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【Objective】 1, retrospective analysis of 419 cases of of gynecological pelvic benign and malignant mass CT features, explore the value of CT scan and enhanced scan in gynecological pelvic benign and malignant tumors in the diagnosis and differential diagnosis. 2, 29 cases of gynecological pelvic tumors or tumor-like lesions underwent CT perfusion imaging (CT perfusionimaging, CTP), analysis of the differences of relatively benign or malignant tumor CT perfusion imaging parameters, evaluation of CT perfusion imaging in identifying gynecological pelvic benign and malignant disease application value. 419 cases of cases like lesions. Aged 16 to 84 years, with an average of 45.35 years old. 2, instrumentation equipment (1) Siemens Somatom Plus 4 single-row spiral CT scanners or GE Lightspeed 16 multi-slice spiral CT scanners. (2) United States MEDRAD production of KMP810P of high-pressure syringe. (3) non-ionic contrast medium, iohexol injection 300mgI/ml. (4) image processing by GEAW 4.2 workstation and PACS network workstations. 3, the scanning method (1) examination preparation: before scanning 12h oral dose of 1 to 2% of the 800ml iohexol filling the small intestine, colon, 1% iohexol 150ml scan before cleaning enema retention enema to filling the rectum, sigmoid . Check fasting for 4-6 hours the day before the examination drinking 800-1000ml upon bladder filling CT scan. (2) scan postural and range: patient supine axial scan to the pubic symphysis to the lower edge of the horizontal continuous scanning up to lesions on the sector and, in some cases, as the tumor size appropriate to expand the scanning range. (3) scan parameters: tube voltage of the single-slice spiral CT machine 140Kv, tube current of 206mA; slice thickness 8.0mm pitch, nonionic contrast agent enhanced scan 80 ~ 100ml, a flow rate of 2.0 ~ 2.5ml / s, by the cubital vein injection, delayed 20 seconds scanning; multi-slice spiral CT tube voltage 120Kv tube current 120 ~ 180mA detector structure using 16 × 1.25mm pattern coverage 20cm / week, pitch 1.375:1 (bed speed: 27.5mm / rev), reconstruction thickness of 7.5mm, the thinnest slice thickness reconstruction 1.25mm. Nonionic contrast agent enhanced scan 70 ~ 80ml, flow rate 2.5 ~ 3.0ml / s, scan delay of 25-30 seconds. 4, will be the end of the data processing and image analysis scanning multidetector CT raw data incoming the GE AW4.2 workstation multi-planar reconstruction (multiplanar reformation, MPR) and surface reconstruction (curvedplanar reformat, CPR). Single-slice spiral CT image analysis, PACS network workstation. Image analysis, including lesions clear boundary, the maximum diameter of the tumor, enhanced amplitude and pelvic lymph nodes were. Statistical analysis using the statistical software SPSS 11.5 software package, test level α = 0.05, P <0.05 was considered significant difference. Border and the group of benign and malignant pelvic lymph nodes and other indicators line χ 2 test; enhanced amplitude were rows and two independent samples t-test between the two groups of age, the maximum diameter of the tumor, CT (Independent-Samples T Test). [Results] (1) 419 cases of CT scan gynecological pelvic masses, benign tumors in 67 cases, accounting for 15.99%, 352 cases of malignant tumors, accounting for 84%. (2) benign lesions clear boundary 51 cases (76.127%), malignant tumor boundary is not clear 323 cases (91.767%), benign and malignant lesions borderline cases the difference was statistically significant (χ 2 = 163.529, P = 0.000). (3) benign lesions, 51 cases of pelvic lymph nodes (76.12%), and the difference is less than 1cm lymph nodes, malignant tumors 96.31% (339 cases) visible to the pelvic lymph nodes and multiple greater than 1cm significant (the χ 2 = 222.585, P = 0.000). (4) the age of the benign lesions (47.97 ± 13.10 years), cross-sectional maximum diameter (3.11 ± 1.21), enhanced the amplitude (27.51 ± 8.13 Hu in); malignancies age (51.65 ± 14.07 years old), the cross-sectional diameter (5.68 ± 3.89 cm), enhanced the amplitude (31.22 ± 11.02). Benign and malignant lesions in age (P = 0.019), the cross-section maximum diameter (P = 0.000) and enhanced amplitude (P = 0.000), the situation of the differences were statistically significant (P <0.05). [Conclusion] 1, spiral CT scanning speed fast, high soft tissue and spatial resolution, full bowel preparation and bladder filling, easy to distinguish between the of gynecological pelvic organs and tumors and tumor-like lesions, the diagnosis of gynecological pelvic tumors and tumor-like lesions commonly used imaging methods. By CT scan and enhanced scan not only good gynecological pelvic tumors and tumor-like lesions of the location, size, and the relationship with the surrounding organs can also clearly show the pelvic lymph nodes and adjacent organs involved, pelvic mass of clinical staging, treatment or surgery program development, and Efficacy provide valuable information. 