本文選題：動態(tài)增強(qiáng)磁共振成像　切入點(diǎn)：月經(jīng)周期　出處：《天津醫(yī)科大學(xué)》2014年碩士論文

【摘要】：目的 評估正常卵巢動態(tài)增強(qiáng)磁共振成像(dynamic contrast-enhanced magnetic resonance imaging, DCE-MRI)檢查的可行性,觀察不同月經(jīng)周期正常卵巢3.0TDCE-MRI參數(shù)及時(shí)間-信號曲線(time-intensity curve, TIC)特點(diǎn)。探討DCE-MRI在不同性質(zhì)囊實(shí)性卵巢腫瘤鑒別診斷方面的價(jià)值,分析其定量參數(shù)值的特點(diǎn),以及DCE-MRI與擴(kuò)散加權(quán)成像(Diffusion-weighted imaging, DWI)對囊實(shí)性卵巢腫瘤鑒別診斷效能的差異,為卵巢腫瘤定性診斷選擇最優(yōu)檢查方法。對象與方法 采用Siemens MAGNETOM Trio Tim3.0T超導(dǎo)型磁共振掃描儀,對33名處于不同月經(jīng)周期的正常卵巢組織患者行盆腔MR平掃+DCE-MRI檢查。同時(shí)對2012年11月-2014年1月間因盆腔腫塊就診的87例患者行盆腔MR、DWI (b值為1000s/mm2)及脂肪抑制DCE-MRI掃描,最終有48例患者入組。掃描完成后均在Siemens Syngo后處理工作站采用Tissue4D軟件進(jìn)行圖像后處理,得到卵巢間質(zhì)組織的TIC圖像及Ktrans、Kep、Ve值。所有卵巢腫瘤患者均于檢查后10天內(nèi)獲得病理結(jié)果,并根據(jù)病理結(jié)果分為卵巢良性腫瘤、交界性腫瘤及惡性腫瘤(1組、2組、3組)三組。采用獨(dú)立樣本t檢驗(yàn)分別比較不同月經(jīng)周期卵巢間質(zhì)Ktrans、Kep及Ve值的差異。分別比較DWI、DCE-MRI及兩者聯(lián)合對卵巢腫瘤診斷效能的差異。分析TIC診斷卵巢腫瘤的靈敏度、特異度、陰性預(yù)測值、陽性預(yù)測值,比較不同組間有無差異。分別測量各組卵巢腫瘤實(shí)性成分的Ktrans、Kep、Ve值及ADC值,采用單因素方差分析比較各組間四個(gè)參數(shù)值的差異。采用ROC曲線比較Ktrans、Kep、Ve值及ADC值對不同性質(zhì)卵巢腫瘤的鑒別診斷效能并確定最佳診斷閾值。 結(jié)果 (1)不同月經(jīng)周期正常卵巢間質(zhì)成分TIC形態(tài)無明顯差異(P0.05),均表現(xiàn)為I型曲線；(2)卵泡期及黃體期正常卵巢間質(zhì)Ktrans值分別為0.213±0.129(min-1)、0.189±0.124(min-1),差異無統(tǒng)計(jì)學(xué)意義；Kep值于卵泡期及黃體期分別為0.237±0.103(min-1)、0.248±0.14差異無統(tǒng)計(jì)學(xué)意義；Ve值于卵泡期及黃體期分別為1.692±1.365、1.575±1.085,差異無統(tǒng)計(jì)學(xué)意義；(3)DWI對卵巢腫瘤鑒別診斷的靈敏度為68.18%,特異度為69.23%,陰性預(yù)測值為72%,陽性預(yù)測值為65.22%；DCE-MRI對卵巢腫瘤鑒別診斷的靈敏度為76.19%,特異度為74.07%,陰性預(yù)測值為80%,陽性預(yù)測值為69.57%；兩者聯(lián)合對卵巢腫瘤鑒別診斷的靈敏度為85.72%,特異度為100%,陰性預(yù)測值為86.96%,陽性預(yù)測值為100%,以上指標(biāo)均高于單一檢查方法；(4)卵巢良性腫瘤與惡性腫瘤之間實(shí)性成分的ADC值差異有統(tǒng)計(jì)學(xué)意義(P=0.000),卵巢交界性腫瘤與良性及惡性腫瘤之間實(shí)性成分的ADC值無統(tǒng)計(jì)學(xué)差異(P=0.052,P=0.051)；(5)卵巢良性腫瘤TIC以I型曲線為主,交界性及惡性腫瘤TIC均以Ⅲ型曲線為主,其中良性腫瘤與交界性和惡性腫瘤之間的TIC差異有統(tǒng)計(jì)學(xué)意義(P0.05),而交界性腫瘤與惡性腫瘤之間的TIC形態(tài)無顯著差異(P0.05)；(6)不同性質(zhì)卵巢腫瘤實(shí)性成分Ktrans值差異均具有統(tǒng)計(jì)學(xué)差異(P0.05),而Kep值及Ve值差異不明顯(P0.05)；(7)ADC值、Ktrans、Kep及Ve值對良性和惡性腫瘤的最佳鑒別診斷閾值分別為1.174×10-3mm2/s、0.123min-1、0.262min-1、0.549,且均有較高的敏感度、陽性預(yù)測值及陰性預(yù)測值,但Kep、Ktrans值及ADC值的AUC無統(tǒng)計(jì)學(xué)差異(P0.05)；對交界性與惡性腫瘤的最佳鑒別診斷閾值分別為0.933×10-3mm2/s、0.212min-1、0.634,敏感度、特異度、陽性預(yù)測值較高,但陰性預(yù)測值較低,其中Kep值無意義；Ve值對良性與交界性腫瘤鑒別無意義；ADC值與Ktrans值對良性與交界性腫瘤的最佳鑒別診斷閾值分別為1.217×10-3mm2/s、0.108min-1,具有很高的敏感度和陰性預(yù)測值。 結(jié)論 利用3.0T DCE-MRI對正常卵巢間質(zhì)檢查具有可行性：正常卵巢間質(zhì)的Ktrans值、Kep值及Ve值分別為卵巢腫瘤特點(diǎn)的研究提供了正常參考價(jià)值；應(yīng)用DCE-MRI無創(chuàng)性鑒別囊實(shí)性卵巢腫瘤性質(zhì)具有可行性,能夠直觀有效量化對不同性質(zhì)囊實(shí)性卵巢腫瘤進(jìn)行鑒別診斷,且Ktrans值對于卵巢腫瘤良惡性的鑒別具有最佳診斷效能。
