本文關鍵詞： 垂體腺瘤 垂體增生 動態(tài)增強磁共振成像 時間-信號強度曲線　出處：《皖南醫(yī)學院》2017年碩士論文　論文類型：學位論文

【摘要】：目的:量化分析動態(tài)增強磁共振成像(DCE-MRI)診斷正常垂體、垂體增生、微腺瘤和大腺瘤的各參數(shù)指標(TTP、Slopemax、Ktrans、Kep、Ve),探討DCE-MRI對垂體腺瘤診斷及鑒別診斷的價值。方法:搜集我院2015年6月至2017年2月經(jīng)內(nèi)分泌檢查、臨床隨訪、診斷性治療、術后病理等手段確診的79例垂體病變和15例正常垂體(臨床癥狀、內(nèi)分泌及影像學檢查均完全正常的對照組),前者包括垂體增生19例、微腺瘤34例、大腺瘤26例。對其均行常規(guī)和動態(tài)增強掃描后獲得時間-信號強度(T-SI)曲線,將TSI曲線分為三型,并對T-SI曲線形態(tài)進行定性分析;分別測量正常垂體、垂體增生、微腺瘤和大腺瘤的半定量參數(shù)達峰時間(TTP)、最大上升斜率(Slopemax)和定量參數(shù)轉(zhuǎn)移常數(shù)(Ktrans)、速率常數(shù)(Kep)、血管外細胞外間隙容積比(Ve)。對正常垂體、垂體增生、微腺瘤、大腺瘤的T-SI曲線類型構(gòu)成行卡方檢驗,分析兩兩差異有無統(tǒng)計學意義;對正常垂體、垂體增生、微腺瘤和大腺瘤的各參數(shù)值進行比較先采用單因素方差分析,然后兩兩間比較采用LSD法,最后對有統(tǒng)計學意義的參數(shù)值繪制ROC曲線,獲得曲線下面積,分析垂體腺瘤診斷及鑒別診斷的最佳診斷閾值,并計算敏感度、特異度、準確度。結(jié)果:1、正常垂體T-SI三型曲線數(shù)目分別為13、2、0,垂體增生分別為15、4、0、垂體微腺瘤分別為1、24、9,垂體大腺瘤分別為14、10、2。2、正常垂體和垂體增生的TTP、Slopemax、Ktrans、Kep、Ve五個參數(shù)值差異均無統(tǒng)計學意義(P0.05)。正常垂體的Slopemax、Ktrans、Kep值均大于微腺瘤,TTP值小于微腺瘤,且差異均有統(tǒng)計學意義(P0.05)。ROC曲線分析:TTP、Ktrans的ROC曲線下面積較大(分別為0.866、0.954),以72.655s作為TTP的診斷閾值時,其敏感度、特異度和準確度分別為74%、87%、61%;以0.793min-1作為Ktrans的診斷閾值時,其敏感度、特異度和準確度分別為80%、97%、77%。正常垂體的Slopemax、Ktrans、Kep值均大于大腺瘤,且差異均有統(tǒng)計學意義(P0.05)。ROC曲線分析:Ktrans、Kep的ROC曲線下面積較大(分別為0.738、0.877),以0.808min-1作為Ktrans的診斷閾值時,其敏感度、特異度和準確度分別80%、69%、49%;以1.176min-1作為Kep的診斷閾值時,其敏感度、特異度和準確度分別為67%、92%、59%。3、微腺瘤的Slopemax、Ktrans值均小于大腺瘤,且差異均有統(tǒng)計學意義(P0.05)。ROC曲線分析:Slopemax、Ktrans的ROC曲線下面積分別為0.675、0.747,以1.679作為Slopemax的診斷閾值時,其敏感度、特異度和準確度分別為77%、53%、30%;以0.654min-1作為Ktrans的診斷閾值時,其敏感度、特異度和準確度分別為50%、97%、47%。4、垂體增生的Slopemax、Ktrans、Kep值均大于微腺瘤,TTP值小于微腺瘤,且差異均有統(tǒng)計學意義(P0.05)。ROC曲線分析:Slopemax、Ktrans的ROC曲線下面積較大(分別為0.874、0.878),以2.969作為Slopemax的診斷閾值時,其敏感度、特異度和準確度分別為87%、82%、69%;以0.720min-1作為Ktrans的診斷閾值時,其敏感度、特異度和特異度分別為79%、94%、73%。5、垂體增生的Slopemax、Ktrans、Kep值均大于大腺瘤,且差異均有統(tǒng)計學意義(P0.05)。ROC曲線分析:Slopemax、Kep的ROC曲線下面積較大(分別為(0.763、0.767),以2.904作為Slopemax的診斷閾值時,其敏感度、特異度分別為90%、65%、55%;以1.176min-1作為Kep的診斷閾值時,其敏感度、特異度和準確度分別為61%、96%、57%。結(jié)論:1、正常垂體和微腺瘤、垂體增生和微腺瘤,微腺瘤和大腺瘤的T-SI曲線類型構(gòu)成均有差異,在一定程度上可以鑒別出微腺瘤。2、Slopemax、Ktrans參數(shù)能夠半定量、定量鑒別診斷微腺瘤和大腺瘤,并反映了兩者血流灌注不同,從血供方面解釋兩者大小不同的生物學特性。3、TTP、Slopemax、Ktrans、Kep參數(shù)能夠半定量、定量鑒別診斷垂體增生和垂體腺瘤,其中Ktrans鑒別微腺瘤較好,Kep鑒別大腺瘤較好,并能進一步反映垂體增生和腺瘤的病理生理差異;Ve在各組間均無統(tǒng)計學意義。
[Abstract]:Objective: quantitative analysis of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) diagnosis of normal pituitary, pituitary hyperplasia, micro adenoma and adenoma parameters (TTP, Slopemax, Ktrans, Kep, Ve), and to evaluate the value of DCE-MRI diagnosis and differential diagnosis of pituitary adenomas. Methods: clinical follow-up collected in our hospital from June 2015 to 2017 2 menstrual endocrine examination, diagnosis, treatment, postoperative 79 cases of pituitary lesions diagnosed by means of pathology and 15 cases of normal pituitary (control group, clinical symptoms, endocrine and imaging examination were completely normal), the former includes 19 cases of pituitary hyperplasia, 34 cases of micro adenoma, 26 cases of macroadenoma. The routine and dynamic contrast-enhanced scan obtained after the time signal intensity curve (T-SI), the TSI curve is divided into three types, and the T-SI curve of qualitative analysis; normal pituitary, pituitary hyperplasia were measured, semi quantitative parameters of micro adenoma and adenoma of the large peak time (TTP), the most Large ascending slope (Slopemax) and quantitative parameters transfer constant (Ktrans), the rate constant (Kep), extravascular extracellular space volume ratio (Ve) of normal pituitary, pituitary hyperplasia, micro adenoma, T-SI adenoma of curve type chi square test, analysis of 22 statistical difference to normal; the pituitary, pituitary hyperplasia, adenoma and micro parameters of large adenoma were compared by single factor analysis of variance, and 22 compared with LSD method, the parameters of the significant value of ROC curve, the area