本文選題：肺癌 + 肺結(jié)節(jié)��； 參考：《河北醫(yī)科大學(xué)》2017年碩士論文

【摘要】：第一部分磁共振檢出小肺結(jié)節(jié)的序列優(yōu)化目的:探討磁共振掃描肺小結(jié)節(jié)的序列選擇及其優(yōu)化。方法:前瞻性收集肺部單發(fā)或多發(fā)≥6mm,≤20mm肺結(jié)節(jié)病人,于CT掃描完成24小時(shí)內(nèi)行3-T磁共振掃描。掃描序列為T1-VIBE,T1-Star-VIBE,T2-TSE,HASTE序列,HASTE及T2-TSE序列分別各自增加240ms的反轉(zhuǎn)恢復(fù)時(shí)間重新掃描。由兩位放射學(xué)專家獨(dú)立讀片。計(jì)算或測量每個(gè)序列肺結(jié)節(jié)總檢出率,實(shí)性結(jié)節(jié)檢出率、磨玻璃結(jié)節(jié)檢出率、CNR(對比噪聲比)值及結(jié)節(jié)最大徑。以CT的圖像表現(xiàn)作為金標(biāo)準(zhǔn),比較各序列結(jié)節(jié)總檢出率、實(shí)性結(jié)節(jié)檢出率、磨玻璃結(jié)節(jié)檢出率、CNR及最大徑是否有差異。采用SPSS21.0軟件進(jìn)行統(tǒng)計(jì)分析。計(jì)量資料的比較采用秩和檢驗(yàn),計(jì)數(shù)資料的比較采用χ2檢驗(yàn)。P0.05認(rèn)為差異有統(tǒng)計(jì)學(xué)意義。計(jì)算兩位磁共振圖像閱片者的一致性,統(tǒng)計(jì)學(xué)方法為Kappa檢驗(yàn)。結(jié)果:2014年12月-2016年12月,共納入肺結(jié)節(jié)病人136名(58.3±12.2歲),男性74名(59.8±10.1歲),女性62名(56.7±14.3歲)。共有結(jié)節(jié)145個(gè)。最大徑為15.2±6.1mm。其中實(shí)性結(jié)節(jié)85例,最大徑為14.7±6.3mm。磨玻璃密度結(jié)節(jié)(包括純磨玻璃密度結(jié)節(jié)及混合密度結(jié)節(jié))結(jié)節(jié)60例,最大徑為14.2±5.2mm。結(jié)節(jié)總檢出率為84.1%。其中實(shí)性結(jié)節(jié)共檢出73例,總檢出率為85.9%,實(shí)性結(jié)節(jié)在各序列的檢出率分別為T1-VIBE(60.0%),STAR-VIBE(72.9%),HASTE(81.1%),HASTE-IR(82.4%),T2-TSE(76.5%),T2-TSE-IR(83.5%)。磨玻璃結(jié)節(jié)共檢出49例,檢出率為81.6%,磨玻璃結(jié)節(jié)在各序列的檢出率分別為T1-VIBE(11.7%),STAR-VIBE(15.0%),HASTE(75.0%),HASTE-IR(78.3%),T2-TSE(66.7%),T2-TSE-IR(81.7%)。實(shí)性結(jié)節(jié)及磨玻璃結(jié)節(jié)的總檢出率無統(tǒng)計(jì)學(xué)差異。各序列的CNR值分別為T1-VIBE(33.7±12.1),STAR-VIBE(95.1±33.2),HASTE(61.0±15.5),HASTE-IR(70.6±21.1),T2-TSE(47.3±12.2),T2-TSE-IR(71.9±22.1),有統(tǒng)計(jì)學(xué)差異。磁共振各序列顯示結(jié)節(jié)的最大徑相較于CT圖像均偏小,且有統(tǒng)計(jì)學(xué)差異。兩位閱片者一致性檢驗(yàn)Kappa值為0.782(P0.001)。結(jié)論:3-T磁共振成像在肺結(jié)節(jié)檢出的應(yīng)用中有著巨大的潛力。HASTE-IR序列及T2-TSE-IR序列可用于≥6mm肺結(jié)節(jié)的檢出。而且磁共振成像可用于磨玻璃結(jié)節(jié)的檢出。第二部分磁共振浸潤性肺腺癌的診斷目的:探討磁共振在鑒別診斷以磨玻璃結(jié)節(jié)為表現(xiàn)的浸潤性肺腺癌中的使用價(jià)值。方法:回顧性分析2014年12月-2016年12月在河北醫(yī)科大學(xué)第四醫(yī)院CT磁共振科行肺部CT及磁共振檢查發(fā)現(xiàn)肺部磨玻璃結(jié)節(jié)患者。所有病人經(jīng)外科手術(shù)切除且病理證實(shí)為癌前病變或臨床分期為Ⅰ期早期肺腺癌。磁共振掃描序列為DWI,T1-Star-VIBE,T2-TSE,HASTE序列,HASTE及T2-TSE序列分別各自增加240ms的反轉(zhuǎn)恢復(fù)時(shí)間重新掃描。由兩位閱片者(閱片者1工作經(jīng)驗(yàn)大于10年,閱片者2工作經(jīng)驗(yàn)小于5年)在不知道病理結(jié)果的情況下分析病變的影像特征,有分歧者經(jīng)兩人商討后達(dá)成一致。測量磁共振圖像以下指標(biāo):(1)病變大小;(2)T2信號(hào)強(qiáng)度;(3)結(jié)節(jié)ADC值。依據(jù)病理結(jié)果進(jìn)行分組,將浸潤前病變(包括AAH、AIS)與微浸潤性病變歸為一組,即組A;浸潤性病變?yōu)橐唤M,即組B。比較兩組病人的3種指標(biāo)是否有差異。采用SPSS21.0軟件進(jìn)行統(tǒng)計(jì)分析。計(jì)量資料如滿足正態(tài)分布采用兩個(gè)獨(dú)立樣本t檢驗(yàn),若不滿足正態(tài)分布采用Mann-Whitney U檢驗(yàn)計(jì)。計(jì)數(shù)資料使用卡方檢驗(yàn)。使用ROC曲線進(jìn)行診斷實(shí)驗(yàn)評(píng)價(jià)。P0.05認(rèn)為差異有統(tǒng)計(jì)學(xué)意義。結(jié)果:最后納入人群共共34人,年齡55.8±12.0歲。其中男性14人,年齡57.1±14.7歲;女性20人,年齡54.9±10.1歲。共納入結(jié)節(jié)34例。組A 15例,包括AAH4例,AIS2例,MIA9個(gè),組B 19例。組B中女性比例高于組A中女性患者的比例(69.4%vs 46.7%),但無統(tǒng)計(jì)學(xué)差異(χ2=0.1.638,P=0.201)。組B中患者發(fā)病年齡小于組A中患者發(fā)病年齡(54.3±13.1歲vs 57.6±10.8歲),但無統(tǒng)計(jì)學(xué)差異(t=0.786,P=0.438)。組A中病變直徑小于組B中病變直徑(9.9±2.6mm vs 13.1±2.7mm),且有統(tǒng)計(jì)學(xué)差異(t=-3.405,P=0.002)。組A中病變的T2信號(hào)強(qiáng)度低于組B中的病變直徑(93.0±8.3 vs 113.6±22.9),且統(tǒng)計(jì)學(xué)差異(t=-3.6,P=0.001)。組A中病變ADC值要低于組B(1.0±0.2*10-3 mm2/s vs 1.3±0.3*10-3 mm2/s),且有統(tǒng)計(jì)學(xué)差異(t=-2.697,P=0.011)。ROC曲線分析,區(qū)分組A病變與組B病變的最佳指標(biāo)是病變大小,界值為11.5mm,敏感度為73.7%,特異度為73.3%。AUC值為0.791(95%可信區(qū)間:0.640,0.942)。結(jié)論:3-T磁共振,使用結(jié)節(jié)大小、T2信號(hào)強(qiáng)度、ADC值,對于鑒別診斷浸潤性肺腺癌是有幫助的。磁共振鑒別浸潤性肺腺癌與浸潤前病變(包括MIA)的最佳指標(biāo)是結(jié)節(jié)大小。
