本文選題：膠質(zhì)瘤 + MRI　； 參考：《天津醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的多模態(tài)影像融合理念對(duì)于膠質(zhì)瘤診斷及鑒別診斷具有重要意義。本研究首先基于已發(fā)表的應(yīng)用MRI結(jié)合PET-CT進(jìn)行膠質(zhì)瘤診斷的相關(guān)研究,進(jìn)行系統(tǒng)評(píng)價(jià)及meta分析。以此更加系統(tǒng)的評(píng)估使用常規(guī)MRI和不同示蹤劑的PET-CT進(jìn)行膠質(zhì)瘤診斷的優(yōu)劣及特點(diǎn)。而后,對(duì)于臨床實(shí)踐中,多模態(tài)影像綜合診斷對(duì)于腫脹性脫髓鞘病變急性期與彌漫性膠質(zhì)瘤鑒別的應(yīng)用價(jià)值進(jìn)行探討。其中,多模態(tài)影像手段包括CT、MRI、~(18)F-FDG PET-CT與~(11)C-MET PET-CT。方法以Pubmed及Cochrane Library為檢索文獻(xiàn)數(shù)據(jù)庫(kù)。文獻(xiàn)檢索期限為2015年12月之前(包括12月)。按照規(guī)定的納入和排除標(biāo)準(zhǔn)篩選出目標(biāo)文獻(xiàn),將文獻(xiàn)中對(duì)于本meta分析有效的信息進(jìn)行提取、綜合,采用非定量方法進(jìn)行系統(tǒng)評(píng)價(jià),探討MRI和不同示蹤劑的PET-CT掃描用于膠質(zhì)瘤診斷的優(yōu)劣及特點(diǎn)。隨后,回顧性搜集患者31例�；颊呒膊√攸c(diǎn)為在就診初期,難以僅通過(guò)單一影像學(xué)檢查,形成腫脹性脫髓鞘病變急性期或彌漫性膠質(zhì)瘤的診斷。所有膠質(zhì)瘤病例均經(jīng)過(guò)組織病理學(xué)證實(shí);部分腫脹性脫髓鞘病變病例經(jīng)過(guò)組織病理學(xué)證實(shí),其他腫脹性脫髓鞘病變病例經(jīng)過(guò)內(nèi)科治療炎癥好轉(zhuǎn)證實(shí)。共納入膠質(zhì)瘤患者17例,脫髓鞘病變患者14例。納入的患者都在疾病診斷階段進(jìn)行過(guò)常規(guī)MRI檢查,包含MRI平掃以及強(qiáng)化MRI(強(qiáng)化對(duì)比劑為釓噴酸葡胺)�；颊咴贛RI檢查后兩周內(nèi)分別進(jìn)行了以~(18)F-FDG及~(11)C-MET為示蹤劑的PET-CT掃描。分析討論,(1)各項(xiàng)影像學(xué)成像特點(diǎn)對(duì)于彌漫性膠質(zhì)瘤及腫脹性脫髓鞘病變急性期鑒別的權(quán)重;(2)兩種不同示蹤劑的PET-CT對(duì)于腫脹性脫髓鞘病變急性期的診斷是否具有價(jià)值;(3)CT掃描對(duì)于膠質(zhì)瘤鑒別診斷的價(jià)值。采用R 3.3.2對(duì)數(shù)據(jù)進(jìn)行統(tǒng)計(jì)學(xué)分析。結(jié)果參照設(shè)定的標(biāo)準(zhǔn)共納入14篇目標(biāo)文獻(xiàn)。每篇文獻(xiàn)涉及的研究,均包含常規(guī)MRI檢查。與此同時(shí),其中4篇文獻(xiàn)涉及~(18)F-FDG PET-CT;5篇文獻(xiàn)涉及~(11)C-MET PET-CT;5篇文獻(xiàn)涉及~(18)F-FET PET-CT;3篇文獻(xiàn)涉及~(18)F-FLT PET-CT。其中包含單一文獻(xiàn)涉及多種不同示蹤劑的PET-CT的研究。各篇文獻(xiàn)具有不可忽視的內(nèi)在局限性,故最終的研究結(jié)論得出采用的是非定量的系統(tǒng)評(píng)價(jià)方法。常規(guī)MRI作為膠質(zhì)瘤診斷的基石,能夠提供較為直接的初步診斷信息。基于不同的成像機(jī)理,常規(guī)MRI對(duì)于解剖結(jié)構(gòu)的顯示能力遠(yuǎn)高于PET-CT。但PET-CT對(duì)于腫瘤生物學(xué)行為的顯示優(yōu)于MRI。具有活性的細(xì)胞能夠攝取~(18)F-FDG,從而顯示出膠質(zhì)瘤內(nèi)部的壞死組織。~(11)C-MET PET-CT所顯示的膠質(zhì)瘤邊界較常規(guī)MRI更加接近生物學(xué)邊界,為手術(shù)治療提供更加準(zhǔn)確的信息。此二者均具有預(yù)估膠質(zhì)瘤惡性程度的能力。相較~(18)F-FLT PET-CT,~(18)F-FET PET-CT所顯示的腫瘤邊界更加接近腫瘤的生物學(xué)邊界。~(18)F-FET PET-CT對(duì)于高級(jí)別膠質(zhì)瘤的診斷具有一定意義。病例研究發(fā)現(xiàn),如果僅僅考慮常規(guī)MRI影像學(xué)特點(diǎn)對(duì)于膠質(zhì)瘤及腫脹性脫髓鞘病變的鑒別能力,占位效應(yīng)及病變周圍水腫程度對(duì)于形成正確的初步診斷的價(jià)值具有統(tǒng)計(jì)學(xué)意義。~(18)F-FDG PET-CT及~(11)C-MET PET-CT對(duì)于膠質(zhì)瘤和腫脹性脫髓鞘病變鑒別診斷的價(jià)值也具有統(tǒng)計(jì)學(xué)意義。結(jié)合二者所得信息,能夠形成更加正確的指導(dǎo)治療方案制定的診斷。結(jié)論常規(guī)MRI掃描能夠更加清晰的顯示膠質(zhì)瘤的解剖結(jié)構(gòu);不同種類示蹤劑的PET-CT掃描基于腫瘤的代謝水平對(duì)膠質(zhì)瘤的惡性程度及邊界等的判斷更具優(yōu)勢(shì)。不同示蹤劑的PET-CT所提供的膠質(zhì)瘤相關(guān)信息不盡相同。常規(guī)MRI成像特征對(duì)診斷膠質(zhì)瘤,鑒別診斷膠質(zhì)瘤及腫脹性脫髓鞘病變的價(jià)值已被廣泛認(rèn)可。基于這樣的特點(diǎn)進(jìn)行二者的鑒別診斷具有統(tǒng)計(jì)學(xué)意義。而對(duì)于一些MRI特點(diǎn)表現(xiàn)得不典型的脫髓鞘病變病例,有條件的單位可以進(jìn)行~(18)F-FDG PET-CT與~(11)C-MET PET-CT檢查,從而提供附加信息。此外,患者就診后首先進(jìn)行的檢查——CT,對(duì)于腫脹性脫髓鞘病變急性期及彌漫性膠質(zhì)瘤的鑒別診斷具有特殊意義。結(jié)合不同影像學(xué)檢查手段所提供的信息,取長(zhǎng)補(bǔ)短,能夠在很大程度上提高膠質(zhì)瘤的初步診斷準(zhǔn)確性。多模態(tài)影像學(xué)綜合診療理念有助于疾病的早期診斷、早期治療,從而達(dá)到更好的預(yù)后。
