显微计算机断层扫描对体表恶性肿瘤成像的研究  

The methodology of Micro-CT imaging of body surface malignant tumors

作　　者：姜伟乾 陈犹白[1] 陶然[1] 杨京润 韩岩[1] Jiang Weiqian;Chen Youbai;Tao Ran;Yang Jingrun;Han Yan(Department of Plastic Surgery,the First Medical Center,Chinese PLA General Hospital,Beijing 100853,China;Dermatology Department,the First Medical Center,Chinese PLA General Hospital,Beijing 100853,China)

机构地区：[1]解放军总医院第一医学中心整形修复科,北京100853 [2]解放军总医院第一医学中心皮肤科,北京100853

出　　处：《中华整形外科杂志》2020年第3期242-250,共9页Chinese Journal of Plastic Surgery

基　　金：国家自然科学基金(81571864);解放军总医院临床科研扶持基金(2012FC-TSYS-4005)。

摘　　要：目的探讨术中应用显微计算机断层扫描(Micro-CT)对体表恶性肿瘤成像的参数设置和效果,总结体表软组织和肿瘤的Micro-CT影像特点。方法根据入选标准,收集2018年10月至2020年1月解放军总医院第一医学中心整形修复科收治的体表恶性肿瘤患者。通过手术切除肿瘤,将离体肿瘤标本分割成合适大小(长×宽×厚不超过5 cm×3 cm×3 cm),置于Micro-CT扫描床上,在不同参数下进行扫描。(1)采用不同时间扫描:保持扫描电压不变(肉瘤为50 kV、鳞状细胞癌及其他肿瘤为70 kV),对同一标本选择4 min和14 min分别进行扫描。(2)采用不同电压扫描:保持扫描时间不变(4 min),对同一标本选择30、50、70、90 kV 4种电压分别进行扫描。对比不同扫描时间及扫描电压下的成像效果,得出不同肿瘤的最佳扫描参数。(3)对影像学感兴趣区进行取材,制作病理学HE染色切片,并采用Precice全自动数字切片扫描系统扫描获得数字切片,与Micro-CT相应截面的影像图进行对比,记录不同组织的影像学特点。结果共纳入27例患者,其中男15例,女12例,年龄33~82岁,平均63.9岁,其中皮肤鳞状细胞癌16例、基底细胞癌2例、乳房外Paget病2例、黑色素瘤1例、隆突性皮肤纤维肉瘤3例、血管肉瘤1例、脂肪肉瘤2例,对比影像学和病理学标本共65组。(1)扫描时间:扫描4 min与14 min均能获得清晰的影像,并能满足观察肿瘤形态、判读肿瘤边界的要求。(2)扫描电压:对于鳞状细胞癌,电压为30、50 kV时成像不清晰,70、90 kV时成像效果较好,部分病例中的微小钙化点在90 kV时与肿瘤组织对比度不高;对于各种肉瘤,电压为30 kV时成像不清晰,50 kV时成像效果较好,70、90 kV时肿瘤与周围脂肪组织对比度不高。(3)Micro-CT影像图与病理切片对比结果显示,体表肿瘤及其周围正常软组织的影像学形态与病理学切片十分接近。正常皮肤与皮下组织分界清楚,毛囊清晰Objective This study is to investigate the parameter settings and imaging effects of Micro-CT scanning externalmalignancies during operation and summarize the characteristics of Micro-CT images regarding external soft tissue and tumors.Methods According to the inclusion criteria,patients with externalmalignancies admitted to the Department of Plastic and Reconstructive Surgery of the First Medical Center of the PLA General Hospital from October 2018 to January 2020 were collected.Through the surgical resection of tumors,the isolated tumor specimens were divided into appropriate sizes(length×width×thickness not exceeding 5 cm×3 cm×3 cm),placed on the Micro-CT scanning bed,and scanned with different parameters.(1)Scanning with different times:with the fixedscanning voltage(50 kV for sarcoma,70 kV for other tumors),the same specimen was scanned with 4min and 14min protocols respectively.(2)Scanning with different voltages:with the fixed scanning time(4 min),the same specimen was scanned with 30,50,70,and 90 kV voltages respectively.After comparing the imaging results with different scanning times and different scanning voltages,the optimal scanning parameters for different tumors were obtained.(3)The regions of interest for radiology were taken from the specimens,and pathological HE stained slides were prepared.Digital slices were obtained by precice automatic digital slice scanning system.The slices were compared with Micro-CT corresponding cross-sectional images and the radiological characteristics of different tissues were recorded.Results A total of 27 patients were included/incorporated into the study and there were 15 males and 12 females,aged from 33 to 82,with an average age of 63.9 years old,including 16 cases of skin squamous cell carcinoma,2 cases of basal cell carcinoma,and 2 cases of extramammary Paget′s disease,1 case of melanoma,3 cases of cutaneous fibrosarcoma,1 case of angiosarcoma,and 2 cases of liposarcoma.A total of 65 groups were compared between Micro-CT images and pathology slides.(1)Sc

关 键 词：显微计算机断层扫描 肿瘤 鳞状细胞癌 隆突性皮肤纤维肉瘤 病理学 

分 类 号：R730[医药卫生—肿瘤]