發(fā)布時(shí)間：2018-03-24 14:31

  本文選題：BLADE　切入點(diǎn)：DWI　出處：《復(fù)旦大學(xué)》2014年博士論文

【摘要】：第一部分鞍區(qū)DWI成像：BLADE序列與EPI序列成像效果的對(duì)比研究目的：該部分實(shí)驗(yàn)的目的是比較BLADE序列以及單次激發(fā)平面回波成像(EPI)擴(kuò)散加權(quán)成像方法在鞍區(qū)顯像的效果以及圖像質(zhì)量。方法：該部分研究,共納入55名具有可疑鞍區(qū)病變的患者(其中52人磁共振發(fā)現(xiàn)鞍區(qū)病變,3名掃描結(jié)果正常)。所有的檢查都是用西門子3.0T磁共振設(shè)備,所有受試者都要對(duì)病灶進(jìn)行BLADE序列以及EPI序列下的擴(kuò)散加權(quán)成像。所有檢查圖像都需要檢測(cè)圖像的信噪比(SNR),同時(shí)由兩位有經(jīng)驗(yàn)的放射科醫(yī)生對(duì)兩種擴(kuò)散加權(quán)成像圖像中的頸內(nèi)動(dòng)脈,視交叉,垂體柄,垂體,鞍區(qū)病灶以及圖像整體的顯像質(zhì)量進(jìn)行獨(dú)立評(píng)估,另兩位放射科醫(yī)生對(duì)病灶的大小進(jìn)行測(cè)量。結(jié)果：BLADE序列的擴(kuò)散加權(quán)成像與EPI序列的擴(kuò)散加權(quán)成像在圖像信噪比方面沒(méi)有顯著性差異(P0.05)。在對(duì)于鞍區(qū)結(jié)構(gòu)顯像方面,BLADE DWI也顯著優(yōu)于EPI DWI,尤其是在頸內(nèi)動(dòng)脈以及總體圖像質(zhì)量方面。將兩種方法中所獲得的圖像質(zhì)量評(píng)分以及病灶的大小進(jìn)行關(guān)聯(lián),擬合曲線后發(fā)現(xiàn),在BLADE DWI成像中病灶冠狀位最小直徑≥12mm時(shí),圖像效果較好,而對(duì)于EPI DWI成像,病灶冠狀位最小直徑需≥31mm。第二部分：垂體瘤質(zhì)地與磁共振信號(hào)的關(guān)系目的：垂體瘤質(zhì)地對(duì)于手術(shù)方式的選擇以及預(yù)后的判斷具有重要價(jià)值,如果可以在術(shù)前通過(guò)影像學(xué)判斷腫瘤質(zhì)地將會(huì)給臨床提供術(shù)式指導(dǎo),改善患者預(yù)后。本部分通過(guò)獲取垂體瘤各項(xiàng)磁共振信號(hào),結(jié)合術(shù)中所見,研究垂體瘤的各項(xiàng)磁共振參數(shù)與腫瘤的術(shù)中質(zhì)地是否具有顯著性聯(lián)系。方法：該部分為前瞻性研究,共納入符合垂體瘤臨床表現(xiàn),于我院接受手術(shù),且術(shù)后病理證實(shí)為垂體瘤的受試者34名,完善術(shù)前各項(xiàng)檢查,使用西門子3.OT磁共振設(shè)備對(duì)病灶行T1冠狀位,T2冠狀位,BLADE序列的冠狀位擴(kuò)散加權(quán)成像以及T1增強(qiáng)后冠狀位掃描。術(shù)中收集患者的質(zhì)地評(píng)估結(jié)果,并結(jié)合術(shù)后病理免疫組化對(duì)患者資料進(jìn)行分析。結(jié)果：腫瘤質(zhì)地與患者年齡,性別,發(fā)病年齡,病程,腫瘤侵襲性,腫瘤的功能均無(wú)顯著相關(guān)性。腫瘤的磁共振檢查結(jié)果包括腫瘤處T1信號(hào)值/正�；屹|(zhì)T1信號(hào)值,腫瘤處T2信號(hào)值/正常白質(zhì)T2信號(hào)值,腫瘤處T1增強(qiáng)信號(hào)值/灰質(zhì)T1增強(qiáng)信號(hào)值以及腫瘤處ADC值/正常腦干ADC值與腫瘤質(zhì)地之間沒(méi)有顯著的相關(guān)性,P0.05,對(duì)于幾種影像學(xué)檢查方法做ROC曲線后發(fā)現(xiàn),相比于其他幾種方法,腫瘤處ADC值/正常腦干ADC值對(duì)于腫瘤質(zhì)地的診斷具有一定的價(jià)值,其曲線下面積(AUC)為0.7724,臨界值為1.077。垂體瘤是否具有分泌功能與腫瘤處T2信號(hào)值/正常白質(zhì)T2信號(hào)值具有顯著相關(guān)性,P=0.03110.05,做ROC曲線,曲線下面積為0.7747,臨界值為1.990,提示腫瘤處T2信號(hào)值/正常白質(zhì)T2信號(hào)值大于該值時(shí),腫瘤為無(wú)功能性垂體瘤的可能大。第三部分：垂體瘤質(zhì)地與腫瘤內(nèi)膠原含量的關(guān)系目的：本部分研究為探討垂體瘤質(zhì)地以及術(shù)前影像學(xué)信號(hào)與術(shù)后病理膠原含量之間是否具有相關(guān)性,各個(gè)類型的腫瘤間質(zhì)中的膠原含量是否具有差異。方法：該部分研究,共納入符合垂體瘤臨床表現(xiàn),于華山醫(yī)院神經(jīng)外科接受手術(shù),且術(shù)后病理證實(shí)為垂體瘤的受試者34名,完善術(shù)前各項(xiàng)檢查,使用西門子3.OT磁共振設(shè)備對(duì)病灶行磁共振冠狀位掃描。術(shù)中收集患者的質(zhì)地評(píng)估結(jié)果,使用HE染色,Masson膠原染色對(duì)腫瘤組織分別進(jìn)行膠原含量的定性以及定量的分析。結(jié)果：不同質(zhì)地分組中膠原含量無(wú)論定性或是定量均具有顯著性差異,質(zhì)地軟組中膠原含量為7.27±1.18%,質(zhì)地韌組的平均膠原含量為17.72±2.00%,P=0.0013,通過(guò)使用ROC曲線,可以發(fā)現(xiàn)膠原含量為15.39%可以作為不同質(zhì)地的臨界值。研究中發(fā)現(xiàn)腫瘤處ADC值/正常腦干ADC值與腫瘤內(nèi)的膠原含量具有一定的相關(guān)性,在膠原定性分組(+),(++), (+++)中,腫瘤處ADC值/正常腦干ADC值(rADC)分別為1.5172,1.0998,1.0431,P=0.016,可以認(rèn)為rADC值隨著膠原含量的增加信號(hào)值下降,但膠原含量與rADC之間并非線性相關(guān),R2=0.2175。其他組影像學(xué)數(shù)據(jù)包括rTl, rT2以及rTl增強(qiáng)值與腫瘤內(nèi)膠原含量均沒(méi)有顯著相關(guān)性,同時(shí)臨床數(shù)據(jù)如患者年齡,性別,病程,腫瘤大小,腫瘤的臨床功能,腫瘤侵襲性以及病理功能分類與腫瘤膠原含量無(wú)顯著相關(guān)性。