[Abstract]:Objective multimodal image fusion is of great significance for the diagnosis and differential diagnosis of glioma. First, based on the published application of MRI combined with PET-CT in the diagnosis of glioma, systematic evaluation and meta analysis were carried out to make a more systematic assessment of the use of conventional MRI and different tracer PET-CT for glioma diagnosis. The application value of multimodal imaging comprehensive diagnosis for the differential diagnosis of swelling demyelinating disease and diffuse glioma is discussed in clinical practice. Among them, multimodal imaging methods include CT, MRI, ~ (18) F-FDG PET-CT and ~ (11) C-MET PET-CT. method with Pubmed and Cochrane Library as the retrieval text The document retrieval period is before December 2015 (including December). According to the prescribed inclusion and exclusion criteria, the target literature is selected and the effective information of the meta analysis in the literature is extracted and integrated, and the non quantitative method is used for systematic evaluation to explore the advantages of PET-CT scanning of MRI and different tracers for the diagnosis of glioma. Then, 31 patients were collected retrospectively. The patient's disease was characterized by the difficulty of the diagnosis of acute or diffuse glioma in the early stage of the treatment by a single imaging examination. All cases of glioma were confirmed by histopathology, and the cases of swollen demyelinating lesions were histopathologically histopathologically divided. It was confirmed that other cases of swollen demyelinating lesions were confirmed by internal medical treatment. 17 patients with glioma, 14 cases of demyelinating disease were included. All the patients were performed routine MRI examination at the stage of disease diagnosis, including MRI plain scan and intensifying MRI (intensifying contrast agent gadolinium gadolinium). Patients had two weeks after MRI examination. PET-CT scanning with ~ (18) F-FDG and ~ (11) C-MET as tracer. Analysis and discussion, (1) the weight of various imaging features for differential diagnosis of diffuse glioma and swelling demyelinating disease; (2) the value of two different tracer PET-CT for the diagnosis of the acute stage of swollen demyelinating disease; (3) CT scan The value of the differential diagnosis of glioma. R 3.3.2 was used to analyze the data statistically. The results were included in the 14 target literature with reference to the set standard. The study involved in each literature included conventional MRI examination. At the same time, 4 of them involved ~ (18) F-FDG PET-CT; 5 literature involved ~ (11) C-MET PET-CT; 5 literature involved ~ (18). F-FET PET-CT; 3 papers related to ~ (18) F-FLT PET-CT. which contains a single document involving a variety of different tracers of PET-CT. The literature