本文選題：腦星形細(xì)胞瘤 + 氫質(zhì)子磁共振波譜��； 參考：《浙江大學(xué)》2014年碩士論文

【摘要】：目的： 分析腦星形細(xì)胞瘤的氫質(zhì)子3D多體素磁共振波譜(proton magnetic resonance spectroscopy,1H-MRS)表現(xiàn),研究NAA, Cho, Cr, Lac and Lip等主要代謝物數(shù)據(jù),測量NAA/Cr, NAA/Cho, Cho/Cr, Lac/Cr的比值變化,初步研究腦星形細(xì)胞瘤1H-MRS術(shù)前分級診斷及其與病理級別相關(guān)性。 方法： 收集自2009年1月至2014年3月在浙江大學(xué)醫(yī)學(xué)院附屬第二醫(yī)院住院經(jīng)手術(shù)病理證實(shí)的45例腦星形細(xì)胞瘤患者,性別構(gòu)成為男患者29例,女患者16例,年齡范圍10-65歲,平均年齡為45歲�；颊呤装l(fā)癥狀：頭痛或頭暈44例,單側(cè)或雙側(cè)肢體無力20例,抽搐發(fā)作13例,病程最短時(shí)間為5小時(shí),最長達(dá)3年,內(nèi)對照部位設(shè)為腫瘤對側(cè)正常腦組織。所有入組患者之前均無手術(shù)及放化療史。研究設(shè)備采用GE3.0T高場磁共振成像系統(tǒng),所有患者均先行常規(guī)磁共振成像掃描,隨后進(jìn)行3D多體素1H-MRS檢查,采集數(shù)據(jù)的感興趣區(qū)(region of interest, ROI)設(shè)定于腫瘤瘤體區(qū),正常對照區(qū)及瘤周區(qū)。波譜技術(shù)選擇點(diǎn)分辨波譜分析法(PRESS)采集相關(guān)信號,然后將采集的MRS原始數(shù)據(jù)傳送到后處理工作站進(jìn)行處理,分別得到N-乙酰天門冬氨酸(NAA),膽堿(Cho),肌酸(Cr),脂質(zhì)(Lip),肌醇(mI)和乳酸(Lac)等化合物峰高度及峰下面積,進(jìn)一步通過計(jì)算NAA/Cr, NAA/Cho, Cho/Cr, Lac/Cr等比值,根據(jù)手術(shù)病理結(jié)果,依照WHO2007年新分類診斷標(biāo)準(zhǔn)分成兩組：分別為高級別腦星形細(xì)胞瘤組(n=28)及低級別腦星形細(xì)胞瘤組(n=17)。分析腦星形細(xì)胞瘤波譜表現(xiàn)及高低級別組間差異。 結(jié)果： 腦星形細(xì)胞瘤3D多體素1H-MRS主要表現(xiàn)為膽堿(Cho)見顯著增高,N-乙酰天門冬氨酸(NAA)明顯下降,肌酸(Cr)基本穩(wěn)定,可輕度上升或下降。在低級別星形細(xì)胞瘤組檢測出3例Lac峰,而在高級別星形細(xì)胞瘤組12例出現(xiàn)Lac峰,同時(shí)高級別組11例出現(xiàn)Lip峰；腦星形細(xì)胞瘤腫瘤組織與對照側(cè)正常腦組織的NAA/Cho, Cho/Cr, NAA/Cr比值存在顯著性差異(P0.05); NAA/Cho、NAA/Cr比值在高低級別腦星形細(xì)胞瘤瘤周近區(qū)存在顯著性差異(P0.05); NAA/Cho、 NAA/Cr比值在高級別腦星形細(xì)胞瘤和低級別腦星形細(xì)胞瘤的腫瘤組織有統(tǒng)計(jì)學(xué)差異(P0.05),腫瘤瘤體區(qū)NAA/Cho比值與腫瘤的級別呈負(fù)相關(guān)(r=-0.542,P0.05),NAA/Cr與腫瘤級別負(fù)相關(guān)(r=-0.502, P0.05), Cho/Cr比值與腫瘤的級別呈正相關(guān)(r=0.420,P0.05)。結(jié)論： 3D多體素1H-MRS能夠?yàn)槟X星形細(xì)胞瘤術(shù)前分級提供定量診斷依據(jù),腫瘤組織與對照側(cè)正常腦組織的NAA/Cr, NAA/Cho, Cho/Cr比值存在顯著性差異；高級別腦星形細(xì)胞瘤和低級別腦星形細(xì)胞瘤腫瘤組織的NAA/Cr, NAA/Cho比值有統(tǒng)計(jì)學(xué)差異,高低級別腦星形細(xì)胞瘤瘤周近區(qū)NAA/Cr, NAA/Cho比值存在顯著性差異,腦星形細(xì)胞瘤的病理級別與多代謝物比值有相關(guān)性,代謝物比值可作為分級診斷依據(jù),可以為臨床治療方案的制定提供幫助,具有臨床應(yīng)用價(jià)值。
[Abstract]:Objective: The proton 3D multibody-voxel magnetic resonance spectroscopy (1H-MRS) of brain astrocytoma was analyzed, and the main metabolites such as NAA, Cho, Cr, Lac and Lip were studied. The ratios of NAA / Cr, NAA / Cr, Chor / Cr, Lac/Cr were measured. To study the preoperative grade diagnosis of astrocytoma by 1H-MRS and its correlation with pathological grade. Methods: From January 2009 to March 2014, 45 patients with brain astrocytoma confirmed by surgery and pathology were admitted to the second affiliated Hospital of the School of Medicine of Zhejiang University. There were 29 male and 16 female patients, aged 10-65 years. The average age is 45 years. The initial symptoms were headache or dizziness in 44 cases, unilateral or bilateral limb weakness in 20 cases, convulsion in 13 cases. The shortest course of disease was 5 hours and the longest was 3 years. All the patients had no history of surgery and chemotherapy before admission. The GE3.0T high-field magnetic resonance imaging system was used in the study. All the patients were scanned by conventional magnetic resonance imaging (MRI), and then the 3D multivoxel 1H-MRS was performed. The region of interest of