本文選題：直腸癌 + 磁共振成像�。� 參考：《廣州醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:探討直腸癌磁共振動態(tài)增強(qiáng)成像(dynamic-contrast enhanced magnetic resonance imaging,DCE-MRI)相關(guān)參數(shù)的變化,闡明直腸癌微血管生成與DCE-MRI血流動力學(xué)之間的關(guān)系。探討DCE-MRI在直腸癌術(shù)前新輔助放化療監(jiān)測中的意義,為直腸癌治療方案的選擇、術(shù)前評估、新輔助治療療效評估提供參考依據(jù)。臨床資料和方法:選取經(jīng)病理證實的直腸癌患者31例,其中分入A組的20例直接行手術(shù)治療,分入B組的11例術(shù)前需行新輔助放化療。A組于手術(shù)前行常規(guī)盆腔MRI及矢狀位動態(tài)增強(qiáng)掃描1次,B組分別于新輔助放化療前及放化療后手術(shù)前各行常規(guī)盆腔MRI及矢狀位動態(tài)增強(qiáng)掃描1次。選擇直腸癌灶、正常直腸腸壁、盆壁肌肉作為感興趣區(qū)(region of interest,ROI)繪制時間-信號曲線(time-intensity curve,TIC),得出曲線參數(shù),包括相對信號強(qiáng)化率(relative enhancement,RE)、最大相對信號強(qiáng)化率(maximum relative enhancement,MRE)、最大信號強(qiáng)化率(maximum enhancement,ME)及信號達(dá)峰時間(time to peak,TTP)。所有病例術(shù)后對癌灶標(biāo)本進(jìn)行常規(guī)HE染色和用單克隆鼠抗人CD34抗體行血管標(biāo)記、染色,測定腫瘤組織內(nèi)腫瘤微血管密度(microvessel density,MVD)。將癌灶、癌灶鄰近正常直腸腸壁、盆壁肌肉組織的TIC參數(shù)進(jìn)行對比分析,然后將A組和B組的MVD值與腫瘤各TIC參數(shù)進(jìn)行對比分析,最后將B組行新輔助放化療前后的磁共振動態(tài)增強(qiáng)影像學(xué)表現(xiàn)及TIC參數(shù)進(jìn)行統(tǒng)計分析。結(jié)果:1、癌灶、正常直腸腸壁及盆壁肌肉的RE值分別為(135.33±41.37)、(92.84±32.10)、(27.76±17.37),MRE值分別為(137.69±41.44)、(103.82±42.14)、(22.81±28.89),RE、MRE值兩兩比較差異均有統(tǒng)計學(xué)意義(p0.05);癌灶、正常直腸腸壁及盆壁肌肉的ME值分別為(1037.16±326.24)、(897.65±387.01)、(160.95±160.34),腫瘤與正常直腸黏膜、肌肉組織ME值差異均有統(tǒng)計學(xué)意義(p0.05);腫瘤TTP值分別明顯低于正常直腸黏膜與肌肉組織,差異有統(tǒng)計學(xué)意義(p0.05),正常直腸黏膜與盆壁肌肉TTP未見顯著性差異。2、31例直腸癌ME值與MVD呈正相關(guān)(p0.05),相關(guān)系數(shù)γ=0.717,RE、MRE、TTP與MVD均無明顯相關(guān)性(p0.05)。A組與未治療前的B組各TIC參數(shù)均未見顯著性差異(p0.05)。A組與行放化療后的B組對比,A組ME值為(1017.67±297.82),明顯高于放化療后B組的(708.30±97.44),差異有統(tǒng)計學(xué)意義(p0.05),兩組間RE、MRE、TTP值差異無統(tǒng)計學(xué)意義(p0.05)。A組MVD值為(16.10±8.77)條/200HP,明顯高于B組的(7.20±4.60)條/200HP,差異有顯著性(p0.05)。3、B組腫瘤放化療后9例見殘留灶,但腫瘤明顯縮小;2例病灶僅見直腸粘膜增厚,未見明顯腫塊影。B組放化療前ME值為(1076.15±412.42),明顯高于放化療后的(708.30±97.44),差異有統(tǒng)計學(xué)意義(p0.05);余RE、MRE、TTP值在放化療前后未見顯著性差異。結(jié)論:1、DCE-MRI的TIC參數(shù)ME、RE、MRE、TTP值均顯著高于較直腸粘膜、肌肉組織,能反映直腸癌高灌注、富血管等特點,對直腸癌的診斷有一定的參考價值。2、直腸癌DCE-MRI的ME值與其病理MVD值呈正相關(guān)性,ME值可作為評價直腸癌微循環(huán)灌注的重要參數(shù)。3、ME值可較客觀地反映直腸癌術(shù)前新輔助放化療過程中腫瘤內(nèi)部微血管的變化,對直腸癌放化療療效的評價有一定參考價值。
[Abstract]:Objective: To investigate the changes in the parameters of dynamic-contrast enhanced magnetic resonance imaging (DCE-MRI) in rectal cancer and to elucidate the relationship between the angiogenesis of rectal cancer and the hemodynamics of DCE-MRI, and to explore the significance of DCE-MRI in the monitoring of neoadjuvant radiochemotherapy before operation for rectal cancer and for the treatment of rectal cancer. Selection, preoperative evaluation and new adjuvant treatment evaluation provided reference basis. Clinical data and methods: 31 cases of rectal cancer confirmed by pathology were selected, of which 20 cases were divided into group A and 20 cases were operated directly, and 11 cases of group B were divided into group.A before operation, and before operation, the routine pelvic MRI and sagittal dynamic enhanced scan was performed before operation, B MRI and sagittal dynamic enhanced scan were performed 1 times before and before neoadjuvant radiotherapy and chemotherapy. Rectal carcinoma, normal rectal wall, and pelvic wall muscles were used as region of interest (ROI) to draw time signal curve (time-intensity curve, TIC), and the curve parameters, including relative signal strength, were obtained. Relative enhancement (RE), the maximum relative signal enhancement rate (maximum relative enhancement, MRE), the maximum signal enhancement rate (maximum