[Abstract]:Partial optimization of the sequence of small pulmonary nodules detected by magnetic resonance: To explore the sequence selection and optimization of magnetic resonance scanning pulmonary nodules. Methods: a prospective collection of pulmonary nodules with single or more 6mm or less 20mm pulmonary nodules was prospectively collected for 24 hours by CT scan. The sequence was T1-VIBE, T1-Star-VIBE, T2-TSE, HASTE sequence. The HASTE and T2-TSE sequences respectively increased the reversal time of 240ms, respectively. The total detection rate of pulmonary nodules, the detection rate of solid nodules, the detection rate of ground glass nodules, the value of CNR (contrast noise ratio) and the maximum diameter of nodules were calculated or measured by two radiologists. The image performance of CT as the gold standard was compared with each other. The total detection rate of serial nodules, the detection rate of solid nodules, the detection rate of glass nodules, CNR and the maximum diameter were different. The statistical analysis was carried out by SPSS21.0 software. The comparison of the data was compared with the rank sum test, and the comparison of the counting data using the x 2 test.P0.05 thought the difference was statistically significant. Results: Kappa test. Results: in December December 2014 -2016, 136 patients with pulmonary nodules (58.3 + 12.2 years old) were included, male 74 (59.8 + 10.1 years), female 62 (56.7 + 14.3 years), 145 nodules with a maximum diameter of 15.2 + 6.1mm., 85 cases of solid nodules, and maximum diameter of 14.7 + 6.3mm. mill glass density nodules (including pure grinding glass). 60 cases of nodules and mixed density nodules were found in 60 cases. The total detection rate of the maximum diameter of 14.2 + 5.2mm. nodules was 84.1%. and the total detection rate was 85.9%. The detection rates of solid nodules were T1-VIBE (60%), STAR-VIBE (72.9%), HASTE (81.1%), HASTE-IR (82.4%), T2-TSE (76.5%), T2-TSE-IR (83.5%), and T2-TSE-IR (83.5%). 49 cases of glass nodules were detected, the detection rate was 81.6%, the detection rates of the glass nodules were T1-VIBE (11.7%), STAR-VIBE (15%), HASTE (75%), HASTE-IR (78.3%), T2-TSE (66.7%), T2-TSE-IR (81.7%). The total detection rates of solid nodules and grinding glass nodules were not statistically different. The CNR values of each sequence were T1-VIBE (33.7 + 12.1), STAR-V, respectively. IBE (95.1 + 33.2), HASTE (61 + 15.5), HASTE-IR (70.6 + 21.1), T2-TSE (47.3 + 12.2), T2-TSE-IR (71.9 + 22.1), there were statistically significant differences. The maximum diameter of the nodules was smaller than that of CT images, and there were statistical differences. The Kappa value of the two film conformance test was 0.782 (P0.001). Conclusion: 3-T magnetic resonance imaging is in the pulmonary nodule. There are huge potential.HASTE-IR sequences and T2-TSE-IR sequences in the detection of pulmonary nodules over 6mm. And magnetic resonance imaging can be used for the detection of glass nodules. The second part of the MRI diagnosis of invasive lung adenocarcinoma: the study of magnetic resonance in