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  • 學位論文

利用電腦斷層評估TACE術後腫瘤內碘油緻密度變化之研究

The Study of Evaluated Variety of Lipiodol Dense in Tumor on Computed Tomography after TACE

指導教授 : 陳泰賓

摘要


電腦斷層攝影(Computed Tomography, CT)是目前醫學造影儀中具有成像時間短、解析度高、應用性廣的臨床影像診斷工具之一。臨床上肝細胞癌(Hepatocellular Carcinoma, HCC)的診斷與追蹤大部分會使用CT 進行影像檢查。然而治療HCC 除了外科手術切除外,肝動脈化療栓塞術(Transcatheter Arterial Chemoembolization, TACE)亦是常用的方法。本研究動機藉由患者TACE 術後,利用電腦斷層肝臟血流動態攝影術(CT of Liver Triphase)定期追蹤TACE 術後腫瘤變化情形。採用回顧性實驗設計方法,收集經TACE 治療及定期追踪患者共23 位總計135 組影像;萃取腫瘤影像特徵包括平均值、標準差、最大值、最小值與體積以及追踪造影間隔時間、性別、年齡、甲基胎兒蛋白(Alpha-Fetoprotein, AFP)、麩草酸轉胺基酵素(Glutamate Oxaloacetate Transaminase, GOT)、麩丙酮酸轉胺基酵素(Glutamic-pyruvic Transaminase, GPT)。利用概化線性模式(Generalized Linear Model, GLM)建立影像特徵與生理生化指數和時間(檢查次數)的關連模型;根據TACE 術後及追蹤的CT 影像特徵和生理生化指數,了解腫瘤內碘油(Lipiodol)CT 值(Hounsfield Unit﹐HU)與時間之變化性。經統計分發現TACE 術後碘油(Lipiodol)CT 值與間隔時間、檢查次數及腫瘤栓塞緻密度之間具有關聯性。當腫瘤內碘油緻密度剩原有的百分之五大約需經過500 天,所以碘油栓塞範圍變小速率愈快,腫瘤治癒率也隨下降,則患者存活率相對也下降。此外,男、女性碘油緻密度下降至原有的百分之5 大約為500 天和1000 天,表示女性比男性的栓塞效果好大約2 倍。

並列摘要


The computed tomography (CT) is one of the clinical imaging diagnostic tool currently with short imaging time, high resolution and wide applicability. The CT is applied to follow-up the prognoses of hepatocellular carcinoma (HCC) in clinics. However, the treatment of HCC is not only by surgical excision, but also applied the hepatic transcatheter arterial chemoembolization (TACE) for the patients. The motivation of this study is to figure the variety of HCC after TACE by hepatic blood flow dynamics scan with computer tomography tomography. The retrospective study was applied to collected 23 patients with total 135 CT images after TACE. The features of CT images on tumor were extracted including mean, standard deviation, minimum and maximum. Meanwhile, the patient’s age, gender, alpha-fetoprotein (AFP), glutamate oxaloacetate transaminase (GOT) and glutamic-pyruvic transaminase (GPT) were recorded per scan by CT. The relations among features of image, spacing time between scans and physiological and biochemical indices were modeling by generalized linear models (GLM). The association between variation of density of lipiodol in tumor and spacing time were estimated by image features and physiological and biochemical indices. The results by statistical analysis were demonstrated the relation among the spacing time, numbers of scan and density of lipiodol with CT images. The remainder of density of lipiodol in tumor less than 5% of initialization was about 500 days. Therefore, the higher decay rates of density of lipiodol in tumor, the lower rates of survival and cure were occurrence. Moreover, the remainder of density of lipiodol in tumor less than 5% of initialization was about 500 and 1000 days with respectively to male and female groups. Thus, the rate of cure in female groups with TACE was double compared with those of male group.

參考文獻


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