| Part ?The application of scan technique with selective photon shield and low tube current with Safire reconstruction in the enlarged cervical lymph nodesObjective To investigate the value of scan technique with selective photon shield and low tube current with Safire reconstruction in the enlarged cervical lymph nodes.Methods The confirmed by pathology of 75 patients which are using the conventional CT scan and dual energy scan for arterial phase, they were randomly divided into three groups before scan. The CTDIVOI of A and B is 14.87 mGy,The tube voltages of A group are 140kV and 80kV, tube currents are 50mAs and 213mAs. The scanning parameters of the B group is:tube voltages are respectively 100kV, Sn140kV, tube currents are 157mAs,123mAs respectively,The scanning parameters of the C group is:tube voltages are respectively 100kV, Sn140kV, tube currents are 117mAs,109mAs respectively,then using SAFIRE iterative reconstruction technique, value 3; The rest protocol are the same. On three groups of image quality scores were double blind method by two experienced physicians, consistency score comparisons between observed by Kappa test; Independent samples test was used to compare the A and B?B and C groups of patients the mean CT value, noise, signal to noise ratio (SNR), contrast to noise ratio (CNR) and the effective radiation dose of B group and C group.Results The mean CT value, noise, signal-to-noise ratio and subjective image of the B group and A group were has not tatistical difference (P>0.05), But statistically significant differences in contrast to noise ratio (P=0.015), The use of energy spectrum purification technology group contrast to noise ratio is higher than the non energy spectrum purification group; the arterial phase CT average value, the noise, signal to noise, contrast to noise ratio compared two Group B and group C,they were no significant difference (P>0.05), but the noise, the signal-to-noise ratio was statistically significant difference.Two sets of A group and B group, B group and C group images of subjective score has good consistency (Kappa value were 0.657,0.720) and has not tatistical difference(P>0.05). The subjective scores were above 4, which can meet the clinical requirements.The B group's CTDIvoi is14.870±0.356mGy, DLP is 320.560±1.577mGy.cm, the effective radiation dose is 1.888±0.009mSv, The C group's CTDIvoi is(10.801±0.594)mGy, DLP is (230.317±5.439)mGy.cm, the effective radiation dose is 1.357±0.031mSv. Group C compared with group B, group C CTDIvol decreased by approximately 4.06mGy, about 27.37%; DLP reduction of about 90.24mGy.cm, about 28.13%; ed decreases about 1.147mSv, about for 28.13%.Conclusion The first, In the condition of the same exposure dose, the dual energy arterial phase scanning in cervical lymph node enlargement, the image quality of using SPS technology is higher than that of unused spectrum purification technology group, recommended for clinical use.The second, In the dual energy arterial phase scanning of cervical lymph node enlargement, low tube current Safire iterative reconstruction can in order to ensure the image quality and reduce the subjects received radiation dose at the same time.Part ?The value of the spectrum curvein dual source CT in cervical lymph node lesionsObjective To explore the value of spectral imaging technique in Dual-energy CT in differential diagnosis of themetastaticlymph nodes in thyroid carcinoma?Squamous cell carcinomametastatic lymph nodes?Lymphoma?tuberculosis of lymph node?hyperplastic lymph node reactionin the neck.Data and Methods In 75 patients with pathologically confirmed with a total of 135 cervical lymph nodes enlargement which are using dual energy scan, Then observe the change trend of the spectrum curve and comparison the three kinds of lymph node energy spectrum curve slope.Results In the 135 lymph nodes,the metastatic lymph nodes in thyroid carcinoma is Twenty-five, Squamous cell carcinoma metastatic lymph nodes is thirty-five?Lymphoma is thirty,tuberculosis of lymph node is twenty-three,hyperplastic lymph node reactionis Twenty-two.From 60 to 180 keV, With the increase of keV values, the three kinds of malignant lymph nodes of the corresponding CT value decreasing and the higher the keV value, the CT value decrease magnitude is small, and the spectrum curve is "drop type".The slope spectrum curve of thefive nodesin arterial phase have difference statistically significant (F=41.084, P<0.05),Lymphoma and reactive lymph node hyperplasia in artery