本文關(guān)鍵詞：多模態(tài)MRI在子宮內(nèi)膜癌術(shù)前分期的應(yīng)用價值　出處：《廣西醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

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【摘要】：研究目的探討多模態(tài)MRI在子宮內(nèi)膜癌術(shù)前分期的應(yīng)用價值。材料與方法1.研究對象收集于2014年6月至2016年12月在廣西醫(yī)科大學(xué)第一附屬醫(yī)院行盆腔MRI的子宮內(nèi)膜癌患者30例,患者年齡28~63歲,平均(50.2±8.3)歲。30例患者均于1周內(nèi)行全子宮切除術(shù)+雙側(cè)附件切除術(shù)+盆腔淋巴結(jié)清掃術(shù)。術(shù)后病理分型:內(nèi)膜樣腺癌28例,腺鱗癌2例。2.MRI檢查采用Siemens Magnetom Verio 3.0T超導(dǎo)型磁共振掃描儀。掃描序列為盆腔常規(guī)掃描:T1WI、T2WI;子宮高分辨掃描序列:T1WI、T2WI的橫斷位、矢狀位,以及脂肪抑制序列;DWI序列(b=1000s/mm~2)、動態(tài)增強(qiáng)掃描序列。3.研究項目以手術(shù)病理分期診斷為金標(biāo)準(zhǔn),評估多模態(tài)MRI,即MRI常規(guī)掃描、DWI結(jié)合動態(tài)增強(qiáng)掃描對子宮內(nèi)膜癌術(shù)前分期的診斷價值。4.統(tǒng)計學(xué)分析采用SPSS 17.0統(tǒng)計學(xué)軟件,以手術(shù)病理分期診斷為金標(biāo)準(zhǔn),分別計算T1WI+T2WI、T1WI+T2WI+DWI、T1WI+T2WI+DWI+DCE-MRI對子宮內(nèi)膜癌各期的敏感度、特異度、陽性預(yù)測值、陰性預(yù)測值和準(zhǔn)確率。T1WI+T2WI和T1WI+T2WI+DWI、T1WI+T2WI+DWI和T1WI+T2WI+DWI+DCE-MRI對子宮內(nèi)膜癌分期準(zhǔn)確率的比較用配對卡方檢驗。結(jié)果30例子宮內(nèi)膜癌中,病理分期(2009年FIGO分期):Ⅰa期18例,Ⅰb期8例,Ⅱ期1例,Ⅲ期3例。子宮內(nèi)膜癌腫瘤在Tl WI上呈等信號,T2WI及T2WI壓脂上呈稍高或高信號,在b值為1000s/mm2的DWI圖上表現(xiàn)為低信號背景中的高信號腫塊,ADC圖表現(xiàn)為低信號。增強(qiáng)掃描病灶強(qiáng)化程度低于正常子宮肌層,以延遲期較明顯。T1WI+T2WI正確判斷16例,高估8例,低估6例;T1WI+T2WI+DWI正確判斷19例,高估6例,低估5例;T1WI+T2WI+DWI+DCE-MRI正確判斷25例,高估2例,低估3例。T1WI+T2WI評估子宮內(nèi)膜癌術(shù)前分期準(zhǔn)確率為53.3%,T1WI+T2WI+DWI為63.3%,T1WI+T2WI+DWI+DCE-MRI為83.3%。應(yīng)用配對卡方檢驗,T1WI+T2WI與T1WI+T2WI+DWI評估子宮內(nèi)膜癌分期的準(zhǔn)確性不具有統(tǒng)計學(xué)差異(P=0.250.05),而T1WI+T2WI+DWI與T1WI+T2WI+DWI+DCE-MRI具有統(tǒng)計學(xué)差異(P=0.0310.05)。結(jié)論多模態(tài)MRI,即聯(lián)合應(yīng)用MRI常規(guī)掃描、DWI結(jié)合動態(tài)增強(qiáng)掃描能提高子宮內(nèi)膜癌術(shù)前分期的準(zhǔn)確率,有助于子宮內(nèi)膜癌的治療及預(yù)后的評估。
[Abstract]:Objective to investigate the application value of multi modality MRI staging in endometrial carcinoma before operation. Materials and methods 1. subjects collected from June 2014 to December 2016 in the First Affiliated Hospital of Guangxi Medical University underwent pelvic MRI in patients with endometrial carcinoma in 30 cases, age 28~63 years old, the average age of.30 (50.2 + 8.3) in all cases within 1 week hysterectomy + bilateral oophorectomy and pelvic lymphadenectomy. Postoperative pathological type: 28 cases of endometrial adenocarcinoma, 2 cases of adenosquamous carcinoma were examined by.2.MRI Siemens Magnetom Verio 3.0T superconducting magnetic resonance scanner. The scanning sequence is: T1WI, T2WI scanning routine pelvic uterus; high resolution scanning sequence: T1WI T2WI, transverse, sagittal, and fat suppression sequence; DWI sequence (b=1000s/mm~2), dynamic enhanced scanning sequence of.3. projects to study the surgical pathological diagnosis as the gold standard, evaluation of multimode state MRI, MRI routine scan Description DWI combined with dynamic enhanced scan of the endometrial cancer preoperative staging and diagnosis value of.4. was analyzed by SPSS 17 statistical software, with surgical pathological diagnosis as the gold standard, T1WI+T2WI T1WI+T2WI+DWI, T1WI+T2WI+DWI+DCE-MRI were calculated, the specific sensitivity of endometrial cancer stages, positive predictive value, negative predictive value and accuracy the rate of.T1WI+T2WI and T1WI+T2WI+DWI, compared with T1WI+T2WI+DWI and T1WI+T2WI+DWI+DCE-MRI in endometrial carcinoma staging accuracy of paired chi square test. Results in 30 cases of endometrial carcinoma, pathological stage (2009 FIGO staging): 1 a 18 cases, type B 8 cases, 1 cases of stage II, 3 cases of stage III endometrial carcinoma tumor. The uterus was isointense on Tl WI, T2WI and T2WI FATSAT showed slightly higher or high signal in the b value of 1000s/mm2 DWI on the map showed high signal and low signal mass in the background, the ADC chart is low signal enhancement scan. Description of lesion degree of enhancement was lower than normal myometrium, with obvious delay of.T1WI+T2WI correctly in 16 cases, 8 cases of 6 cases of overvalued, undervalued; T1WI+T2WI+DWI correctly in 19 cases, 6 cases of 5 cases of overvalued, undervalued; T1WI+T2WI+DWI+DCE-MRI correctly in 25 cases, 2 cases of 3 cases of overvalued, undervalued.T1WI+ T2WI assessment of preoperative endometrial carcinoma staging accuracy rate is 53.3%, T1WI+T2WI+DWI is 63.3%, T1WI+T2WI+DWI+DCE-MRI chi square test for the application of 83.3%., T1WI+T2WI and T1WI+T2WI+DWI staging accuracy assessment of endometrial cancer has no statistical difference (P=0.250.05), T1WI+ T2WI+DWI and T1WI+T2WI+DWI+DCE-MRI have significant difference (P=0.0310.05). Conclusion: Combined Application of multi mode MRI, conventional MRI scanning, combined with dynamic DWI the enhanced scan can improve the accuracy of staging of endometrial carcinoma preoperative assessment, treatment and prognosis in endometrial carcinoma.

【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R737.33;R445.2

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