本文選題：結直腸癌 + 磁共振�。� 參考：《寧夏醫(yī)科大學》2014年碩士論文

【摘要】：目的：探討3.0T超導體MRI常規(guī)序列聯(lián)合DWI（b=1000s/mm2）對結直腸癌術前T、N分期的價值及病灶、淋巴結ADC值的臨床意義。 方法：收集2013年6月至11月期間經(jīng)臨床手術病理確診結直腸癌患者71例。全部病例均行3.0TMRI常規(guī)序列及DWI檢查。納入標準：①首診懷疑結直腸癌患者，或病理證實為結直腸癌；②MRI檢查前未經(jīng)過任何放射性或化學性治療；③行3.0TMRI檢查并采用相同序列；④MRI檢查后2周內(nèi)行手術治療，并得到腫瘤病灶及淋巴結病理結果。嚴格按照以上標準進行篩選，最終符合條件的患者57例；其中男性患者39例，女性患者18例，年齡41～81歲，平均為60.17±11.89歲。 所以病例采用SIEMENS Skyra3.0T超導MRI，18通道體線圈掃描�；颊哳^先進，行常規(guī)T1WI軸位(FOV：360×360mm，矩陣：314×448)、T2WI矢狀位（FOV：261×261mm，矩陣：256×320）、冠狀位（FOV：401×401mm，矩陣：256×256）、FST2WI軸位（FOV：320×320mm，矩陣：269×384）及DWI軸位（FOV：380×380mm，矩陣：326×384，b=1000s/mm2）。 運用SPSS統(tǒng)計軟件統(tǒng)計分析3.0TMRI常規(guī)序列、常規(guī)序列聯(lián)合DWI對結直腸癌術前T、N分期的準確率、敏感度、特異度、陽性預測值、陰性預測值。采用kappa檢驗診斷結果的一致性，評估3.0T MRI檢查在結直腸癌中應用的價值。 測量病灶、轉移淋巴結、脂肪間隙轉移性結節(jié)的ADC值，記錄分析有淋巴結和或遠處轉移的病灶、無轉移的病灶的ADC值、轉移的淋巴結、脂肪間隙轉移性結節(jié)的ADC值，采用獨立樣本t檢驗，檢驗水準α=0.05，p0.05有統(tǒng)計學意義。 結果：57例病例，MRI常規(guī)序列檢查T分期的總準確率為87.72%，與病理結果一致性一般，，kappa=0.69；N分期的總準確率為84.21%，與病理結果一致性好，kappa=0.76。MRI常規(guī)序列聯(lián)合DWI檢查T分期的總準確率為91.23%，與病理結果一致性好，kappa=0.79；N分期總準確率為78.95%，與病理一致性一般，kappa=0.69。結直腸癌轉移組瘤體ADC值小于無轉移組，差異有統(tǒng)計學意義(p=0.03)。 結論：MRI常規(guī)序列聯(lián)合DWI檢查可以提高T分期診斷準確率。測量瘤體、淋巴結ADC值在一定程度上可評估、預測其浸襲性。
[Abstract]:Objective: to evaluate the value of 3T superconductor MRI routine sequence combined with DWI (1000s / m2) in preoperative staging of colorectal cancer and the clinical significance of ADC value of lymph node and lesion. Methods: from June to November, 2013, 71 patients with colorectal cancer confirmed by clinical operation and pathology were collected. All cases were examined by 3.0TMRI routine sequence and DWI. Inclusion Standard: 1 first diagnosed suspected colorectal cancer, or confirmed by pathology that colorectal cancer was diagnosed by 2MRI without any radiotherapeutic or chemotherapeutic 3.0TMRI examination and surgical treatment within 2 weeks after using the same sequence of MRI. The pathological results of tumor focus and lymph node were obtained. According to the above criteria, 57 patients were selected, including 39 male patients and 18 female patients, with an average age of 60.17 鹵11.89 years. So the SIEMENS Skyra3.0T superconducting MRI 18 channel body coil scan was used. Patients with advanced head were given routine T1WI axial position FOV: 360 脳 360 mm, matrix: 314 脳 448 / T _ 2WI sagittal position: 261 脳 261 mm, matrix: 256 脳 320m, coronal position FOV: 401 脳 401 mm, matrix 256 脳 256F T _ 2WI axis FOV: 320 脳 320mm, matrix: 269 脳 384) and DWI axis position FOV: 380 脳 380mm, matrix: 326 脳 384s / 1000 s / r ~ 2mm. The accuracy, sensitivity, specificity, positive predictive value and negative predictive value of 3.0TMRI routine sequence combined with DWI in preoperative staging of colorectal cancer were analyzed by SPSS statistical software. The value of 3.0T MRI in colorectal cancer was evaluated by using kappa test to evaluate the consistency of diagnostic results. The ADC values of metastatic nodes, metastatic lymph nodes, fat space metastatic nodules were measured. The ADC values of lymph nodes and distant metastases, non-metastatic lesions, metastatic lymph nodes and fat space metastatic nodules were recorded and analyzed. Using independent sample t test, the test level of 偽 0.05 p 0.05 has statistical significance. Results the total accuracy of T staging by conventional MRI sequence was 87.722.The total accuracy rate of T staging was 84.21 in general agreement with pathological results, and good agreement with pathological results. The total accuracy of DWI combined with conventional MRI sequence was 0.76.The total accuracy rate of T staging was better than that of conventional MRI sequence. The total accuracy of 0.79 N staging was 78.95 and 0.69 with pathological consistency. The ADC value of colorectal cancer metastasis group was lower than that of no metastasis group, the difference was statistically significant. Conclusion the diagnostic accuracy of T-staging can be improved by combining DWI with conventional Mr sequence. The ADC value of lymph node can be evaluated to some extent and its invasion can be predicted.
【學位授予單位】：寧夏醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R445.2;R735.3

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相關期刊論文 前1條

1 歐陽漢,張紅梅,袁興華,楊翠柳,周純武;MR平掃和增強掃描在直腸癌分期的應用價值[J];中國醫(yī)學影像技術;2003年05期

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