under the curve obtained, the best diagnostic threshold of diagnosis and differential diagnosis of pituitary adenoma, and calculate the sensitivity degree of specificity, accuracy. Results: 1, the number of type three T-SI curve of normal pituitary pituitary hyperplasia were 13,2,0 and 15,4,0 respectively, pituitary microadenoma were 1,24,9, pituitary adenomas were 14,10,2.2, normal pituitary and pituitary hyperplasia TT P, Slopemax, Ktrans, Kep, Ve values of five parameters showed no significant difference (P0.05). Normal pituitary Slopemax, Ktrans, Kep values were greater than the micro adenoma, TTP value is less than the micro adenoma, and the differences were statistically significant (P0.05).ROC curve analysis: TTP, Ktrans and ROC curve under a large area (0.866,0.954), using 72.655s as the diagnostic threshold of TTP, its sensitivity, specificity and accuracy were 74%, 87%, 61%; 0.793min-1 Ktrans as a diagnostic threshold, the sensitivity, specificity and accuracy were 80%, 97%, 77. The normal pituitary Slopemax, Ktrans, Kep value was more than that of adenoma, and the differences were statistically significant (P0.05).ROC curve analysis: Ktrans, ROC under the Kep curve of large area (0.738,0.877), using 0.808min-1 as the diagnostic threshold of Ktrans, its sensitivity, specificity and accuracy were 80%, 69%, 49%; 1.176min-1 as Kep the The diagnostic threshold, the sensitivity, specificity and accuracy were 67%, 92%, 59%.3, Slopemax micro adenoma, Ktrans values were less than macroadenomas, and the differences were statistically significant (P0.05).ROC curve analysis: Slopemax, ROC area under the Ktrans curve was 0.675,0.747, with 1.679 as the diagnostic threshold of Slopemax when the sensitivity, specificity and accuracy were 77%, 53%, 30%; 0.654min-1 Ktrans as a diagnostic threshold, the sensitivity, specificity and accuracy were 50%, 97%, 47%.4, Ktrans, Slopemax of pituitary hyperplasia, Kep values were greater than the micro adenoma, TTP value is less than the micro adenoma, and the differences were statistically significant (P0.05).ROC curve analysis: Slopemax, ROC under the Ktrans curve of large area (0.874,0.878), with 2.969 Slopemax as a diagnostic threshold, the sensitivity, specificity and accuracy were 87%, 82%, 69%; 0.720min-1 as Ktrans The diagnostic threshold, the sensitivity, specificity and specificity were 79%, 94%, 73%.5, Ktrans, Slopemax of pituitary hyperplasia, Kep values were greater than the adenomas, and the differences were statistically significant (P0.05).ROC curve analysis: Slopemax, ROC area under the Kep curve of large (respectively (0.763,0.767) in 2.904, Slopemax as a diagnostic threshold, the sensitivity and specificity of 90%, respectively, 65%, 55%; 1.176min-1 Kep as a diagnostic threshold, the sensitivity, specificity and accuracy were 61%, 96%, 1, 57%.. Conclusion: the normal pituitary and pituitary micro adenoma, hyperplasia and adenoma T-SI, curve type and micro adenoma adenoma which were different, in a certain extent can identify the micro adenoma.2, Slopemax, Ktrans parameters can be semi quantitative, quantitative differential diagnosis of micro adenoma and colorectal adenoma, and reflects the blood flow perfusion, for both interpretation of different sizes from the blood The biological characteristics of.3, TTP, Slopemax, Ktrans, Kep parameters can be semi quantitative, quantitative differential diagnosis of pituitary hyperplasia and pituitary adenoma, in which the identification of Ktrans micro adenoma good Kep differential adenoma is better, and can further reflect the pathophysiological differences of pituitary hyperplasia and adenoma; Ve had no statistical significance between the two groups.

【學位授予單位】：皖南醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R736.4;R445.2

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