發(fā)布時(shí)間：2018-03-28 04:26

  本文選題：小肝癌　切入點(diǎn)：MRI　出處：《蘇州大學(xué)》2014年碩士論文

【摘要】：目的 分析小肝癌瘤灶的多期增強(qiáng)信號變化特點(diǎn)，探討其與血供類型及病理分級的相關(guān)性，旨在提高小肝癌術(shù)前診斷水平，預(yù)估其惡性程度。 資料與方法 選取90名患者經(jīng)手術(shù)病理證實(shí)的93枚小肝癌病灶作為研究對象，男性74例，女性16例，年齡25~84歲，平均54.6±12.1歲。全部病例術(shù)前均分別進(jìn)行T2WI（采用呼吸觸發(fā)脂肪抑制快速恢復(fù)自旋回波）、T1WI（采用屏氣的雙回波擾相梯度回波）、采集b值為1000時(shí)的小肝癌結(jié)節(jié)灶的DWI信號，并采用肝臟容積超快速三維成像(LAVA) 序列進(jìn)行多期增強(qiáng)掃描，軸位或者冠狀位，測量并記錄病灶在增強(qiáng)后各期圖像上的相對信號值，制成強(qiáng)化曲線，將其分成流出型、平臺型、單相型、乏血供型四類，分析各型的供血方式及其與病理分級的相關(guān)性；算出各期最大強(qiáng)化率[pCER=（SI增強(qiáng)-SI平掃）/SI平掃*100，其中SI增強(qiáng)為病灶各期增強(qiáng)后測量值，SI平掃為病灶平掃后測量值]，并將患者的性別、年齡、強(qiáng)化曲線類型及病理分級分別與病灶動脈期、門脈期及延遲期的最大強(qiáng)化率pCER做多元線性回歸分析，P0.05為差異有統(tǒng)計(jì)學(xué)意義。 結(jié)果 (1)小肝癌表現(xiàn)為流出型增強(qiáng)曲線者大多病理類型為低分化，，平臺型大多表現(xiàn)為中分化，單相型大多表現(xiàn)為高分化（P0.05）；乏血供型無統(tǒng)計(jì)學(xué)意義；(2)瘤灶的DWI信號越高，病理分級越趨向于低分化（P0.05）；(3)動脈期最大強(qiáng)化率越高，門脈期最大強(qiáng)化率越低，瘤灶的病理分級越趨向于低分化（P0.05）；延遲期最大強(qiáng)化率無統(tǒng)計(jì)學(xué)意義；(4)在本研究年齡范圍內(nèi)（25-84歲，平均54.6±12.1），年齡越小，動脈期最大強(qiáng)化率相對越高，病理分級更趨向于低分化（P0.05）；而門脈期及延遲期最大強(qiáng)化率與年齡無統(tǒng)計(jì)學(xué)意義；各期最大強(qiáng)化率與性別無統(tǒng)計(jì)學(xué)意義。 結(jié)論 (1)小肝癌的多期增強(qiáng)信號曲線與瘤體血供特點(diǎn)相關(guān)；(2)小肝癌的多期增強(qiáng)信號曲線、DWI信號、最大強(qiáng)化率及年齡等因素與病理分級有一定相關(guān)性，有望作為術(shù)前預(yù)估小肝癌分化程度的參考指標(biāo)。
[Abstract]:Purpose. In order to improve the preoperative diagnosis level and predict the malignancy of small hepatocellular carcinoma (SHCC), the characteristics of multi-phase enhanced signal were analyzed, and the correlation with blood supply type and pathological grade was discussed. Data and methods. Ninety-three small hepatocellular carcinoma (SHCC) lesions confirmed by surgery and pathology were selected from 90 patients (74 males and 16 females, aged 25 to 84 years). The mean age was 54.6 鹵12.1 years. All patients underwent T2WI (rapid recovery of spin echo T1WI with respiratory triggered fat suppression) before operation. The DWI signals of small hepatocellular carcinoma nodules with b value of 1000 were collected. Liver volume ultrafast three-dimensional imaging (LAVA) was used. The sequence was scanned by multi-phase enhancement, axial or coronal. The relative signal values of each phase of enhancement were measured and recorded, and the enhancement curve was made into four types: outflow type, platform-type, single-phase type and lack of blood supply type. The maximum enhancement rate of each stage was calculated by analyzing the blood supply mode of each type and its correlation with pathological grade. The maximum enhancement rate of each phase was calculated [pCER=(SI enhancement-SI plain scan / SI plain scan 100, in which SI enhancement was measured after each stage of enhancement and SI plain scan was taken as the measured value of lesion after plain scan], and the sex of the patients was calculated. Age, type of enhancement curve and pathological grade were significantly different from the maximal enhancement rate of arterial phase, portal phase and delayed phase by multiple linear regression analysis (pCER). Results. (1) in patients with small hepatocellular carcinoma with efflux enhancement curve, the pathological type was low differentiation, the platform type was moderately differentiated, and the monophasic type was highly differentiated P0.05G; the lack of blood supply type was not statistically significant; the higher the DWI signal was, the higher the DWI signal was in the tumor foci. The higher the maximum enhancement rate in arterial phase and the lower the maximum enhancement rate in portal vein phase, the more the pathological grade of tumor focus tended to be P0.05, while the maximum enhancement rate in delayed stage was not statistically significant (P 0.05) in the age range of this study, the maximum enhancement rate was 25 to 84 years old in the present study, and there was no significant difference between the pathological grade and the low differentiation P0. 05% (P 0. 05%, P 0. 05%, P 0. 05%). The average value was 54.6 鹵12.1g, the younger the age, the higher the maximal enhancement rate of arterial phase, and the higher the pathological grade was, the lower the differentiation was (P0.05A), but there was no significant difference between the maximum enhancement rate and age in portal phase and delayed stage, and the maximum enhancement rate and sex in each stage were not statistically significant. Conclusion. (1) Multi-phase enhanced signal curve of small hepatocellular carcinoma was correlated with the characteristics of blood supply. (2) the multiphase enhanced signal curve of small hepatocellular carcinoma (SHCC) was correlated with the DWI signal, the maximum enhancement rate and age were correlated with the pathological grade. It is expected to be a reference index for predicting the differentiation of small hepatocellular carcinoma (HCC) before operation.
【學(xué)位授予單位】：蘇州大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R735.7;R445.2