enhancement, ME) and signal peak time (time to). The tumor microvascular density (microvessel density, MVD) in the tumor tissue was compared with the TIC parameters of the muscle tissue of the pelvic wall adjacent to the normal rectal wall. Then the MVD values of the A and B groups were compared with the TIC parameters of the tumor. Finally, the dynamic enhanced imaging performance of the magnetic resonance imaging (MRI) before and after the new adjuvant radiochemotherapy was performed in the B group. The results were as follows: 1: 1, the RE values of the carcinoma, the normal rectal wall and the pelvic wall were (135.33 + 41.37), (92.84 + 32.10), (27.76 + 17.37), the MRE values were (137.69 + 41.44), (103.82 + 42.14), (22.81 + 28.89), RE, MRE values were statistically significant (P0.05), cancer, normal rectal wall and pelvic wall muscle. The ME value of meat was (1037.16 + 326.24), (897.65 + 387.01) and (160.95 + 160.34). The difference of ME value between the tumor and normal rectal mucosa and muscle tissue was statistically significant (P0.05), and the TTP value of the tumor was significantly lower than that of the normal rectal mucosa and muscle tissue (P0.05). There was no significant difference between the normal rectal mucosa and the TTP of the pelvic muscles. There was no significant correlation between the ME value of rectal cancer in.2,31 and MVD (P0.05). There was no significant correlation between the correlation coefficient gamma =0.717, RE, MRE, TTP and MVD (P0.05).A group and the B group before and before the treatment. The value of the group was (1017.67 + 297.82), which was significantly higher than that of the group after radiotherapy and chemotherapy (708.30 + 97.) 44) the difference was statistically significant (P0.05). There was no significant difference in the value of RE, MRE, and TTP between groups (P0.05).A group MVD value (16.10 + 8.77) /200HP, obviously higher than (7.20 + 4.60) /200HP in group B (7.20 + 4.60) /200HP, the difference was significant (P0.05).3, 9 cases of tumor after radiotherapy and chemotherapy, but the tumor was obviously narrowed, and the lesions of the rectum were only thickened in the 2 case. The ME value of.B group was (1076.15 + 412.42) before and after chemotherapy, which was significantly higher than that after radiotherapy and chemotherapy (708.30 + 97.44). The difference was statistically significant (P0.05); the value of residual RE, MRE and TTP had no significant difference before and after radiotherapy and chemotherapy. Conclusion: 1, DCE-MRI TIC parameters ME, RE, MRE, significantly higher than the rectal mucosa, muscle tissue, reflecting higher rectal cancer. The characteristics of perfusion, rich blood vessel and so on have certain reference value for the diagnosis of rectal cancer. The ME value of rectal cancer DCE-MRI is positively correlated with the MVD value of the pathology. ME value can be used as an important parameter to evaluate the microcirculation perfusion of rectal cancer. The ME value can objectively reflect the changes of the microvessels within the neoplasm in the neoadjuvant radiotherapy and chemotherapy of rectal cancer before operation. The value of ME can be objectively reflected. The evaluation of the efficacy of radiotherapy and chemotherapy for colorectal cancer is of some reference value.

【學(xué)位授予單位】：廣州醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R735.37;R445.2

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