phase difference rate was not statistically significant (P=0.217>0.05),The remaining five lymph node lesions between the two two differences were statistically significant (P<0.05).And thyroid carcinoma in arterial spectrum curve slope is the largest decline in lymph node metastases, The rest followed by lymph node, metastasis of squamous cell carcinoma, lymph node tuberculosis, lymphoma and reactive lymph node hyperplasia. Comparison of five kinds of different pathological types of parenchymal phase slope, the difference was statistically significant (F=11.765, P<0.05). Lymph node metastatic lymph nodes with squamous cell carcinoma, lymphoma, reactive hyperplasia of lymph node metastasis of thyroid carcinoma, squamous cell carcinoma, metastatic lymph nodes and lymphoma and reactive lymph node hyperplasia, lymphoid tuberculosis, lymphoma and reactive lymph node hyperplasia two two differences were statistically significance (P<0.05), Lymph node, metastasis lymph node tuberculosis and squamous cell carcinoma of thyroid cancer lymph node metastasis, lymphoma and reactive lymph node hyperplasia in two two between the difference had no statistical significance (P>0.05), And the parenchymal phase spectrum curve slope is the largest decline in lymph node metastases of thyroid carcinoma, the rest followed by lymph node tuberculosis, squamous cell carcinoma, lymphoma, metastatic lymph node reactive hyperplasia of lymph node. Through the analysis, the removal of lymph nodes between different properties of the repeated part, We concluded, The arterial phase energy spectrum curve slope (K) of the range is as follows:If 0.36>K>0.24, then the possibility of lymphoma; If 039>K>0.36, then the reactive hyperplasia of lymph node. The possibility of a large, if 0.78>K>0.56, may be the lymph node tuberculosis, if 0.81?K? 0.78,may be a squamous cell carcinoma metastatic lymph node, if 1.65>K>0.98, may be of lymph node metastasis in thyroid carcinoma; Real time energy spectrum curve slope (K) of the range is as follows:If 0.34>K>0.23,then the reactive hyperplasia of lymph node. If 0.38>K>0.34, squamous cell carcinoma lymph node metastasis is the possibility of a large, if 0.52>K>0.38, may be lymphoma, if 0.56>K>0.55, may be the lymph node tuberculosis, if 1.18?K?0.56, may be lymph node metastasis in thyroid carcinoma.Conclusion The energy spectrum curve slope of arterial phase and parenchymal phase has some significance lymph node metastasis of in thyroid carcinoma?the metastatic lymph nodes?Lymphoma?tuberculosis of lymph node?hyperplastic lymph node reactionin the neck.Part ? The application value of iodine maps and spectrum curve in Squamous cell carcinoma lymph node metastasis and tuberculosis of lymph node on neckObjective To explore the value of dual energy technique in Dual-energy CT in differential diagnosis of the Squamous cell carcinoma metastatic lymph nodes and Lymph node tuberculosis in the neck.Methods In 20 patients with pathologically confirmed with a total of 58 cervical lymph nodes enlargement which are using dual energy scan, Then measurement of two kinds of different pathological lymph node parenchyma iodine coverage value?observe the change trend of the spectrum curve and comparison the two kinds of lymph node energy spectrum curve slope.Results In the 58 lymph nodes,the Squamous cell carcinoma metastatic lymph nodes is thirty-two and Lymph node tuberculosis is thirty.The iodine coverage value of the squamous cell carcinoma metastatic lymph nodes and Lymph node tuberculosis is 39.20±10.43 and 28.15±10.10, the differences in this two kinds of lymph nodes havestatistical significance (t=3.806, p<0.001). From 60 to 180keV,With the increase of keV values, the two kinds of lymph nodes of the corresponding CT value decreasing and the higher the keV value, the CT value decrease magnitude is small, and the spectrum curve is "drop type".The slope spectrum curve of thetwo lymph nodes are difference, Each is 0.88±0.10 and 0.65± 0.260, the differences in this two kinds of lymph nodes havestatistical significance (t=3.698,p=0.001)Conclusion The iodine coverage value and the energy spectrum curve slope of thetwo lymph nodes are different,thesquamous cell carcinomametastatic lymph nodes is bigger than the lymph node tuberculosis. The iodine coverage value and the energy spectrum curve slope of arterial phase has some significance in differential imaging diagnosis in different pathological properties of nodes. |
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