本文選題：動態(tài)磁敏感對比增強(qiáng) + 三維準(zhǔn)連續(xù)動脈自旋標(biāo)記�。� 參考：《中國人民解放軍醫(yī)學(xué)院》2014年博士論文

【摘要】：第一部分動態(tài)磁敏感對比增強(qiáng)與三維準(zhǔn)連續(xù)動脈自旋標(biāo)記灌注成像在腦神經(jīng)上皮腫瘤分級評估中的對照研究 目的：通過比較高級別腫瘤組與低級別腫瘤組腫瘤最大血流量與正常小腦白質(zhì)血流量的比值（nCBF）以及最大相對血流量與正常小腦白質(zhì)血流量的比值（nrCBF）組間差異，回顧性分析動態(tài)磁敏感對比（DSC）增強(qiáng)灌注成像和三維準(zhǔn)連續(xù)動脈自旋標(biāo)記成像（3D-PCASL）在腦神經(jīng)上皮腫瘤分級中的診斷準(zhǔn)確性。 材料與方法：62個經(jīng)病理證實的神經(jīng)上皮腫瘤病人術(shù)前行常規(guī)磁共振平掃、3D-PCASL、團(tuán)注造影劑的同時行DSC灌注成像，然后行常規(guī)增強(qiáng)掃描。運用后處理圖像，根據(jù)3D-PCASL-CBF圖及DSC-rCBF圖，術(shù)后測量腫瘤區(qū)最大CBF值及正常小腦白質(zhì)區(qū)CBF值并求比值（nCBF），同樣的方法測量nrCBF值，按照病理結(jié)果分高、低級別組進(jìn)行相應(yīng)參數(shù)的統(tǒng)計學(xué)分析和Pearson相關(guān)性分析。 結(jié)果：低級別腫瘤組平均nCBF值（1.796±1.289）明顯低于高級別組（4.329±2.046），差異具有統(tǒng)計學(xué)意義（P＜0.05）。低級別腫瘤組平均nrCBF值（1.778±1.209）明顯低于高級別組（5.927±3.448），差異同樣具有統(tǒng)計學(xué)意義（P＜0.05）。腫瘤nCBF與nrCBF值存在明顯正相關(guān)關(guān)系，相關(guān)系數(shù)為0.790（P＜0.001）。結(jié)論：由于諸多內(nèi)在的優(yōu)勢，3D-PCASL完全可以用于評價腫瘤微血管灌注情況，明確區(qū)分高級別及低級別神經(jīng)上皮腫瘤，具有與DSC相當(dāng)?shù)脑\斷效能，在需要反復(fù)隨訪和不適宜用造影劑的病例，可作為DSC的優(yōu)先選擇方法。 第二部分多b值擴(kuò)散加權(quán)成像在腦神經(jīng)上皮腫瘤分級評估中的應(yīng)用 目的：分別以標(biāo)準(zhǔn)DWI和動態(tài)磁敏感對比（DSC）增強(qiáng)灌注成像為對照，評價多b值擴(kuò)散加權(quán)成像（DWI）擴(kuò)散參數(shù)和灌注相關(guān)參數(shù)在神經(jīng)上皮腫瘤分級中的應(yīng)用價值。 材料與方法：62個經(jīng)病理證實的神經(jīng)上皮腫瘤病人術(shù)前行常規(guī)磁共振、多b值DWI以及DSC檢查、常規(guī)增強(qiáng)掃描。分別以腫瘤內(nèi)rCBF熱點區(qū)為參照，測量腫瘤內(nèi)多b值DWI單指數(shù)模型、雙指數(shù)模型與灌注相關(guān)參數(shù)fast ADC-mono、fraction of fastADC-mon、fast ADC-bi、fraction of fast ADC-bi值，以腫瘤內(nèi)標(biāo)準(zhǔn)DWI中最低ADC值為參照，測量腫瘤內(nèi)多b值DWI單指數(shù)模型、雙指數(shù)模型與擴(kuò)散相關(guān)參數(shù)slowADC-mono、slow ADC-bi值以及拉伸指數(shù)模型DDC和α值，按照病理結(jié)果分高低級別腫瘤組分別與相關(guān)參數(shù)進(jìn)行組間統(tǒng)計學(xué)差異分析。 結(jié)果：以rCBF值為參照，低級別組平均fast ADC-mono值（3.794±2.186）×10-3mm2/s稍低于高級別組（4.030±1.597）×10-3mm2/s，差異無明顯統(tǒng)計學(xué)意義（P=0.612）。低級別組平均fraction of fast ADC-mono值（0.398±0.217）稍低于高級別組（0.419±0.172），差異無明顯統(tǒng)計學(xué)意義（P=0.356）。低級別組平均fast ADC-bi值（10.578±14.261）×10-3mm2/s與高級別組（13.141±12.895）×10-3mm2/s無明顯差異（P=0.462）。低級別組平均fraction of fast ADC-bi值（0.558±0.173）稍低于高級別組（0.679±0.157），差異無明顯統(tǒng)計學(xué)意義（P=0.172）。