本文選題：GD-EOB-DTPA　切入點(diǎn)：MRI　出處：《廣西醫(yī)科大學(xué)》2017年碩士論文　論文類(lèi)型：學(xué)位論文

【摘要】：目的:探討肝臟磁共振特殊對(duì)比劑GD-EOB-DTPA MRI增強(qiáng)表現(xiàn)在不同分化程度HCC的應(yīng)用價(jià)值。材料與方法:本研究收集2011年11月至2016年2月期間在我院術(shù)前行MRI特異對(duì)比劑增強(qiáng)及DWI檢查并行手術(shù)后有病理診斷的病人56例(男53例,女3例),年齡30-69歲,共61個(gè)病灶。按照病理分別分為高分化HCC10個(gè)病灶、中分化HCC24個(gè)病灶、低分化HCC17個(gè)病灶三組及對(duì)照組DN 10個(gè)病灶。掃描程序?yàn)?先常規(guī)MRI平掃,靜脈注射GD-EOB-DTPA對(duì)比劑,0.12-0.2ml/kg,進(jìn)行三期動(dòng)態(tài)增強(qiáng)掃描,掃描時(shí)間分別為注射對(duì)比劑后25、60及120 S,20min后行特異期掃描,期間行DWI掃描。圖像處理,在3.0TVerio磁共振儀后處理處用toolcircle測(cè)量病灶肝臟特異對(duì)比劑MRI增強(qiáng)圖像各期信號(hào)值及ADC值,并計(jì)算病灶CR、ER、RER值。在肝臟特異對(duì)比劑MRI增強(qiáng)圖像及DWI圖像分析各組病灶數(shù)目、形態(tài)、大小、強(qiáng)化方式、信號(hào)表現(xiàn),并觀察病灶特異期信號(hào)的均勻程度。采用SPSS 1 7.0軟件進(jìn)行統(tǒng)計(jì)學(xué)處理。不同分化程度HCC患者的動(dòng)脈期、門(mén)脈期、平衡期、特異期的CR、ER、RER采用LSD-t檢驗(yàn)多重比較,特異期病灶信號(hào)均勻程度對(duì)比用卡方檢驗(yàn),檢驗(yàn)水準(zhǔn)0.05。結(jié)果:術(shù)后病理確診的肝細(xì)胞癌及穿刺活檢不典型增生結(jié)節(jié)患者56例,共61個(gè)病灶。61例病灶在T1WI圖像均呈稍低-低信號(hào)、T2WI圖像上均呈稍高信號(hào),三期動(dòng)態(tài)增強(qiáng)掃描表現(xiàn)存在差異:39個(gè)病灶(其中DN1例,高分化4個(gè)、中分化19個(gè)、低分化15個(gè))呈典型的"快進(jìn)快出"表現(xiàn),另22個(gè)呈不典型表現(xiàn)。肝膽特異期圖像上除了3個(gè)高分化HCC病灶及2個(gè)DN病灶的信號(hào)呈高信號(hào)外其余均表現(xiàn)為低信號(hào);特異期不同分化程度HCC低信號(hào)均勻程度不一致,但差異無(wú)統(tǒng)計(jì)學(xué)意義(p0.05)。DWI圖像上DN均呈低信號(hào),HCC病例均見(jiàn)明顯彌散受限,呈明顯高信號(hào);不同分化程度HCC的ADC值比較差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。在動(dòng)脈期、門(mén)脈期、平衡期及特異期各組強(qiáng)化率(ER)、相對(duì)強(qiáng)化率(RER)分別兩兩比較,差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。在肝膽特異期圖像上,DN組與高、中、低分化HCC三組的對(duì)比率(CR),高分化HCC與低分化HCC的CR之間比較均存在差異,且具有統(tǒng)計(jì)學(xué)意義(p0.05);但在動(dòng)脈期、門(mén)脈期、平衡期,DN組及高、中、低分化HCC三組之間CR之間比較差異無(wú)統(tǒng)計(jì)學(xué)意義(p0.05)。結(jié)論:大部分中、低分化HCC強(qiáng)化方式典型,少部分中低分化HCC及大部分高分化HCC強(qiáng)化方式不典型;特異期病灶底信號(hào)的均勻程度對(duì)評(píng)估HCC的分化程度意義不大;肝臟特異對(duì)比劑MRI增強(qiáng)檢查肝膽特異期病灶信號(hào)對(duì)比率與病灶良惡性程度相關(guān),特異期病灶信號(hào)對(duì)比率的測(cè)量對(duì)良惡性鑒別及評(píng)估不同分化程度HCC有重要意義。
[Abstract]:Objective: to investigate the value of contrast-enhanced GD-EOB-DTPA MRI in different differentiation degree of HCC. Materials and methods: from November 2011 to February 2016, we performed MRI specific contrast enhancement in our hospital from November 2011 to February 2016. There were 56 patients (53 males, 53 males) with pathological diagnosis after operation by strong and DWI examination. Three female patients, aged 30-69 years, were divided into three groups according to pathology: well-differentiated HCC10, moderately differentiated HCC24, low-differentiated HCC17, and control group. GD-EOB-DTPA contrast agent 0.12-0.2ml / kg was injected intravenously to perform three phase dynamic contrast-enhanced scanning. The scanning time was 2560 min after injection of contrast agent and 120Sh 20min after injection, and then DWI scan was performed. Toolcircle was used to measure the signal value and ADC value of liver specific contrast agent MRI enhancement images at the post-processing point of 3.0T Verio MRI. The number, shape and size of the lesions were analyzed by MRI enhanced images and DWI images. Enhancement mode, signal manifestation, and