[Abstract]:The first part of the sellar region DWI imaging: Objective To compare the effect of BLADE sequence and EPI sequence imaging effect: the part of experiment is to compare BLADE sequence and single shot echo planar imaging (EPI) diffusion weighted imaging method in sellar region imaging effect and image quality. Methods: this part of the study, 55 patients with suspicious saddle lesions were included (including 52 magnetic resonance imaging revealed a sellar region lesions and 3 normal scans). All the checks are using SIEMENS 3.0T MRI equipment, all subjects are diffusion weighted imaging BLADE sequence and EPI sequence on the lesion. All images are needed to detect image signal the signal-to-noise ratio (SNR), at the same time by two experienced radiologists on two kinds of diffusion weighted imaging in the image of the internal carotid artery, optic chiasm, pituitary stalk, pituitary gland, sellar region lesions and the overall image quality of imaging alone Li assessment, another two radiologists in lesion size were measured. Results: diffusion weighted imaging diffusion weighted imaging and EPI BLADE sequences in the image signal to noise ratio had no significant difference (P0.05). In the sellar region structure imaging, BLADE DWI was significantly better than EPI DWI, especially in the areas of the internal carotid artery and overall image quality. The two methods to obtain the image quality score and the size of the lesion were correlated, fitting curves show that the BLADE in DWI imaging of lesions of coronal minimum diameter greater than or equal to 12mm, the image effect is better, and for EPI DWI imaging, coronary lesions required minimum diameter larger than 31mm. second part objective: the relationship between pituitary adenoma with magnetic resonance signals: the pituitary adenoma has important value for the choice of surgical approach and prognosis, if the preoperative imaging by judging swelling The texture will be provided for the clinical tumor operation guidance, improve the prognosis of the patients. This part by acquiring the pituitary magnetic resonance signal, combined with intraoperative findings, the magnetic resonance parameters and tumor of pituitary tumor surgery were associated with the texture is. Methods: as part of the forward research, included with the clinical manifestations of pituitary tumor in our hospital underwent surgery and postoperative pathology were subjects of pituitary tumor 34, improve the preoperative check, the use of SIEMENS 3.OT MRI equipment on the lesion of coronal T1, coronal T2, BLADE series of coronal diffusion weighted imaging and T1 enhanced after the coronal scan texture. Evaluation results were collected during surgery, and postoperative pathology immunohistochemistry of patients were analyzed retrospectively. Results: the tumor texture and patient age, gender, age of onset, course of disease, tumor invasion, tumor function was no significant Correlation between MRI results. Tumor including tumor T1 signal value / normal gray matter T1 signal value, the value of the T2 signal at the tumor / normal white matter T2 signal values of tumor enhanced T1 signal value / gray T1 signal enhancement value and ADC