標(biāo)準(zhǔn)DWI中低級別腫瘤組最小ADC值（0.939±0.436）×10-3mm2/s明顯高于高級別組（0.560±0.191）×10-3mm2/s，差異有明顯統(tǒng)計學(xué)意義（P=0.005）。以標(biāo)準(zhǔn)DWI中最小ADC值為參照，低級別組平均slow ADC-mono值（0.777±0.315）×10-3mm2/s明顯高于高級別組（0.488±0.163）×10-3mm2/s，差異有明顯統(tǒng)計學(xué)意義（P=0.004）。低級別組平均slow ADC-bi值（0.675±0.726）×10-3mm2/s高于高級別組（0.319±0.276）×10-3mm2/s，但無明顯差異（P=0.091）。低級別組平均DDC值（1.200±0.670）×10-3mm2/s高于高級別組（0.617±0.235）×10-3mm2/s，差異具有明顯統(tǒng)計學(xué)意義（P=0.006）。低級別組平均α值（0.878±0.085）與高級別組0.834±0.107差異無明顯統(tǒng)計學(xué)意義（P=0.191）。 結(jié)論：在神經(jīng)上皮腫瘤分級中，多b值DWI單、雙指數(shù)模型與灌注相關(guān)參數(shù)尚不具有分級價值，能否體現(xiàn)腫瘤的灌注情況還有待進(jìn)一步實驗證實。多b值DWI單、雙指數(shù)模型與擴(kuò)散相關(guān)參數(shù)及拉伸指數(shù)模型參數(shù)比標(biāo)準(zhǔn)ADC更能夠體現(xiàn)腫瘤的真實擴(kuò)散情況，其中以slow ADC-mono差異最明顯。 第三部分聯(lián)合不同灌注成像技術(shù)與多b值擴(kuò)散加權(quán)成像在腦神經(jīng)上皮腫瘤分級評估中的應(yīng)用 目的：分別聯(lián)合動態(tài)磁敏感對比增強(qiáng)（DSC）灌注成像與多b值DWI和三維準(zhǔn)連續(xù)動脈自旋標(biāo)記（3D-PCASL）灌注成像與多b值DWI成像方法，分析比較聯(lián)合灌注與多b值DWI雙模態(tài)技術(shù)與任何單一模態(tài)技術(shù)在神經(jīng)上皮腫瘤中的分級效能。 材料與方法：62個經(jīng)病理證實的腦神經(jīng)上皮腫瘤病人術(shù)前行常規(guī)磁共振、多b值DWI（0～4000s/mm2，一共12個b值）、3D-PCASL及DSC檢查。提取前述有關(guān)灌注參數(shù)與擴(kuò)散參數(shù)，按照高低級別腫瘤組分組分別進(jìn)行ROC曲線分析及相關(guān)性分析，確定各自診斷閾值，分析評估各自及聯(lián)合診斷效能。 結(jié)果：如前所述，腫瘤nCBF與nrCBF值存在明顯正相關(guān)關(guān)系，相關(guān)系數(shù)為0.790（P＜0.001），以nCBF值2.380和nrCBF值3.134作為閾值，，可分別達(dá)到93.3%、96.7%的診斷敏感性，81.3%、87.5%的特異性和85.4%、91.9%的準(zhǔn)確性。腫瘤nCBF或nrCBF與slow ADC-mono值存在明顯負(fù)相關(guān)關(guān)系，相關(guān)系數(shù)分別為R=-0.519（P＜0.001）和R=-0.537（P＜0.001），以slow ADC-mono值0.578×10-3mm2/s作為診斷閾值，能夠達(dá)到95.1%的診斷敏感性，64.3%的特異性和82.3%的準(zhǔn)確性。分別聯(lián)合腫瘤nCBF或nrCBF與slow ADC-mono值，能夠達(dá)到96.7%和97.3%診斷敏感性、94.4%和92.3%特異性、90.3%和93.7%的準(zhǔn)確性。 結(jié)論：分別聯(lián)合兩種灌注成像技術(shù)與多b值DWI可以明顯提高腦神經(jīng)上皮腫瘤的分級診斷效能，尤其是三維準(zhǔn)連續(xù)動脈自旋標(biāo)記灌注成像聯(lián)合多b值DWI，由于不用造影劑而具有更加廣泛的臨床應(yīng)用前景。
[Abstract]:Comparative study of dynamic magnetic susceptibility contrast enhancement and three - dimensional quasi - continuous artery spin - labeled perfusion imaging in the assessment of neuroepithelial tumors