the homogeneity of the signal in the specific phase of the lesion were observed. Statistical analysis was carried out with the software of SPSS 17.0.The arterial phase, portal phase, equilibrium phase of HCC patients with different differentiation degrees were analyzed. The LSD-t test was used to compare the signal uniformity of specific stage lesions with chi-square test. Results: 56 patients with hepatocellular carcinoma and atypical hyperplastic nodules were diagnosed by pathological examination after operation. A total of 61 lesions were slightly hypointensity on T _ 1WI and slightly hyperintense on T _ 2WI images. There were significant differences in dynamic contrast-enhanced imaging findings in three phases: 39 lesions (including DN1, 4 well differentiated, 19 moderately differentiated). Low differentiation (15) showed typical fast in and out (22 cases). In hepatobiliary phase images, the signal intensity of 3 well-differentiated HCC lesions and 2 DN lesions showed hypointensity, except for 3 well-differentiated HCC lesions and 2 DN lesions. There was no significant difference in the homogeneity of low signal intensity in different differentiation degree of HCC, but the difference was not statistically significant. All the cases with low signal intensity on HCC images were obviously diffusion-limited and showed obvious high signal intensity. There was no significant difference in the ADC value of HCC with different differentiation degrees (P 0.05). The enhancement rate and relative enhancement rate were compared in arterial phase, portal phase, equilibrium stage and specific stage, respectively. There was no significant difference in contrast ratio between DN group and high, middle and low differentiated HCC groups, and there was significant difference in CR between well-differentiated HCC and poorly differentiated HCC, but in arterial phase, portal phase, there was no significant difference between the three groups in the specific phase of hepatobiliary tract (P 0.05), but in arterial phase, portal phase, there was no significant difference in the contrast ratio between the three groups (P 0.05), but in arterial phase, portal phase, there were significant differences in the contrast ratio between the three groups. There was no significant difference in CR between the three groups (P 0.05). Conclusion: in most cases, the enhancement mode of low-differentiated HCC is typical, and a few of middle-low-differentiated HCC and most of well-differentiated HCC are not typical. The homogeneity of the signal at the bottom of the lesion in the specific phase is of little significance in evaluating the differentiation of HCC, and the ratio of the signal to the signal in the liver and bile specific phase is correlated with the degree of benign and malignant lesions. The measurement of signal pair ratio is of great significance in differentiating benign and malignant lesions and evaluating HCC with different degrees of differentiation.
【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R445.2;R575;R735.7

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