[Abstract]:objective
Evaluation of normal ovarian dynamic enhanced magnetic resonance imaging (dynamic contrast-enhanced magnetic resonance imaging, DCE-MRI) to examine the feasibility of observing the signal curve of different menstrual cycle in normal ovarian 3.0TDCE-MRI parameters and time (time-intensity curve, TIC). To explore DCE-MRI in differential diagnosis of different cystic ovarian tumors and to analyze the characteristics of quantitative parameters the value of DCE-MRI and diffusion weighted imaging (Diffusion-weighted imaging, DWI) in the differential diagnosis of cystic ovarian cancer diagnostic efficacy differences, ovarian cancer diagnosis to select the optimal inspection method. Object and method
The Siemens MAGNETOM Trio Tim3.0T superconducting magnetic resonance scanner in 33 patients at different menstrual cycle in normal ovarian tissue underwent pelvic MR scan and +DCE-MRI examination. On November 2012 -2014 year in January for 87 cases of patients with pelvic pelvic masses were MR, DWI (b = 1000s/mm2) and fat suppression DCE-MRI scan, the final 48 patients were enrolled. After scanning were Siemens Syngo postprocessing workstation for postprocessing images using Tissue4D software, get the ovarian interstitial TIC image and Ktrans, Kep, Ve. All patients with ovarian tumor were obtained in 10 days after the examination of pathological results, and according to the pathological results were divided into benign ovarian the tumor, borderline tumors and malignant tumors (1 group, 2 group, 3 group). Three groups of independent samples t test was used to compare different menstrual cycle and ovarian stromal Ktrans, the difference of Kep and Ve value were compared. DWI, DCE-MRI And the combination for diagnosis of ovarian neoplasms. The efficiency difference sensitivity analysis, TIC diagnosis of ovarian tumor specificity, negative predictive value, positive predictive value, comparison between different groups have no difference. The ovarian tumor solid component were measured Ktrans, Kep, Ve and ADC values, the difference produced by single factor analysis of variance comparisons between groups of values of four parameters. The ROC curve of Ktrans, Kep, Ve and ADC values in differential diagnosis of ovarian tumor efficacy of different nature and determine the best diagnostic threshold.