the differential diagnosis of invasive lung adenocarcinoma with glass nodule as the manifestation Methods: a retrospective analysis was made to a retrospective analysis of pulmonary CT and magnetic resonance imaging in the CT MRI Department of the fourth hospital of Hebei Medical University, December 2014, in December -2016. All patients were excised by surgical excision and were confirmed by pathology as precancerous lesions or clinical stages as early stage of lung adenocarcinoma. Magnetic resonance scanning sequence. DWI, T1-Star-VIBE, T2-TSE, HASTE sequences, HASTE and T2-TSE sequences respectively increased the reversal time of 240ms, respectively. The image features of the lesions were analyzed under the condition of not knowing the pathological results without the pathological results, and the disagreement was discussed by two people. The following indexes of MRI images were measured: (1) lesion size; (2) T2 signal intensity; (3) ADC value of nodules. According to the pathological results, the preinvasive lesions (including AAH, AIS) and microinvasive lesions were classified as a group, namely, group A; the group of invasive lesions was a group, that is, the 3 indexes of group B. compared to the two groups were different. SPSS21.0 soft. Two independent sample t tests were used to satisfy normal distribution. If the normal distribution was not satisfied with the normal distribution, the Mann-Whitney U test was used. The counting data was checked by chi square test. The diagnostic test of the ROC curve was used to evaluate.P0.05. The difference was statistically significant. Finally, 34 people were included in the population, and the age was 55.8 + 12. .0 years old, of which 14 men, age 57.1 + 14.7 years, women 20, age 54.9 + 10.1 years old, were included in 34 cases. Group A 15 cases, including AAH4, AIS2, MIA9, and B 19. The proportion of women in group B was higher than that of women in A (69.4%vs 46.7%), but there was no statistical difference (chi 2=0.1.638, P=0.201). The onset age of the patients (54.3 + 13.1 years vs 57.6 + 10.8 years old), but there was no statistical difference (t=0.786, P=0.438). The diameter of the lesion in group A was less than that in group B (9.9 + 2.6mm vs 13.1 + 2.7mm), and there were statistical differences (t=-3.405, P=0.002). The intensity of the T2 signal in group A was lower than that in the group (93 + 8.3 113.6 + 22.9), and statistics The difference (t=-3.6, P=0.001). The ADC value in group A was lower than that of group B (1 + 0.2*10-3 mm2/s vs 1.3 + 0.3*10-3 mm2/s), and there was a statistical difference (t=-2.697, P=0.011) curve analysis. The best index to distinguish between group and group was the size of lesion, the boundary value was 73.7%, and the specificity was 0.791 (95% confidence interval: 0.640,0.942) conclusion: 3-T magnetic resonance, using nodule size, T2 signal intensity, and ADC value, is helpful in the differential diagnosis of invasive lung adenocarcinoma. The best indicator of the differential diagnosis of invasive lung adenocarcinoma and preinvasive lesions (including MIA) is the size of the nodules.

【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R445.2;R734.2

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