本文選題：甲狀腺結(jié)節(jié) + 良惡性��； 參考：《江蘇大學(xué)》2017年碩士論文

【摘要】：目的:探討應(yīng)用多參數(shù)MRI平掃、動態(tài)增強及常規(guī)增強的單一參數(shù)及聯(lián)合應(yīng)用多參數(shù)MRI成像各參數(shù)在鑒別甲狀腺結(jié)節(jié)良惡性中的價值。材料與方法:共計85例甲狀腺結(jié)節(jié)患者被納入本研究,這些患者被檢測出一個或多個甲狀腺結(jié)節(jié)。對患者進行甲狀腺區(qū)的常規(guī)MRI平掃、MRI彌散加權(quán)成像(Diffusion weighted imaging,DWI)及MRI增強(包括MRI動態(tài)增強)掃描。在T2WI、DCE-MRI及常規(guī)MRI(Contrast-Enhanced MRI,CE-MRI)增強圖像中,觀察結(jié)節(jié)邊界(分別標(biāo)為MT2、MDCE及MCE)是否清楚,并將其分為邊界清楚和邊界不清兩組。對每個結(jié)節(jié)表觀彌散系數(shù)(Appearent Diffusion Coeficient,ADC)值、動態(tài)增強MRI(Dynamic Contrast-Enhanced MRI,DCE-MRI)的時間信號強化曲線(Time Signal-intensity Curve,TIC)等各主要參數(shù)等定量分析資料進行了測量、記錄和分析。本研究中所有患者均于檢查后72小時內(nèi)行甲狀腺一側(cè)葉切除或甲狀腺全切手術(shù)。最后將MR檢查結(jié)果與手術(shù)病理結(jié)果進行對比分析。結(jié)果:本組病例共檢出144個甲狀腺結(jié)節(jié),病理及免疫組化結(jié)果顯示其中的83個為惡性結(jié)節(jié),61個為良性結(jié)節(jié)。以單個結(jié)節(jié)為觀察單位,惡性結(jié)節(jié)組患者的年齡較良性結(jié)節(jié)組小。多參數(shù)MRI成像顯示的單個變量(MT2、MDCE、MCE、ADC及IR)對甲狀腺結(jié)節(jié)的良惡性的鑒別診斷存在顯著的統(tǒng)計學(xué)差異,P0.01。惡性結(jié)節(jié)傾向于邊界不清,但是MT2、MDCE及MCE顯示良惡性甲狀腺結(jié)節(jié)邊界是否清楚的特異性較低,不足以滿足臨床診斷的需求。惡性甲狀腺結(jié)節(jié)的最大徑較良性結(jié)節(jié)小;惡性結(jié)節(jié)在不同b值(b-300s/mm2,b-500s/mm2和800s/mm2)時的ADC值、DCE-MRI增強前的病灶信號值(Signal-intensity of precontrast,Ipre)較良性結(jié)節(jié)小;而惡性結(jié)節(jié)的流入增強比(Increment Ratio,IR)明顯高于良性結(jié)節(jié)。運用Logistic回歸分析中的Forward/Wald方法對所有的多參數(shù)數(shù)據(jù)進行篩選、分析時,我們發(fā)現(xiàn)聯(lián)合應(yīng)用b-500 ADC、MDCE和IR(%)時,可以得到最佳的鑒別診斷效果(P0.0001)。最終聯(lián)合應(yīng)用多參數(shù)進行的統(tǒng)計學(xué)分析,其AUC為0.853,敏感性為81.25%,特異性為76.67%,PPV為82.3%、NPV為75.4%。在聯(lián)合應(yīng)用的分析方法中,b值取500 s/mm2時的ADC值,MDCE和IR(%)的P值分別為0.026,0.002和0.009。結(jié)論:本研究中,聯(lián)合運用多參數(shù)MRI掃描可以提高MR鑒別診斷甲狀腺結(jié)節(jié)良惡性的能力,最佳的解決方案是聯(lián)合應(yīng)用b-500時的ADC值,MDCE和IR(%)對甲狀腺結(jié)節(jié)的良惡性進行鑒別診斷。
[Abstract]:Objective: To investigate the value of multi parameter MRI scan, dynamic enhanced and conventional enhanced single parameters and the combination of multi parameter MRI imaging parameters in the differential diagnosis of benign and malignant thyroid nodules. Materials and methods: a total of 85 patients with thyroid nodules were included in this study, and these patients were detected one or more thyroid nodules. Routine MRI scan, MRI diffusion weighted imaging (Diffusion weighted imaging, DWI) and MRI enhancement (including MRI dynamic enhancement) scan were performed in the thyroid region. In the enhanced images of T2WI, DCE-MRI, and conventional MRI (Contrast-Enhanced), it was observed whether the boundary of nodules was clear and divided into clear boundaries and edges. Two groups were not clearly defined. Quantitative analysis data, such as the apparent dispersion coefficient (Appearent Diffusion Coeficient, ADC) of each nodule, the dynamic enhanced MRI (Dynamic Contrast-Enhanced MRI, DCE-MRI) time signal enhancement curve (Time Signal-intensity Curve,) were measured, recorded and analyzed. All the patients in this study were recorded and analyzed. 72 hours after examination, the thyroidectomy or total thyroidectomy was performed within 72 hours. Finally, the results of the examination were compared with the results of the operation and pathology. Results: 144 thyroid nodules were detected in this group. Pathological and immunohistochemical results showed that 83 of them were malignant nodules and 61 were benign nodules. Single nodules were observed. The age of the patients with malignant nodules was smaller than that in the benign nodule group. The single variable (MT2, MDCE, MCE, ADC, and IR) of multiple parameter MRI imaging showed significant differences in the differential diagnosis of benign and malignant thyroid nodules. The P0.01. malignant nodules tended to be indistinct, but MT2, MDCE, and MCE showed whether the border of benign and malignant thyroid nodules was on the border. The clear specificity is low enough to meet the needs of the clinical diagnosis. The maximum diameter of the malignant thyroid nodule is smaller than the benign nodule; the ADC value of the malignant nodules at different b values (b-300s/mm2, b-500s/mm2 and 800s/mm2), the signal value of the lesion before DCE-MRI enhancement (Signal-intensity of precontrast, Ipre) is smaller than the benign nodule; and the flow of the malignant nodules. The Increment Ratio (IR) was significantly higher than the benign nodule. Using the Forward/Wald method in the Logistic regression analysis, all the multiparameter data were screened. When we found the combined application of b-500 ADC, MDCE and IR (%), we found the best diagnostic diagnostic effect (P0.0001). Finally, the combined application of multi parameter statistics was found. The AUC was 0.853, the sensitivity was 81.25%, the specificity was 76.67%, the PPV was 82.3%, and the NPV was 75.4%. in the combined application. The b value was 500 s/mm2 ADC, MDCE and IR (%) P values were 0.026,0.002 and 0.009. conclusions: in this study, the combined use of multi parameter scanning can improve the differential diagnosis of thyroid nodules. The best solution is the ADC value when combined with b-500, and MDCE and IR (%) are used for differential diagnosis of benign and malignant thyroid nodules.

【學(xué)位授予單位】：江蘇大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R581;R445.2

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