of low-dose pancreas perfusion by 640-slice helical CT:a whole-organ perfusion[J].Springerplus,2015,4:192
[29]Sigal-Cinqualbre A.Hennequin R,Abada H,et al.Low-Kilovoltage multi-detector row chest Ctin adults:Feasibility and effect on image quality and iodine dose[J].Acta Radiologica,2005,46(4):396-46
[30]解骞,梁宗辉.胰腺C T灌注成像的研究进展[J].C T理论与应用研究,2014,23(1):183-191
[31]张健,贾宁阳,余仲飞,等.FDG PET与增强CT异机融合图像在胰腺病变良恶性鉴别诊断及胰腺癌分期中的价值[J].中华胰腺病杂志,2014,14(6):374-379
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[34]陈雷,周正荣,彭卫军,等.正常胰腺64层螺旋CT灌注成像的初探[J].上海医学影像,2012,21(1):51-54
[35]Ng Qs.Goh V.Milner J.et a1.Quantitative helical dynamic contrast enhanced computed tomography assessment of the spatial variation in whole tumour blood volume with radiotherapy in lung cancer[J].Lung Cancer,2010,69(1):71-76
[36]张鹏,陈克敏.胰腺癌多层螺旋CT灌注成像的临床应用研究[J].重庆医学,2013,42(27):3289-3291