本文選題：磁共振 + 磁共振波譜成像�。� 參考：《青海大學(xué)》2017年碩士論文

【摘要】：實(shí)驗(yàn)?zāi)康?通過(guò)分析1H-MRS肝臟囊型包蟲(chóng)病藥物治療前后的代謝產(chǎn)物的波峰形態(tài)特征及代謝差異性,為臨床早期判定囊型包蟲(chóng)病藥物治療效果提供一種新的影像學(xué)途徑。對(duì)象和方法:收集2015年4月至2016年12月在青海大學(xué)附屬醫(yī)院通過(guò)實(shí)驗(yàn)室檢查、影像學(xué)檢查與臨床方法確診為肝臟囊型包蟲(chóng)病患者23例,分別于藥物治療前及藥物治療半年后行3.0T MRI腹部常規(guī)序列及磁共振波譜序列掃描,每個(gè)病人選一個(gè)病灶,每個(gè)病灶測(cè)一個(gè)體素,其中多發(fā)病灶選取最大病灶,觀察并對(duì)比分析其譜線特點(diǎn)及差別,并分別測(cè)量出組織內(nèi)水(H2O)、脂肪亞甲基(Lip2)峰高及峰下面積、膽堿復(fù)合物(Cho)峰高及峰下面積、Cho/Lip2峰高的比值,并對(duì)其結(jié)果進(jìn)行對(duì)比和分析。結(jié)果:23個(gè)肝臟囊型包蟲(chóng)病灶中,藥物治療前MRS顯示18個(gè)病灶內(nèi)檢測(cè)出輕度升高的Cho峰,檢出率達(dá)到78.3%(18/23),其中3個(gè)病灶檢測(cè)到倒置的Cho峰,所有病灶內(nèi)均檢測(cè)到H2O峰及Lip2峰,檢出率100%(23/23);藥物治療后MRS顯示20個(gè)病灶內(nèi)檢測(cè)出略高的Cho峰,檢出率達(dá)到86.9%(20/23),其中有1個(gè)病灶內(nèi)檢測(cè)到倒置的Cho峰,所有病灶內(nèi)均檢測(cè)到H2O峰及Lip2峰,檢出率100%(23/23);23個(gè)肝臟囊型包蟲(chóng)病病灶中藥物治療前的Cho峰有19個(gè)低于藥物治療后;23個(gè)肝臟囊型包蟲(chóng)病灶中藥物治療前的Lip2峰有15個(gè)高于藥物治療后;23個(gè)肝臟囊型包蟲(chóng)病灶中藥物治療前的Cho峰下面積有14個(gè)低于藥物治療后;23個(gè)肝臟囊型包蟲(chóng)病灶中藥物治療前的Lip2峰下面積有14個(gè)低于藥物治療后;比較兩組樣本中Lip2峰的峰高及峰下面積變化不明顯,差異無(wú)統(tǒng)計(jì)學(xué)意義(t=-0.882、0.346,P0.05);比較兩組樣本中Cho的峰高及峰下面積及Cho/Lip2峰高的比值,均較前明顯減低,差異有統(tǒng)計(jì)學(xué)意義(t=5.641、2.442、3.157,P0.05)。結(jié)論:肝臟囊型包蟲(chóng)病藥物治療前與藥物治療半年后常規(guī)磁共振檢查,大小、信號(hào)未見(jiàn)明顯差異;然而通過(guò)氫質(zhì)子磁共振波譜檢查發(fā)現(xiàn)一定的特異性,1H-MRS能夠無(wú)創(chuàng)性的早期通過(guò)Cho的峰高、峰下面積及Cho/Lip2的峰高比值的變化發(fā)現(xiàn)病變進(jìn)展情況,為早期判定囊型包蟲(chóng)病藥物治療效果提供新的途徑,亦為臨床進(jìn)一步治療提供一定的幫助。
[Abstract]:Objective: to provide a new imaging approach for early clinical evaluation of the efficacy of drug therapy for cystic hydatid disease by analyzing the peak morphological characteristics and metabolic differences of metabolites before and after drug therapy in 1H-MRS liver cystic hydatid disease. Participants and methods: from April 2015 to December 2016, 23 patients with hepatic cystic hydatid disease were diagnosed by laboratory, imaging and clinical methods in the affiliated Hospital of Qinghai University. 3. 0T MRI abdominal routine sequence and magnetic resonance spectrum sequence were performed before and half a year after drug treatment. Each patient selected one lesion, each lesion measured an individual element, and multiple lesions selected the largest lesion. The characteristics and differences of the spectral lines were observed and compared. The peak height and the area under the peak of H _ 2O _ 2, lipid methylene lipid _ (2), the ratio of the peak height of choline complex Choand the area under the peak of Cho-P / Lip2 were measured respectively, and the results were compared and analyzed. Results: of the 23 hepatic cystic hydatidosis foci, MRS showed slightly elevated Cho peaks in 18 lesions before drug therapy, and the detection rate was 78.3% 18 / 23%. Among them, 3 lesions detected inverted Cho peaks, and all lesions detected H2O peaks and Lip2 peaks. After drug treatment, MRS showed slightly higher Cho peaks in 20 lesions, and the detectable rate reached 86.9 / 20 / 23. In one of the 20 lesions, inverted Cho peaks were detected, and H2O and Lip2 peaks were detected in all the lesions. The detection rate was 100% 23 / 23; 19 of 23 hepatic cystic hydatid lesions were lower than those after drug treatment; 15 of 23 hepatic cystic hydatid foci had higher Lip2 peaks before and after drug treatment; and 23 liver cystic hydatid foci had higher Lip2 peaks before and after drug treatment. The subpeak area of Cho in 23 hepatic cystic hydatid foci before and after drug therapy was 14 lower than that after drug therapy. There was no significant difference in peak height and subpeak area of Lip2 between the two groups, there was no significant difference between the two groups, and the ratio of peak height and subpeak area to Cho/Lip2 peak height in the two groups was significantly lower than that in the previous two groups, and the difference was statistically significant (P 0.05). Conclusion: there was no significant difference in the size and signal intensity of hepatic cystic hydatid disease before and six months after drug treatment. However, the results of hydrogen proton magnetic resonance spectroscopy showed that a certain specificity of 1H-MRS could noninvasively detect the progression of Cho by changing the peak height of Cho, the area under the peak and the ratio of peak height to peak height of Cho/Lip2. It provides a new approach for early evaluation of the efficacy of drug therapy for cystic hydatid disease, and also provides some help for further clinical treatment.
【學(xué)位授予單位】：青海大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R532.32;R445.2

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