本文選題：子宮 + 磁共振擴散加權(quán)成像　； 參考：《重慶醫(yī)科大學(xué)》2015年碩士論文

【摘要】：第一部分子宮擴散加權(quán)成像磁化率偽影與腸道準(zhǔn)備之間的相關(guān)性研究目的：探討腸道準(zhǔn)備對子宮擴散加權(quán)成像磁化率偽影的影響。方法：將60名健康女性受檢者(23-45歲)隨機分為兩組(無腸道準(zhǔn)備組和腸道準(zhǔn)備組),每組30名受檢者,然后對每一位受檢者進(jìn)行T2軸位和失狀位、DWI掃描,然后由兩名醫(yī)師分別對其圖像進(jìn)行雙盲法評價。結(jié)果：兩名醫(yī)師評價無腸道準(zhǔn)備組腸道以氣體為主的出現(xiàn)率平均為65.00%,以液體為主的出現(xiàn)率平均為35.00%；腸道準(zhǔn)備組腸道以氣體為主的出現(xiàn)率平均為23.33%,腸道以液體為主的出現(xiàn)率平均為76.67%,兩名醫(yī)師評價的兩組結(jié)果均具有統(tǒng)計學(xué)差異(PI=0.001,P2=0.002)。腸道以氣體為主時子宮DWI磁化率偽影陽性率平均為82.91%,腸道以液體為主時子宮DWI磁化率偽影陽性率平均為13.46%,兩名醫(yī)師評價磁化率偽影結(jié)果均具有統(tǒng)計學(xué)差異(P1=0.OOO,P2=0.000)。結(jié)論：子宮DWI檢查前進(jìn)行腸道準(zhǔn)備有助于減少子宮DWI磁化率偽影的產(chǎn)生,從而提高子宮DWI的圖像質(zhì)量,這更有利于我們進(jìn)行子宮組織學(xué)的研究、子宮疾病的診斷、監(jiān)測以及治療后的療效評價。第二部分正常子宮肌層擴散加權(quán)成像ADC值在時間與空間上的對比研究目的：探討健康女性子宮肌層ADC值在絕經(jīng)期與育齡期子宮體、子宮頸的差異。方法：90名健康女性(絕經(jīng)期、增殖期、分泌期各30名)均接受MR掃描,分別測量子宮體和子宮頸肌層ADC值,然后進(jìn)行對比分析。結(jié)果：絕經(jīng)期、分泌期、增殖期宮體肌層ADC值分別為(1.23±0.31)×10-3mm2/s、(1.86±0.13)×10-3mm2/s、(1.72±0.18)×10-3mm2/s,差異有統(tǒng)計學(xué)意義(F=67.30,P0.001);子宮頸肌層ADC值分別為(1.19±0.37)×10-3mm2/s、(1.82±0.18)×10-3mm2/s、(1.68 ±0.16)×10-3mm2/s,差異有統(tǒng)計學(xué)意義(F=47.89,P0.001)。絕經(jīng)期、增殖期、分泌期的宮體和宮頸肌層ADC值均差異無統(tǒng)計學(xué)差異(P均0.05)。絕經(jīng)期肌層ADC值明顯低于增殖期、分泌期肌層ADC值(P0.05),增殖期肌層ADC值低于分泌期(P0.05)。結(jié)論：不同生理周期及不同子宮區(qū)域肌層ADC值的改變對影像學(xué)診斷子宮病變、鑒別子宮肌層的生理改變與病理改變、確立惡性腫瘤的侵犯范圍及疾病治療前后的隨訪具有重要的參考價值。第三部分不同月經(jīng)周期正常子宮肌層ADC值的可重復(fù)性研究目的：探討正常子宮肌層ADC值測量者內(nèi)、測量者間的一致性以及不同月經(jīng)周期正常子宮肌層ADC值的可重復(fù)性。方法：采用3.0 T磁共振對34例健康女性(增殖期18名,分泌期16名)進(jìn)行2次盆腔MR掃描,前后兩次掃描間隔一個月經(jīng)周期。由兩名放射科醫(yī)師獨立進(jìn)行子宮肌層ADC值的測量,每一次掃描同一名醫(yī)師間隔一周進(jìn)行兩次測量,分析比較各自前后兩次測量的一致性(即測量者內(nèi)的一致性),再取每一次掃描每一名醫(yī)師兩次測量的子宮肌層ADC值的平均值進(jìn)行同一次掃描兩名醫(yī)師之間的一致性檢驗(即測量者間的一致性)以及兩次掃描不同月經(jīng)周期正常子宮肌層ADC值可重復(fù)性檢驗。結(jié)果：兩次MR掃描兩名醫(yī)師測量者內(nèi)一致性均較好,其ICC分別0.95,0.82,0.85,0.89；兩次MR掃描測量者間的一致性均較好,其ICC分別為0.92,0.88。兩名醫(yī)師測量的子宮肌層ADC值在分泌期均大于增殖期,且差異具有統(tǒng)計學(xué)意義(P0.05)。增殖期和分泌期在兩次檢查中的差異均不具有統(tǒng)計學(xué)意義(P均0.05)。Bland-Altman分析發(fā)現(xiàn)兩名醫(yī)師測量得到的子宮肌層ADC值在增殖期95%的置信區(qū)間分別為：-14.3%-13.6%和-11.5%-12.8%；在分泌期95%的置信區(qū)間分別為：-7.6%-7.0%和-7.7%-7.8%。分泌期相對于增殖期較好。結(jié)論：正常子宮肌層ADC值的測量者內(nèi)、測量者間的一致性較好,為正常子宮肌層ADC值的廣泛運用于臨床提供了證據(jù),但正常子宮肌層ADC值可重復(fù)性在分泌期較增殖期好。
[Abstract]:The study of the correlation between magnetic susceptibility artifacts and intestinal preparation in the first part of the uterine diffusion-weighted imaging objective: To explore the effect of intestinal preparation on the susceptibility artifacts of diffusion-weighted imaging of the uterus. Methods: 60 healthy female subjects (23-45 years old) were randomly divided into two groups (no intestinal preparative group and intestinal preparation group), 30 subjects in each group. The T2 axis and DWI scan were performed on each patient, and the images were evaluated by two doctors respectively. Results: the average rate of gas based in the intestinal intestinal preparation group was 65%, the average rate of liquid dominated by two doctors was 65%, and the intestinal bowel preparation group was dominated by gas in the intestinal preparation group. The average rate of occurrence was 23.33%, the average rate of liquid dominated intestinal tract was 76.67%, and the two groups evaluated by two doctors were statistically different (PI=0.001, P2=0.002). The average susceptibility rate of DWI susceptibility in the intestines was 82.91%, while the DWI susceptibility rate of the uterus was 13.46% when the intestine was mainly liquid, and the average rate of false positivity was 13.46%. Two physicians evaluated the magnetic susceptibility artifacts with statistical differences (P1=0.OOO, P2=0.000). Conclusion: intestinal preparation before DWI examination can help reduce the production of DWI susceptibility artifacts and improve the image quality of uterine DWI, which is more conducive to the study of uterine histology, diagnosis and monitoring of uterine diseases. The second part of the normal uterine myometrium diffusion weighted imaging ADC value in time and space: To explore the difference between