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胰腺脂肪沉积(pancreatic fat deposition,PFD)是指胰腺腺泡或胰岛细胞中有三酰甘油累积,或胰腺实质被脂肪组织替代[1]。PFD的发生可直接损害胰岛β细胞或间接抑制细胞胰岛素信号转导,最终诱发β细胞凋亡引起糖尿病,而糖尿病、肥胖、代谢综合征等又可导致胰腺发生脂肪化,进一步加重病人病情[2-6]。脂肪积聚于胰腺实质胰岛细胞或腺泡细胞是可逆的,称为胰腺脂肪浸润;脂肪细胞积聚于胰腺实质内是不可逆的,称为胰腺脂肪替代[7-8]。由于胰腺脂肪沉积部分为可逆性的,因此定量评价胰腺脂肪含量对于胰腺脂肪沉积的早期诊断、早期干预十分重要,而双能量能谱CT定量分析技术能够克服传统CT的伪影及部分容积效应等弊端、对病灶脂肪含量精准判断,对胰腺脂肪沉积预防、早期诊断具有重要价值。本研探讨双能量能谱CT定量分析技术在PFD中的诊断价值。现作报道。
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所有平扫单能量图像传输至GE ADW 4.6工作站处理,进行后处理脂肪测量及分析,随着胰腺实质中脂肪含量的增强,胰腺组织能谱曲线的斜率逐渐降低。典型病例见图 1~3。
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观察组35例中,BMI为19.03~42.44 kg/m2,8例BMI正常,其余均为超重或肥胖;胰腺平均CT值随着BMI增高呈下降趋势,而平均脂含量值随BMI增高呈上升趋势,差异均有统计学意义(P < 0.01)(见表 1)。观察组胰腺组织的能量CT值及水含量值均显著低于对照组,脂肪含量值显著高于对照组(P < 0.01)(见表 2)。
分组 n CT值/Hu 脂肪含量(脂-水配对)/(mg/mL) BMI/(kg/m2) < 24 8 40.33±4.41 -106.21±43.29 24~ < 28 19 35.35±6.07 -80.45±62.01 ≥28 8 22.71±6.81**## 37.42±53.69**## F — 19.49 15.76 P — < 0.01 < 0.01 MS组内 — 35.124 3 203.463 q检验与BMI < 24 kg/m2比较**P < 0.01,与BMI 24~28 kg/m2比较##P < 0.01 表 1 观察组BMI值、胰腺CT值及脂肪含量值分布情况(x±s)
分组 n CT值/Hu 脂肪含量(脂-水配对)/(mg/mL) 水含量(水-脂配对)/(mg/mL) 观察组 35 31.91±6.72 -22.37±64.56 1 182.69±52.17 对照组 30 50.23±4.13 -179.23±8.95 1 305.10±20.65 t — 13.44 14.22 12.76 P — < 0.01 < 0.01 < 0.01 表 2 观察组和对照组单能量CT值及脂肪含量值比较(x±s)
双能量能谱CT物质定量分析技术对胰腺脂肪沉积的诊断价值
Diagnostic value of dual-energy spectral CT material quantitative analysis in pancreatic fat deposition
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摘要:
目的探讨双能量能谱CT物质定量分析技术对胰腺脂肪沉积的诊断价值。 方法选取临床诊断为肥胖症、高血糖、脂肪肝等代谢综合征症候群病人35例(观察组),在最佳KeV值单能量图像上,分别测定胰腺头、体、尾部的CT值;在脂肪-水物质图像上,分别测定胰腺头、体、尾部的脂肪含量;获得胰腺各部组织的能谱曲线,并做出平均能谱曲线。将该结果与30例因体检或其他疾病行腹部CT扫描的病人(对照组)所测定的脂肪含量值进行对照研究。 结果观察组35例中8例体质量指数(BMI)正常,其余均为超重或肥胖;观察组中胰腺平均CT值随着BMI增高呈下降趋势,而平均脂肪含量值随BMI增高呈上升趋势(P < 0.01);观察组胰腺组织的能量CT值及水含量值均明显低于对照组,脂肪含量值明显高于对照组(P < 0.01)。 结论双能量能谱CT定量分析技术可客观、定量地描述胰腺中的脂肪沉积,为临床早期诊断、早期治疗提供更加有价值的信息。 -
关键词:
- 脂肪代谢障碍 /
- 胰腺疾病 /
- 体层摄影术,X线计算机 /
- 定量研究
Abstract:ObjectiveTo explore the diagnostic value of dual-energy spectral CT material quantitative analysis for pancreatic fat deposition. MethodsA total of 35 patients with metabolic syndrome, such as obesity, hyperglycemia and fatty liver, were selected as the observation group.The CT values of the head, body and tail of pancreas were measured on the single energy image of optimal keV value.The fat contents of the head, body and tail of pancreas were determined on the fat-water material image.The spectral curves of pancreatic tissues were obtained to make the average spectral curves.The results were compared with the fat contents measured in 30 patients who underwent abdominal CT scan for physical examination or other diseases in the control group. ResultsAmong 35 cases in the observation group, 8 cases were found with normal body mass index, and the rest were overweight or obesity.The average CT value of pancreas decreased with the increase of body mass index (P < 0.01), while the average fat content increased with the increase of body mass index(P < 0.01).The energy CT value and water content of pancreatic tissues in observation group were significantly lower than those in control group, and the fat content was significantly higher than that in control group(P < 0.01). ConclusionsDual-energy spectral CT quantitative analysis can objectively and quantitatively describe the fat deposition in pancreas, and provide more valuable informations for early diagnosis and treatment in clinic. -
表 1 观察组BMI值、胰腺CT值及脂肪含量值分布情况(x±s)
分组 n CT值/Hu 脂肪含量(脂-水配对)/(mg/mL) BMI/(kg/m2) < 24 8 40.33±4.41 -106.21±43.29 24~ < 28 19 35.35±6.07 -80.45±62.01 ≥28 8 22.71±6.81**## 37.42±53.69**## F — 19.49 15.76 P — < 0.01 < 0.01 MS组内 — 35.124 3 203.463 q检验与BMI < 24 kg/m2比较**P < 0.01,与BMI 24~28 kg/m2比较##P < 0.01 表 2 观察组和对照组单能量CT值及脂肪含量值比较(x±s)
分组 n CT值/Hu 脂肪含量(脂-水配对)/(mg/mL) 水含量(水-脂配对)/(mg/mL) 观察组 35 31.91±6.72 -22.37±64.56 1 182.69±52.17 对照组 30 50.23±4.13 -179.23±8.95 1 305.10±20.65 t — 13.44 14.22 12.76 P — < 0.01 < 0.01 < 0.01 -
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