本文關(guān)鍵詞：胰腺癌磁共振波譜分析和胰周淋巴結(jié)轉(zhuǎn)移的診斷研究　出處：《第二軍醫(yī)大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 胰腺 胰腺癌 磁共振成像 波譜 胰腺癌 淋巴結(jié) 轉(zhuǎn)移 體層攝影術(shù) X線計算機(jī) 胰腺癌 淋巴結(jié) 轉(zhuǎn)移 磁共振成像

【摘要】：第一部分氫質(zhì)子磁共振波譜對胰腺癌分析及其分化程度相關(guān)性研究研究目的:探討氫質(zhì)子磁共振波譜(~1H MRS)分析胰腺癌瘤體與瘤旁導(dǎo)管上皮內(nèi)瘤變(Pan IN病變)及腫瘤不同分化程度的代謝物差異。研究方法:病理確診為胰腺導(dǎo)管腺癌的患者47例(低分化17例、中分化30例),術(shù)前均行~1H MRS檢查,使用呼吸門控的抑水PRESS序列對腫瘤的瘤體、瘤旁組織進(jìn)行~1H MRS檢測。分析出每個~1H MRS數(shù)據(jù)的膽堿峰(CCM)/脂肪峰(Lip)、膽固醇及不飽和脂肪酸峰(Chol+Unsat)/Lip、Chol+Unsat/CCM的峰下面積比,采用配對樣本t檢驗比較瘤體和瘤旁組織的代謝物差異,用獨立樣本t檢驗比較胰腺導(dǎo)管腺癌低分化組和中分化組的代謝物差異。結(jié)果:同時獲得瘤體和瘤旁數(shù)據(jù)共24例,瘤體組織的CCM/Lip(2.66±0.84)×10-1高于瘤旁組織(2.00±0.81)×10-1,瘤體組織的Chol+Unsat/Lip(3.24±1.09)×10-1高于瘤旁組織(2.58±0.92)×10-1,差異均有統(tǒng)計學(xué)意義(P0.05),瘤體和瘤旁組織的Chol+Unsat/CCM無統(tǒng)計學(xué)差異;胰腺低分化和中分化導(dǎo)管腺癌的CCM/Lip、Chol+Unsat/Lip、Chol+Unsat/CCM無統(tǒng)計學(xué)差異。結(jié)論:~1H MRS對鑒別胰腺癌與瘤旁Pan IN病變具有一定意義,但不可預(yù)測其腫瘤分化程度。第二部分胰腺癌淋巴結(jié)轉(zhuǎn)移MSCT影像特征與病理對照研究研究目的:探討胰腺癌淋巴結(jié)轉(zhuǎn)移的MSCT影像學(xué)特征。研究方法:選取經(jīng)病理確診為胰腺癌且有淋巴結(jié)轉(zhuǎn)移的患者30例,術(shù)前均進(jìn)行多層螺旋CT(MSCT)胰腺增強(qiáng)掃描,分析轉(zhuǎn)移淋巴結(jié)的部位、最大短軸徑(MSAD)、淋巴結(jié)密度、強(qiáng)化、內(nèi)部壞死及融合情況。結(jié)果:病理診斷轉(zhuǎn)移淋巴結(jié)63枚,影像診斷轉(zhuǎn)移淋巴結(jié)53枚。胰頭癌以第13組、第17組轉(zhuǎn)移率較高,胰體尾癌以第18組轉(zhuǎn)移率較高。轉(zhuǎn)移淋巴結(jié)MSAD為2~17mm,平均(7.23±4.03)mm。按淋巴結(jié)大小分為MSAD5mm組、5mm~10mm組和≥10mm組,每組轉(zhuǎn)移淋巴結(jié)分別為10枚、18枚和25枚。3組轉(zhuǎn)移淋巴結(jié)的強(qiáng)化枚數(shù)隨淋巴結(jié)的增大而減少,而內(nèi)部壞死、融合枚數(shù)隨淋巴結(jié)的增大而增加,差異均有統(tǒng)計學(xué)意義(P0.05)。兩兩組間比較,MSAD5mm組(7/10)和5mm~10mm組(11/18)強(qiáng)化淋巴結(jié)枚數(shù)顯著多于≥10mm組(2/25);MSAD5mm組(6/10)邊緣清楚淋巴結(jié)顯著多于≥10mm組(5/25);MSAD5mm組(2/10)內(nèi)部壞死枚數(shù)顯著少于≥10mm組(18/25);MSAD5mm組(0/10)和5mm~10mm組(2/18)融合淋巴結(jié)枚數(shù)顯著少于≥10mm組(22/25),差異均有統(tǒng)計學(xué)意義(P0.05),其余指標(biāo)差異均無統(tǒng)計學(xué)意義。結(jié)論:淋巴結(jié)不明顯強(qiáng)化、內(nèi)部壞死及融合為轉(zhuǎn)移淋巴結(jié)主要影像學(xué)特征,結(jié)合淋巴結(jié)密度不均勻、邊緣模糊的特征更有助于診斷轉(zhuǎn)移淋巴結(jié)。第三部分胰腺癌淋巴結(jié)轉(zhuǎn)移3.0T磁共振彌散加權(quán)成像的診斷研究研究目的:探討術(shù)前3.0T磁共振彌散加權(quán)成像(DWI)對胰腺癌淋巴結(jié)轉(zhuǎn)移的診斷價值。研究方法:選取經(jīng)病理確診為胰腺癌且有淋巴結(jié)轉(zhuǎn)移的患者30例,術(shù)前均進(jìn)行磁共振DWI檢查,對應(yīng)病理證實的轉(zhuǎn)移和非轉(zhuǎn)移淋巴結(jié),分析淋巴結(jié)轉(zhuǎn)移部位、測量淋巴結(jié)表觀擴(kuò)散系數(shù)(ADC)值和最大短軸直徑(MSAD),采用受試者工作特征(ROC)曲線評估ADC值和MSAD對胰腺癌淋巴結(jié)轉(zhuǎn)移的診斷價值。結(jié)果:DWI檢查共明確淋巴結(jié)108枚,其中轉(zhuǎn)移淋巴結(jié)54枚,非轉(zhuǎn)移淋巴結(jié)54枚。胰頭癌轉(zhuǎn)移淋巴結(jié)的位置以第13組、16組、17組多見,胰體尾癌以第16組多見。