the ADC values of the uterine myometrium in the healthy women and the uterine cervix at the menopause and the childbearing age. Methods: 90 healthy women (menopause, proliferation, and secretory period 30) were all received MR scan, The ADC values of the uterine and cervical muscles were measured and compared. Results: the ADC values of the myometrium in the menopause, the secretory period and the proliferation period were (1.23 + 0.31) x 10-3mm2/s, (1.86 + 0.13) x 10-3mm2/s and (1.72 + 0.18) x 10-3mm2/s, and the difference was statistically significant (F=67.30, P0.001), and the ADC value of the cervix cervix was (1.19 + 0.37) x 10-3mm, respectively. 2/s (1.82 + 0.18) x 10-3mm2/s, (1.68 + 0.16) x 10-3mm2/s, the difference was statistically significant (F=47.89, P0.001). There was no statistical difference between the menopause period, the proliferative stage and the ADC value of the uterine cervix and cervix (P 0.05). The ADC value of the menopause myometrium was significantly lower than that of the colonization period, the secretory phase of muscularis ADC value (P0.05), and the ADC value of the proliferation stage muscle layer was lower than the secretory period. (P0.05) conclusion: the changes in the ADC values of different physiological cycles and different uterine regions have important reference value in imaging diagnosis of uterine lesions, identifying the physiological changes and pathological changes of the uterine myometrium, establishing the range of the invasion of the malignant tumor and the follow-up of the treatment of the disease before and after the treatment. The third part of the normal uterine myometrium is different from the menstrual cycle ADC. Objective: To investigate the repeatability of the ADC values in the normal uterine myometrium, the consistency between the surveyors and the repeatability of the ADC values of the normal uterine myometrium in different menstrual cycles. Methods: 3 T MRI were used in 34 healthy women (18 in proliferating period, 16 in secretory phase) for 2 pelvic MR scans, and one of the two intervals. The menstrual cycle. The ADC values of the myometrium of the uterus were measured independently by two radiologists, two measurements per week at the same doctor at each scan. The consistency of the two measurements before and after each (the consistency of the measured person) was compared, and the mean value of the ADC value of the uterine myometrium measured by each doctor at each scan was taken. The consistency test between the two doctors of the same scan (the consistency between the surveyors) and the reproducibility test of the normal uterine myometrium ADC value of the two scans in different menstrual cycles were tested. Results: the consistency of the two physicians in the two MR scans was better, the ICC was 0.95,0.82,0.85,0.89 respectively, and the one between the two MR scanned measurements. The ADC values of the ICC of the two physicians of 0.92,0.88. were all higher than the proliferation period, and the difference was statistically significant (P0.05). The difference between the proliferative and secretory phases in the two examinations was not statistically significant (P 0.05).Bland-Altman analysis found the A of the uterine myometrium measured by two physicians. The confidence intervals of the DC value of 95% in the proliferation period were -14.3%-13.6% and -11.5%-12.8%, respectively, and the confidence intervals of 95% in the secretory period were respectively: -7.6%-7.0% and -7.7%-7.8%. secreting phase were better than the proliferation period. Conclusion: the consistency of the surveyors is better within the ADC values of normal uterine myometrium, and it is widely used for the ADC value of the normal uterine myometrium. It provides evidence in clinical practice, but the ADC value of normal myometrium is reproducible in secretory phase than in proliferative phase.

【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R445.2

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