interest, ROI) of the collected data was located in the tumor area. Normal control area and surrounding tumor area. The point resolution spectrum analysis method (PRESS) is used to collect the related signals, and then the collected MRS raw data is transmitted to the post-processing workstation for processing. The peak height and area under the peak of N- acetyl aspartate, choline chorus, creatine, lipids, inositol and lactate Lacs were obtained, and the ratios of NAA / Cr, NAA / P ChoC, Chor / CrCr, Lac/Cr and so on were calculated according to the results of surgery and pathology. According to the new classification and diagnosis criteria of WHO2007's year, they were divided into two groups: high grade astrocytoma group (n = 28) and low grade brain astrocytoma group (n = 17). The spectrum of astrocytoma and the difference between high and low grade groups were analyzed. Results: In brain astrocytoma, the main 1H-MRS of 3D polypeptide was choline chondrocytoma. The increase of NAA of N-acetylaspartate was obviously decreased, the creatine Cr) was stable, and the content of creatine was slightly increased or decreased. Lac peak was detected in 3 cases in low grade astrocytoma group, Lac peak in 12 cases in high grade astrocytoma group and Lip peak in 11 cases in high grade astrocytoma group. There were significant differences in the ratios of NAA / ChoR, Cho-Cr, NAA/Cr between the tumor tissues of brain astrocytoma and the normal brain tissues of the control side (P0.05), the ratio of NAA / Cho-NAA / Cr / Cr in the proximal area around the tumors of brain astrocytomas of high and low grade had significant difference (P0.05A), and the ratios of na / Choand NAA/Cr in the high-grade brain astrocytomas were significantly different (P < 0.05). There was a significant difference in tumor tissue between tumor and low grade astrocytoma (P 0.05). The ratio of NAA/Cho in tumor area was negatively correlated with the grade of tumor. There was a negative correlation between the ratio of NAA / Cr and the grade of tumor. There was a positive correlation between the ratio of Cho/Cr and the grade of tumor. Conclusion: 3D multivoxel 1H-MRS could provide quantitative diagnostic basis for preoperative grading of brain astrocytoma. There were significant differences in the ratios of NAA / Cr, NAA / Choand Cho/Cr between tumor tissues and normal brain tissues of the control side. The ratio of NAA / Cr, NAA/Cho in high grade brain astrocytoma and low grade brain astrocytoma was significantly different from that in high grade brain astrocytoma and low grade brain astrocytoma, and the ratio of NAA / Cr and NAA/Cho was significantly different between high grade brain astrocytoma and low grade brain astrocytoma. The pathological grade of astrocytoma is correlated with the ratio of multiple metabolites. The ratio of metabolites can be used as the basis of grading diagnosis and can provide help for the formulation of clinical treatment plan. It has clinical application value.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R445.2;R739.4

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