本文選題：鼻腔鼻竇病變 + 多模態(tài)磁共振成像　； 參考：《青島大學》2017年碩士論文

【摘要】：目的:磁共振檢查技術在診斷及鑒別診斷鼻腔鼻竇病變中發(fā)揮著越來越大的作用,尤其是功能磁共振成像,如彌散加權成像(Diffusion Weighted Imaging,DWI)、動態(tài)增強掃描(Dynamic Contrast-enhanced Magnetic Resonance Imaging,DCE-MRI)技術的應用。本研究的目的在于探討多模態(tài)磁共振成像(Multi-parametric MRI,Mp-MRI)技術對鼻腔鼻竇良惡性病變的診斷價值。材料與方法:1.研究對象:收集2014年03月~2017年-03月于我院行鼻竇MRI檢查的患者76例,年齡11~73歲,平均年齡48.6歲,其中男性患者42例,女性患者34例。所有患者均行常規(guī)MR掃描、DWI和DCE-MRI掃描,均得到手術或穿刺活檢病理證實,回顧性分析其常規(guī)MR掃描、DWI和DCE-MRI掃描的影像表現(xiàn)及相關參數(shù)分析。2.研究方法:所有患者均行常規(guī)MR、DWI和DCE-MRI掃描,(1)常規(guī)MR掃描包括橫軸位、冠狀位的TI WI、FS T2WI序列,觀察病變的形態(tài)學特征,如部位、形態(tài)、信號強度、邊界、有無包膜、生長方式、有無轉移等。(2)DWI成像采用SE平面回波(echo planarimaging,EPI)序列,采用擴散敏感系數(shù)(b值)為0、800s/mm2,選取感興趣區(qū)(region of interest,ROI),測量表觀擴散系數(shù)(Apparent Diffusion Coefficien,ADC)值,并計算其平均值。(3)DCE-MRI掃描采用vibe序列,選取ROI后處理獲得病變的時間-信號強度變化曲線(Time Intensity Curve,TIC)。測量指標包括TIC類型,增強前信號強度(pre-enhanced signal intensity,SIpre)、最大信號強度(maximum signal intensity,SImax)、峰值信號強度(peak signal intensity,SIpeak)、達峰時間(time to peak,Tpeak),進而計算出最大線性斜率(the slope of signal intensity-time curve,Slope值)、邊緣-中心向心強化程度比值(Rrim-center)等半定量參數(shù)值并進行分析。將鼻腔鼻竇病變的TIC分為三個類型:A型:緩慢上升型;B型:速升平臺型;C型:速升速降型。測量并分析ROI內的定量參數(shù)值,如對比劑容積轉換常數(shù)(volume transfer constant of the contrast agent,Ktrans)、運動速率常數(shù)(rate constant between plasma and EES,Kep)、單位體積容積分數(shù)(volume of EES,Ve)。采用受試者工作曲線(receiver operator characteristic cure,ROC)確定差異有統(tǒng)計學意義的ADC值、Slope值、Rrim-center、Ktrans的診斷閾值,進而對病灶的性質進行判定。結果:(1)良性病變35例,常規(guī)MRI上多表現(xiàn)為形態(tài)較規(guī)則,其內信號較均勻,邊界較清楚,膨脹性生長為主。惡性病變41例多表現(xiàn)為形態(tài)不規(guī)則、囊變壞死多見、邊界欠清、侵襲性生長、周圍組織結構受累嚴重。單純憑借MR常規(guī)掃描,從形態(tài)學表現(xiàn)分析判斷病變的良惡性很容易造成誤診。(2)鼻竇炎、鼻息肉的平均ADC值分別為1.74±0.39×10-3mm2/s,1.58±0.26×10-3mm2/s,與惡性病變的平均ADC值1.24±0.92×10-3 mm2/s之間差異有統(tǒng)計學意義(P0.01);良、惡性病灶的平均ADC值分別為1.46±0.89×10-3mm2/s和1.24±0.92×10-3mm2/s,二者之間差異無統(tǒng)計學意義(P0.05)(3)35例良性病變TIC曲線以A型為主,41例惡性病變TIC表現(xiàn)為B或C型。本組良、惡性病變的Tpeak、Slope值、Rrim-center值、Ktrans有統(tǒng)計學差異(P0.05)。(4)良惡性病變的最大線性斜率Slope值分別為15.75±6.20×10-3、10.51±10.2×10-3,兩者間差異有統(tǒng)計學意義(P0.05),取良、惡性病變的診斷閾值Slope=10.58×10-3,得到其敏感性為73.2%,特異性為78.1%。(5)鼻腔鼻竇良惡性病變的Rrim-center值分別為0.12±0.085、0.26±0.065,兩者間差異具有統(tǒng)計學意義(P0.01),取診斷閾值Rrim-center=0.21,其敏感性為74.5%,特異性為91.6%。(6)本組良惡性病變的定量參數(shù)Ktrans有統(tǒng)計學差異(P0.05),取診斷閾值Ktrans=0.121,獲得的敏感性為65%,特異性為75%,曲線下面積約0.733。而Ve及Kep差異無統(tǒng)計學差異(P0.05)。結論:(1)DWI成像在一定程度上可以提示鼻腔鼻竇病變的良惡性。(2)DCE-MRI成像對判斷鼻腔鼻竇病變的良、惡性具有重要提示作用。TIC曲線有助于鼻竇病變的定性診斷。(3)良、惡性病變Slope值、Rrim-center值、Ktrans均有統(tǒng)計學差異(P0.05),在判斷鼻腔鼻竇病變的良、惡性方面有較好的應用價值。
[Abstract]:Objective: magnetic resonance imaging (MRI) plays a more and more important role in diagnosis and differential diagnosis of nasal sinus diseases, especially functional magnetic resonance imaging (Diffusion Weighted Imaging, DWI), and the application of dynamic enhanced scan (Dynamic Contrast-enhanced Magnetic Resonance Imaging, DCE-MRI). The purpose of this study is to explore the diagnostic value of Multi-parametric MRI (Mp-MRI) technique in the diagnosis of benign and malignant nasal sinus diseases. Materials and methods: 1. the objective of this study was to collect 76 cases of MRI in our hospital in -03 month, 03 month, 2014, ~2017 years, age 11~73, with an average age of 48.6 years, including 42 male and female patients. 34 cases. All patients underwent routine MR scan, DWI and DCE-MRI scan. All patients were confirmed by surgery or biopsy. A retrospective analysis of conventional MR scans, DWI and DCE-MRI scan imaging features and related parameters analysis.2. study methods: all patients underwent conventional MR, DWI and DCE-MRI scans, and (1) routine MR scan included transverse axis, coronal T I WI, FS T2WI sequence, observe the morphological features of the lesions, such as location, morphology, signal intensity, boundary, or without envelope, growth mode, and metastasis. (2) DWI imaging uses the SE plane echo (echo planarimaging, EPI) sequence, and uses the diffusion sensitivity coefficient (b value) as 0800s/mm2, and selects the region of interest (region) to measure apparent diffusion. The value of the coefficient (Apparent Diffusion Coefficien, ADC) and the average value are calculated. (3) the DCE-MRI scan uses the vibe sequence and selects the ROI post-processing to obtain the time signal intensity change curve (Time Intensity Curve, TIC). The measurement index includes the TIC type, the enhancement before the signal intensity, the maximum signal intensity. Ximum signal intensity, SImax), peak signal intensity (peak signal intensity, SIpeak), peak time (time to peak, Tpeak), and then calculate and analyze the semi quantitative parameter values of the maximum linear slope, edge center centripetal intensification range ratio and analysis. The TIC of the lesion is divided into three types: A type: slow rising type; B type: speed rise platform type; C type: speed rise and speed drop type. Measurement and analysis of quantitative parameter values in ROI, such as the volume conversion constant of the contrast agent volume (volume transfer constant of the contrast agent), motion rate constant, Volume Volume Volume Scores (volume of EES, Ve). Use the subjects' working curve (receiver operator characteristic cure, ROC) to determine the statistically significant ADC values, Slope values, Rrim-center, and the diagnosis threshold, and then determine the nature of the lesion. Results: (1) 35 cases of benign lesions, the regular patterns are more regular, and the internal signal is more than the normal. 41 cases of malignant lesions were characterized by irregular shape, more cystic degeneration, less clear boundary, invasive growth, and serious involvement of the surrounding tissue structure. It was easy to judge the misdiagnosis of pathological changes from morphological analysis by MR routine scan. (2) the average AD of sinusitis and nasal polyps. The C values were 1.74 + 0.39 x 10-3mm2/s and 1.58 + 0.26 x 10-3mm2/s respectively. The difference between the average ADC value of malignant lesions 1.24 + 0.92 x 10-3 mm2/s was statistically significant (P0.01). The average ADC values of benign and malignant lesions were 1.46 + 0.89 x 10-3mm2/s and 1.24 + 0.92 x 10-3mm2/s respectively. There was no statistically significant difference between two (P0.05) (P0.05) (P0.05) (P0.05) The curve was A type, and the TIC of 41 cases of malignant lesions was B or C. The Tpeak, Slope value, Rrim-center value and Ktrans of the malignant lesions were statistically different (P0.05). (4) the maximum linear slope Slope values of the benign and malignant lesions were 15.75 + 6.20 * 10-3,10.51 + 10.2 x 10-3, respectively. There were statistical significance (P0.05), benign and malignant lesions. The diagnostic threshold was Slope=10.58 x 10-3, and its sensitivity was 73.2% and the specificity of 78.1%. (5) of benign and malignant nasal sinus lesions was 0.12 + 0.085,0.26 + 0.065. The difference was statistically significant (P0.01), the diagnostic threshold was Rrim-center=0.21, its sensitivity was 74.5%, and the specificity was 91.6%. (6) benign and malignant lesions. The quantitative parameters Ktrans were statistically different (P0.05), the diagnostic threshold was Ktrans=0.121, the sensitivity was 65%, the specificity was 75%, the area under the curve was about 0.733. and there was no statistical difference between Ve and Kep (P0.05). Conclusion: (1) DWI imaging could indicate the benign and malignant of the nasal sinus diseases to a certain extent. (2) DCE-MRI imaging to judge nasal nasal nasal. The.TIC curve of the benign and malignant sinus lesions is helpful to the qualitative diagnosis of the sinus diseases. (3) the Slope value, the Rrim-center value and the Ktrans of malignant lesions have statistical differences (P0.05). It has a good application value in judging the benign and malignant aspects of the sinus and sinus diseases.

【學位授予單位】：青島大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R445.2;R739.62;R765

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