has the inherent limitations that can not be ignored. Therefore, the final conclusions draw a non quantitative system evaluation method. Conventional MRI, as the cornerstone of the diagnosis of glioma, can provide more Direct preliminary diagnosis information. Based on different imaging mechanisms, conventional MRI shows much higher ability to display anatomical structures than PET-CT., but PET-CT shows that cells with active MRI. can take ~ (18) F-FDG to show the necrotic tissues within the glioma. ~ (11) C-MET PET-CT shows gliomas. The boundary is closer to the conventional MRI than the biological boundary, providing more accurate information for surgical treatment. These two all have the ability to predict the malignancy of glioma. Compared with ~ (18) F-FLT PET-CT, the tumor boundary displayed by ~ (18) F-FET PET-CT is closer to the biological boundary of the tumor. ~ (18) F-FET PET-CT is a diagnostic tool for high grade glioma The case study found that the value of the occupying effect and the degree of peripheral edema in the differential diagnosis of glioma and swollen demyelinating lesions is statistically significant for the formation of a correct initial diagnosis. ~ (18) F-FDG PET-CT and ~ (11) C-MET PET-CT are for glioma and swelling. The value of differential diagnosis of demyelinating disease is also of statistical significance. Combined with the information obtained by the two, it can form a more correct guidance for the diagnosis of the treatment plan. Conclusion conventional MRI scan can show the anatomical structure of glioma more clearly; the PET-CT scan of different tracers based on the metabolic level of tumor to glioma The diagnosis of gliomas provided by PET-CT with different tracers is different. The value of conventional MRI imaging features for the diagnosis of gliomas, the differential diagnosis of gliomas and swelling demyelinating lesions has been widely recognized. The differential diagnosis based on such a point is statistically significant in the differential diagnosis of the two For some cases of demyelinating lesions characterized by atypical MRI characteristics, conditional units can perform ~ (18) F-FDG PET-CT and ~ (11) C-MET PET-CT examination to provide additional information. In addition, the first examination after the patient's treatment is CT, for the differential diagnosis of the acute stage of swelling demyelinating lesions and diffuse glioma. It is of special significance. The information provided by different imaging methods can improve the preliminary diagnosis accuracy of glioma to a great extent. The concept of multimodal imaging comprehensive diagnosis and treatment will help the early diagnosis and early treatment of the disease, so as to achieve better prognosis.

【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R739.41;R445.2;R730.44

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本文編號(hào)：1883272