3, the results of this study show that: gynecological of pelvic malignant and benign mass boundary pelvic lymph nodes and enhanced the amplitude of the difference was statistically significant, benign mass clear boundary (51/67) without pelvic lymph nodes ( 51/67); malignant tumor boundary is not clear (323/352), common pelvic lymph nodes (339/352), and enhanced magnitude higher than benign mass; combination of clinical signs and symptoms and adjacent organs involvement identify gynecological important basis for pelvic benign and malignant masses. The second part of multi-slice spiral CT perfusion imaging to identify gynecological pelvic benign and malignant disease of the Applied Research [Materials and methods] 1, subjects choose the period June 2007 - March, Nanfang Hospital, the clinical suspicion of gynecological pelvic tumors or tumor like lesions of 29 patients with CT perfusion scan. The benign masses 15 cases, 14 cases of malignant tumors. Aged 28 to 68 years, with an average age of 47.46 years. Instrumentation equipment (1) GE Lightspeed 16 multi-slice spiral CT scan machine. (2) more than the first part. 3, the scanning method (1) Check preparation: with the first portion. (2) scan postural and range: plain with the first part, and to determine the level of perfusion scan. (3) perfusion scan the of 5mm × 4 layer axis sweep mode, the tube voltage 120Kv, tube current of 40mA, 50 ml of the total of non-ionic contrast agent, a flow rate of 4.0ml / s, the start scanning elbow intravenous contrast agent after 10 seconds, the first stage scanning 30 times, 1/1 second interval; scanning the second stage 30 times every three seconds, a total of 190 seconds. Produce 240 images. (4) perfusion scan line conventional enhanced scan. Contrast medium 30ml, flow rate 2.5 ml / s, cubital vein finished after contrast agent injection scan, scan range and conditions of the same level sweep. 4, image post-processing the scan is complete, the raw data transmitted perfusion imaging GE AW 4.2 workstation. The workstation comes with part of the data on the perfusion CT Perfusion 3 software (deconvolution, deconvolution) basin abdominal tumor pattern algorithm. First select the maximum level of mass of-200-120Hu, as a post-treatment levels, the threshold value (Thresholds). Manually select the side of the internal iliac artery for arterial input (such as the side of the internal iliac artery bad alternative) contralateral iliac artery in vascular strengthening obvious when determining region of interest (the range ofinterest ROI) enter the artery ROI as large as possible, but do not exceed the vascular range. Rong Zhuo Palmetto neon arrived even bran should be possible election? Can select several regions of interest), to reduce the impact of noise, but it should not be too close to the edge of the mass, in order to avoid the partial volume effect, at the same time avoid the large blood vessels branch and obvious cystic necrosis or calcification zone. CT values ??in the ROI area inside the artery can be calculated by the software and mass to generate the appropriate time - density curve (time-density Curve, TDC), and automatically generate a series of pseudo-color perfusion image and display perfusion indicators, including blood flow (blood flow, BF), blood volume (blood volume, BV), mean transit time (mean transit time, MTT), capillary permeability surface (the permeability surface areaproduct, PS), observed TDC curve shape. Record the various indicators, all indicators take repeated 2 times the average recorded. Statistical analysis using statistical software SPSS 11.5 software package, the group of benign and malignant tumors of blood flow (BF), blood volume (BV), mean transit time (MTT) and permeability surface (PS) indicators row two independent sample t-test (Independent-Samples T Test). The inspection level α = 0.05, P <0.05 difference was statistically significant. [Results] (1) 29 cases of CTP gynecologic pelvic masses, benign tumors in 15 cases, accounting for 51.7% of the 14 cases of malignant tumors, accounting for 48.3%. (2) CTP TDC of the curve: The shape of gynecological pelvic benign TDC-liter flat-type speed and malignant form of the TDC showed a rapid rise with gradual decline. (3) perfusion parameters were: the benign lumps group BF value (61.17 ± 31.99 ml · min -1 · 100g -1 ), BV (4.60 ± 0.95 ml · 100g -1 ), MTT values ??(7.77 ± 1.96 S), PS values ??(13.69 ± 3.31ml · min -1 · 100g -1 ); malignant group BF (154.81 ± 54.05 ml · min -1 · 100g -1 ), BV value (6.29 ± 1.05 ml 100g -1 ), MTT (6.44 ± 1.04 S), PS value (17.26 ± 2.67 ml · min -1 100g -1 ). Comparison between benign masses and malignant group BF values ??(P = 0.000), BV value (P = 0.000), PS values ??(P = 0.031) and MTT values ??(P = 0.004), the differences were statistically significant (P <0.05). [Conclusion] 1 female pelvic relatively fixed position, less affected by respiratory motion, is conducive to a CT perfusion studies. CT perfusion imaging as a noninvasive evaluation of tissue blood perfusion status of functional imaging methods, quantitative observation of gynecological benign or malignant tumor perfusion changes. This study shows that the the gynecological malignancies TDC morphology rapid rise with a gradual decline, benign TDC the morphology to speed-liter flat-type; malignant tumor perfusion index BF, BV and PS values ??significantly higher than benign tumors, and MTT values ??than benign lesions The difference was statistically significant, a certain value of the differential diagnosis. CT perfusion imaging of gynecologic oncology through a check at the same time to obtain information of the morphology and function of learning both provide more diagnosis is based on good clinical application prospect.
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