本文選題：乳腺病變 + 磁共振成像�。� 參考：《河北醫(yī)科大學》2014年碩士論文

【摘要】：第一部分3.0T MRI乳腺動態(tài)增強曲線半定量分型方法的初步研究 目的：探討3.0T磁共振（MRI）動態(tài)增強曲線的半定量分型方法鑒別乳腺良、惡性病變的診斷價值。 方法：對72例(81個病灶)女性乳腺疾病患者(平均年齡為48.05±12.59歲)行動態(tài)增強掃描。應用半定量方法，采用多個臨界值（每秒平均流出斜率的0.03%、每秒平均流出斜率的0.06%、增強初期后信號變化5%及增強初期后信號變化10%）對動態(tài)增強曲線進行分型，，并參考Fischer評分標準，分析比較不同的臨界值確定的曲線類型聯(lián)合Fischer評分標準中其它評價指標后用于鑒別診斷良、惡性病變的敏感性、特異性及準確性。 結果：每秒平均流出斜率的0.03%、每秒平均流出斜率的0.06%、增強初期后信號變化5%、增強初期后信號變化10%這四個臨界值定量評價曲線類型的受試者工作特征曲線(ROC)的曲線下面積（AUC）分別為0.768、0.736、0.764、0.728；由每秒平均流出斜率的0.03%、每秒平均流出斜率的0.06%、增強初期后信號變化5%、增強初期后信號變化10%四個臨界值確定的曲線類型結合Fischer評分表中其它指標鑒別良惡性病變的敏感性分別為93.18%、90.91%、88.64%及86.36%；特異性分別為67.57%、59.46%、67.56%及59.46%；準確性分別為81.48%、76.54%、79.01%及74.07%。 結論：應用每秒平均流出斜率的0.03%這一臨界值劃分的動態(tài)增強曲線類型最有利于3.0T DCE-MRI對乳腺良惡性病變的鑒別診斷。 第二部分3.0T DW-MRI對乳腺局部病變定量的客觀性研究 目的：通過設計不同的表觀擴散系數(shù)(ADC值)測量的影響因素，驗證3.0T磁共振擴散加權成像（DWI）對乳腺局灶性病變診斷的可重復性 及客觀性。 方法：對53例(61個病灶)女性乳腺疾病患者(平均年齡為47.61±13.09歲)進行DWI掃描。兩名觀察者分別對不同b值(500，700，1000s/mm2)的DWI圖像進行兩個感興趣區(qū)（ROI，ROI/2）ADC值的測量；半年后再由觀察者A對上述病變的ADC值進行重復測量。 結果：1.觀察者間及觀察者內測量的ADC值差異均無統(tǒng)計學意義(P值分別為0.957，0.547)；兩名觀察者間所測量ADC值差值平均值為0.00×10-3mm2/s(一致性界限：-0.32×10-3mm2/s-0.32×10-3mm2/s)；同一觀察者前、后兩次測量的ADC值差值為0.08×10-3mm2/s(一致性界限：-1.26×10-3mm2/s-1.41×10-3mm2/s)。2.在b值相同時，同一觀察者對不同ROI大小測量ADC值的差異均無統(tǒng)計學意義（P0.05）。3.不同b值組間比較，ROI組b=500s/mm2組與b=700s/mm2組間、ROI/2組b=500s/mm2組與b=1000s/mm2組間ADC值的差異均具有統(tǒng)計學意義（P0.05），且前者均大于后者。 結論：3.0T MRI擴散加權成像ADC值在乳腺病變定性診斷中具有較好的客觀性及可重復性，應用同一b值進行疾病診斷更具有臨床價值。 第三部分3.0T DW-MRI不同b值對乳腺良惡性病變診斷閾值的研究 目的：探討3.0T磁共振(MRI)不同擴散敏感因子（b值）下彌散加權成像(DWI)對良、惡性病變的診斷水平。 方法：對53例(61個病灶)女性乳腺疾病患者(平均年齡為47.61±13.09歲)進行DWI掃描，分別在不同b值(500，700，1000s/mm2)下測量病變的ADC值。根據(jù)受試者工作特性曲線（ROC）確定不同b值下DWI鑒別診斷良惡性病變的敏感性、特異性以及鑒別良、惡性病變ADC值的最佳閾值。 結果：三組b值組中，良性病變與惡性病變ADC值的差異均具有統(tǒng)計學意義(P0.05)，且良性組ADC值均大于惡性組。無論是良性組還是惡性組，三個b值組間的ADC值比較差異并不明顯(P0.05)，但經兩兩比較后發(fā)現(xiàn)b=500s/mm2組與b=1000s/mm2組間ADC值存在差異，且差異具有統(tǒng)計學差異(P0.05)。b=500s/mm2時，以1.8×103mm2/s為閾值，鑒別診斷良、惡性病變的敏感度、特異度分別為68%、73%；而b=700s/mm2及b=1000s/mm2時，以ADC閾值分別為1.445×103mm2/s、1.44×103mm2/s，相應鑒別良惡性病變的敏感度、特異度分別為80%、66.7%及72%、80%。 結論：DWI對乳腺良惡性病變的鑒別診斷具有重要價值，當b=700s/mm2時有利于病變的檢出。
[Abstract]:The first part is a preliminary study on semi quantitative typing of 3.0T MRI dynamic enhancement curve.
Objective: To explore the diagnostic value of semi quantitative typing of 3.0T magnetic resonance (MRI) dynamic enhancement curve in differentiating benign and malignant breast lesions.
Methods: dynamic enhanced scan was performed on 72 cases (81 lesions) of female breast disease (average age of 48.05 + 12.59 years). Semi quantitative method was used, using multiple critical values (0.03% of the average outflow rate per second, 0.06% of the average outflow slope per second, enhanced initial signal change 5%, and enhanced initial signal change 10%). The lines were typed, and the Fischer scoring standard was used to analyze the sensitivity, specificity and accuracy of the diagnosis of benign and malignant lesions after the analysis of the different critical values of the curve types combined with the other evaluation indexes in the Fischer scoring standard.
Results: 0.03% of the average outflow slope per second, 0.06% of the average outflow slope per second, the enhancement of the initial signal change 5%, and the enhancement of the initial signal change 10%, the area (AUC) under the curve of the subjects' working characteristic curve (ROC) of the four critical value curve types is 0.768,0.736,0.764,0.728, respectively, and the average outflow slope per second. 0.03%, 0.06% of the average outflow rate per second, the enhanced initial signal change 5%, the enhanced initial signal change 10% four critical values of the curve type combined with the other indicators in the Fischer score table to identify the sensitivity of benign and malignant lesions were 93.18%, 90.91%, 88.64% and 86.36%, and the specificity were 67.57%, 59.46%, 67.56% and 59.46%, respectively. The accuracy was 81.48%, 76.54%, 79.01% and 74.07%., respectively.