value of tumor / normal brain ADC value and there is no significant tumor texture correlation, P0.05, for several imaging methods of ROC curves show that compared with other methods, the ADC value of tumor / normal brain stem ADC value has a certain value for the diagnosis of tumor texture, the area under the curve (AUC) was 0.7724, the critical value is whether 1.077. has the secretion of pituitary tumor and tumor. The value of the T2 signal / normal white matter was significantly correlated with the value of the T2 signal, P=0.03110.05, ROC curve, the area under the curve was 0.7747, the critical value is 1.990, the value of the T2 signal at tumor / normal white matter signal value is greater than the T2 value, tumor reactive Of pituitary tumor may be large. The third part: the objective relationship between collagen content of tumor and tumor in the pituitary of texture: this part is to study whether there is any correlation between study of pituitary adenoma and the preoperative imaging signal and postoperative pathological collagen content, various types of tumor whether there is difference in the content of collagen quality. Methods: this part of the study, in accordance with clinical manifestations of pituitary tumor in Huashan Hospital Department of Neurosurgery, surgery, and postoperative pathology confirmed subjects of pituitary tumor 34, improve the preoperative check, the use of SIEMENS 3.OT MRI equipment for lesions underwent magnetic resonance coronary scanning. Texture evaluation results were collected during operation, using HE staining, the tumor tissue collagen content were qualitative and quantitative analysis of collagen Masson staining. Results: the collagen content of different texture in both qualitative and quantitative grouping is all out There are significant differences, the collagen content of soft texture group was 7.27 + 1.18%, the average content of collagen texture was 17.72 + ductile group 2%, P=0.0013, by using the ROC curve, can be found in collagen content of 15.39% can be used as the critical value of different texture. The tumor was found at the ADC / ADC value normal collagen and brainstem tumor in a certain correlation study, qualitative groups in collagen (+), (+ +), (+ + +), tumor / normal brain stem ADC value ADC value (rADC) were 1.5172,1.0998,1.0431, P=0.016, rADC value can be considered along with the increase of signal collagen content decreased, but the content of collagen and rADC and nonlinear correlation, R2=0.2175. imaging data of other groups including rTl, rT2 and rTl enhance the value and content of collagen within the tumor showed no significant correlation, while the clinical data such as age, gender, disease duration, tumor size, clinical features of tumor, tumor invasion There was no significant correlation between the classification of sex and pathological function and the content of tumor collagen.

【學(xué)位授予單位】：復(fù)旦大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2014
【分類號(hào)】：R445.2;R736.4

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