轉(zhuǎn)移淋巴結(jié)ADC值(1.51±0.28)×10-3 mm2/s明顯低于非轉(zhuǎn)移淋巴結(jié)ADC值(2.08±0.35)×10-3 mm2/s,轉(zhuǎn)移淋巴結(jié)MSAD(7.03±2.49)mm長于非轉(zhuǎn)移淋巴結(jié)MSAD(4.40±0.97)mm,差異均有統(tǒng)計學(xué)意義(P0.05)。ADC值診斷轉(zhuǎn)移淋巴結(jié)的ROC曲線下面積為0.894,最佳閾值為1.78×10-3mm2/s,敏感度和特異度分別為85.2%、85.2%;MSAD診斷轉(zhuǎn)移淋巴結(jié)的ROC曲線下面積為0.876,最佳閾值為5.65mm,敏感度和特異度分別為68.5%、90.7%。結(jié)論:3.0T磁共振DWI對胰腺癌淋巴結(jié)轉(zhuǎn)移有較高的診斷價值。
[Abstract]:The first part of proton magnetic resonance spectroscopy of pancreatic cancer and its correlation analysis of differentiation research: Study of proton magnetic resonance spectroscopy (~1H MRS) of pancreatic carcinoma and peritumoral ductal intraepithelial neoplasia (Pan IN lesions) metabolite differences and tumour differentiation. Methods: 47 patients with pathologically diagnosed pancreatic ductal adenocarcinoma patients (17 cases of low differentiated, moderately differentiated in 30 cases), underwent ~1H MRS examination before operation, PRESS water suppression sequence using respiratory gating on tumor tumor and tumor adjacent tissues were detected. ~1H MRS analysis of each ~1H MRS according to the number of choline (CCM) / fat (peak Lip), cholesterol and unsaturated fatty acids (Chol+Unsat) /Lip, peak area of Chol+Unsat/CCM peak ratio, the difference of metabolite paired samples t test comparison of tumor and tumor adjacent tissues, independent samples t test to compare pancreatic ductal adenocarcinoma and low differentiation group and moderately differentiated group The difference of metabolites. Results: the tumor and its'contiguous also obtained data of a total of 24 cases, the tumor tissue of CCM/Lip (2.66 + 0.84) * 10-1 higher than the tumor adjacent tissues (2 + 0.81) * 10-1, tumor Chol+Unsat/Lip (3.24 + 1.09) * 10-1 higher than the tumor adjacent tissues (2.58 + 0.92) * 10-1, the difference had statistical significance (P0.05), no significant difference between tumor and tumor adjacent tissues Chol+Unsat/CCM; low differentiated pancreatic ductal adenocarcinoma of the CCM/Lip, Chol+Unsat/Lip, Chol+Unsat/CCM no significant difference. Conclusion: ~1H MRS has a certain significance for the differential diagnosis of pancreatic carcinoma and tumor adjacent Pan IN lesions, but can not predict the the degree of tumor differentiation. The second part of lymph node metastasis of pancreatic cancer MSCT image and pathology study objective: To explore the MSCT imaging features of lymph node