Conclusion: the type of dynamic enhancement curve, which is divided by the 0.03% critical value of the average outflow rate per second, is most beneficial to the differential diagnosis of 3.0T DCE-MRI for benign and malignant breast lesions.
The second part is the objectivity of quantitative analysis of breast lesions by 3.0T DW-MRI.
Objective: to verify the repeatability of 3.0T magnetic resonance diffusion-weighted imaging (DWI) in the diagnosis of focal lesions of the breast by designing different factors of apparent diffusion coefficient (ADC) measurement.
And objectivity.
Methods: 53 cases (61 lesions) of women with breast disease (average age of 47.61 + 13.09 years) were scanned by DWI. Two observers measured the ADC values of the DWI images of different b values (5007001000s/mm2) in two regions of interest (ROI, ROI/2), and then repeated the measurements of the ADC values of the above lesions by the viewer A.
Results: there was no significant difference in the ADC values measured between the 1. observers and the observers (P value was 0.957,0.547); the average value of the ADC value difference between two observers was 0 x 10-3mm2/s (-0.32 x 10-3mm2/s-0.32 x 10-3mm2/s), and the difference value of the ADC value of the latter two measurements was 0.08 * 10-3mm2/s before the same observer. Consistency limits: -1.26 x 10-3mm2/s-1.41 x 10-3mm2/s).2., when the b value is the same, there is no statistically significant difference between the same observer on the measurement of ADC values of different ROI sizes (P0.05).3. (P0.05).3. different b values. P0.05), and the former is larger than the latter.
Conclusion: the ADC value of 3.0T MRI diffusion weighted imaging has good objectivity and repeatability in the qualitative diagnosis of breast lesions. It is of more clinical value to use the same b value to diagnose the disease.
The third part is the study of the diagnostic threshold of 3.0T DW-MRI with different b values for benign and malignant breast lesions.
Objective: To evaluate the diagnostic accuracy of diffusion-weighted imaging (DWI) of 3.0T diffusion weighted imaging (MRI) with different diffusion sensitive factors (b) in benign and malignant lesions.
Methods: 53 cases (61 lesions) of women with breast disease (average age of 47.61 + 13.09 years) were scanned by DWI, and the ADC values were measured at different b values (5007001000s/mm2). The sensitivity, specificity, and differential diagnosis of benign and malignant diseases in the differential diagnosis of benign and malignant lesions under different b values were determined according to the working characteristic curve of the subjects (ROC). The best threshold for changing the ADC value.
Results: in the three groups of B values, the difference of ADC values between benign lesions and malignant lesions were statistically significant (P0.05), and the ADC values in the benign group were all larger than those of the malignant group. The ADC values between the benign groups and the malignant groups were not significant (P0.05), but the ADC values between the b=500s/mm2 and the b=1000s/mm2 groups were found after 22 comparison. When the difference was statistically different (P0.05).B=500s/mm2, 1.8 x 103mm2/s was used as threshold value to identify the sensitivity of benign and malignant lesions, the specificity was 68%, 73% respectively. While b=700s/mm2 and b=1000s/mm2, the ADC threshold was 1.445 * 103mm2/s and 1.44 x 103mm2/s respectively, and the sensitivity of the benign and malignant lesions was identified, and the specificity was 8, respectively. 0%, 66.7% and 72%, 80%.
Conclusion: DWI is of great value in the differential diagnosis of benign and malignant breast lesions. When b=700s/mm2 is helpful for the detection of lesions.

【學位授予單位】：河北醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R445.2;R737.9

【引證文獻】

相關期刊論文 前1條

1 尹華;黃瑞歲;胡宗永;袁紅梅;;磁共振診斷乳腺疾病的臨床價值研究[J];中國CT和MRI雜志;2015年11期

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