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 戴琳;馮筱榕;陳永鵬;文維群;許乙凱;;超聲、超聲造影及多層螺旋CT對小肝癌的影像學(xué)診斷[J];南方醫(yī)科大學(xué)學(xué)報(bào);2008年08期

2 王爽;趙心明;林蒙;趙燕風(fēng);周純武;;肝臟CT灌注成像在肝癌早期診斷中的價(jià)值[J];放射學(xué)實(shí)踐;2008年03期

3 羅琳;王勁;;肝硬化結(jié)節(jié)自然病程的磁共振功能成像研究進(jìn)展[J];國際醫(yī)學(xué)放射學(xué)雜志;2009年03期

4 王金淳;楊波;潘文琴;王堅(jiān);沈杰;李樹平;;肝細(xì)胞肝癌MR DWI表現(xiàn)與病理學(xué)等級關(guān)系的分析[J];東南國防醫(yī)藥;2012年05期

5 陳紅;郭長義;楊林;熊義富;張紹金;徐其顯;;肝細(xì)胞癌彌散加權(quán)成像與腫瘤血管生成的相關(guān)性[J];中國CT和MRI雜志;2014年02期

6 王玉廷;李盛輝;;肝硬化結(jié)節(jié)與小肝癌的影像學(xué)鑒別診斷[J];實(shí)用醫(yī)藥雜志;2007年04期

7 李振明;姜曉靜;;肝動脈造影和碘油CT對小肝癌的診斷(附15例報(bào)告)[J];現(xiàn)代生物醫(yī)學(xué)進(jìn)展;2006年02期

8 李勇;吳卓;張嶸;江容堅(jiān);鐘鏡聯(lián);梁碧玲;;肝內(nèi)再生性結(jié)節(jié)、增生性結(jié)節(jié)和小肝癌的磁共振征象與鑒別[J];實(shí)用放射學(xué)雜志;2008年07期

9 余水全;王耿;李水連;肖格林;;多層螺旋CT及MRI對小肝癌診斷的對比研究[J];實(shí)用醫(yī)技雜志;2008年19期

10 盧炳豐,龍莉玲,黃仲奎;小肝癌SCT動脈期最大強(qiáng)化率與組織病理及免疫組化的多因素相關(guān)性研究[J];醫(yī)學(xué)影像學(xué)雜志;2005年09期

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