metastasis in pancreatic cancer. Methods: selected pathologically confirmed pancreatic cancer and lymph node metastasis in 30 cases of patients, surgery All of multi-slice spiral CT (MSCT) pancreatic enhancement scanning, analysis of lymph node metastasis sites, the maximum short axis diameter (MSAD), lymph node density, internal enhancement, necrosis and fusion. Results: the pathological diagnosis of metastatic lymph node 63, imaging diagnosis of lymph node metastasis in 53 cases. Pancreatic cancer in thirteenth groups seventeenth, group transfer rate is high, with eighteenth groups of pancreatic body and tail carcinoma metastasis rate of lymph node metastasis is higher. MSAD is 2~17mm, the average (7.23 + 4.03) mm. according to the size of lymph node were divided into MSAD5mm group, 5mm~10mm group and 10mm group, each group of metastatic lymph nodes were 10, 18 and 25 in group.3 lymph node metastasis were enhanced to reduce the number of lymph nodes increases, and increases the number of internal necrosis, fusion with lymph node increased, the differences were statistically significant (P0.05). The comparison between the 22 groups, MSAD5mm group (7/10) and 5mm~10mm group (11/18) enhanced lymph node number was significantly higher than than in group 10mm (2/25); MSAD5mm group (6 /10) clear edge lymph nodes were significantly more than 10mm group (5/25); MSAD5mm group (2/10) were significantly less than the number of internal necrosis than 10mm group (18/25); MSAD5mm group (0/10) and 5mm~10mm group (2/18) fusion lymph node number was significantly less than 10mm group (22/25), the differences were statistically significant (P0.05), the other indexes showed no significant difference. Conclusion: the lymph node is not obvious enhancement, necrosis and fusion for internal features of metastatic lymph node imaging, combined with lymph node density, blurred edge features more helpful in the diagnosis of lymph node metastasis of pancreatic cancer. The third part to study lymph node diagnosis of 3.0T magnetic resonance diffusion weighted imaging transfer: To investigate the preoperative 3.0T magnetic resonance diffusion-weighted imaging (DWI) node metastases diagnostic value for pancreatic cancer lymph. Methods: selected pathologically confirmed pancreatic cancer and lymph node metastasis in 30 cases of patients, preoperative MRI 鎸疍WI媯，

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