Result
(1) no significant difference in different menstrual cycle normal ovarian stromal component (P0.05), the morphology of TIC showed I curve; (2) follicular phase and luteal phase of normal ovarian interstitial Ktrans = 0.213 + 0.129 + 0.124 (min-1), 0.189 (min-1), there was no significant difference in Kep value; in the follicular phase and luteal phase were 0.237 + 0.103 (min-1), no statistically significant difference of 0.248 + 0.14; the value of Ve in follicular phase and luteal phase were 1.692 + 1.365,1.575 + 1.085, the difference was not statistically significant; (3) the sensitivity of DWI for differential diagnosis of ovarian tumors was 68.18%, the specificity was 69.23%, negative the predictive value was 72%, the positive predictive value was 65.22%; the sensitivity of DCE-MRI for differential diagnosis of ovarian tumors was 76.19%, the specificity was 74.07%, the negative predictive value was 80%, the positive predictive value was 69.57%; the combination of differential diagnosis of ovarian tumor sensitivity was 85.72%, specificity was 100%, negative The predictive value was 86.96%, the positive predictive value was 100%, the above indicators were higher than the single test method; (4) between ovarian benign tumor and malignant tumor solid composition ADC value difference was statistically significant (P=0.000), borderline ovarian tumors between benign and malignant tumors and solid components showed no significant difference (ADC value P=0.052, P=0.051); (5) TIC in benign ovarian tumor I curve, borderline and malignant tumors TIC were mainly type III curve, which was statistically significant between benign and borderline and malignant tumors TIC (P0.05), and the difference between the junction of tumor and malignant tumor morphology had no significant TIC the difference (P0.05); (6) ovarian tumor solid composition Ktrans value difference was statistically significant (P0.05), while Kep and Ve values were not significantly different (P0.05); (7) the value of ADC, Ktrans, Kep and Ve was the best for the identification of benign and malignant tumors The diagnostic threshold was 1.174 * 10-3mm2/s, 0.123min-1,0.262min-1,0.549, and has high sensitivity, positive predictive value and negative predictive value, but no significant difference in Kep, Ktrans and ADC values of AUC (P0.05); the optimal threshold for differential diagnosis of borderline and malignant tumors were 0.933 * 10-3mm2/s, 0.212min-1,0.634, sensitivity the specificity, the positive predictive value is higher, but the negative predictive value is low, the Kep value is meaningless; Ve value of benign and borderline tumors without meaning; the ADC value of the best discrimination of benign and borderline tumor differential diagnosis threshold was 1.217 * 10-3mm2/s, and the Ktrans value of 0.108min-1, with a sensitivity and negative predictive the very high value.
conclusion
The normal ovarian interstitial examination has the feasibility of using 3.0T DCE-MRI: normal ovarian interstitial Ktrans value, Kep value and Ve value of the normal reference value of ovarian tumor characteristics respectively; application of DCE-MRI noninvasive identification of cystic ovarian tumors is feasible, can effective quantification of the different nature of cystic ovarian the differential diagnosis of tumor, and the value of Ktrans has the best diagnostic efficacy for differential diagnosis of benign and malignant ovarian tumors.

【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R737.31;R445.2

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