Objective : To investigate the diagnostic accuracy of dynamic magnetic sensitivity contrast ( DSC ) - enhanced perfusion imaging and three - dimensional quasi - continuous arterial spin - labeled imaging ( 3D - PCASL ) in the classification of brain neuroepithelial tumors by comparing the ratio of maximum blood flow ( nCBF ) and the ratio of maximum relative blood flow ( nCBF ) and normal cerebellar white blood flow ( nCBF ) between high - grade tumor group and low - grade tumor group .

Materials and Methods : Sixty - two patients with neuroepithelial tumor proved by pathology underwent conventional magnetic resonance plain scan , 3D - PCASL , bolus contrast agent simultaneous scanning calorimetry ( DSC ) perfusion imaging , followed by routine enhanced scanning . Using post - processing image , the maximal CBF value and CBF value of normal cerebellum were measured and the ratio ( nCBF ) was measured in the same way . The statistical analysis of the parameters and Pearson correlation analysis were performed according to the pathological results .

Results : The mean nCBF value of low grade tumor group ( 1.796 鹵 1.289 ) was significantly lower than that in the advanced group ( 4.329 鹵 2.46 ) . The difference was statistically significant ( P < 0.05 ) .

Application of the second part of multi - b - valued diffusion - weighted imaging in the assessment of neuroepithelial tumors

Objective : To evaluate the value of diffusion - weighted imaging ( DWI ) diffusion parameters and perfusion - related parameters in the classification of neuroepithelial tumors by contrast with standard DWI and dynamic magnetic sensitive contrast ( DSC ) .

Materials and Methods : Sixty - two patients with neuroepithelial tumor proved by pathology were subjected to routine magnetic resonance , multi - b - value DWI , DSC and conventional enhancement scanning . The tumor was divided into multiple - index DWI single - index model , dual - exponential model and perfusion - related parameters fast ADC - bi , fraction of fast ADC - bi values .

Results : The average fast ADC - bi values of low - grade group were significantly higher than that in the advanced group ( P = 0 . 05 ) . The mean slow ADC - bi values ( 0 .

Conclusion : In the classification of neuroepithelial tumors , the multi - value DWI alone , biexponential model and perfusion - related parameters are not of the hierarchical value , and whether the perfusion of tumor can be demonstrated . The multi - b - value DWI single , double exponential model and diffusion - related parameters and tensile index model parameters can reflect the true diffusion of tumors more clearly than the standard ADC , with slow ADC - mono difference being the most obvious .

Application of the third part combined with different perfusion imaging techniques and multi - b - value diffusion weighted imaging in the assessment of brain neuroepithelial tumors

Objective : To compare the imaging of dynamic magnetic susceptibility contrast enhancement ( DSC ) perfusion imaging with multi - b - value DWI and 3D - PCASL perfusion imaging and multi - b - value DWI imaging .

Materials and Methods : Sixty - two patients with neuroepithelial tumors confirmed by pathology underwent conventional magnetic resonance , multi - b - value DWI ( 0 - 4000s / mm2 , total 12 b - values ) , 3D - PCASL and DSC . The above - mentioned perfusion parameters and diffusion parameters were extracted , ROC curve analysis and correlation analysis were carried out according to the tumor component groups at high and low levels , and the respective diagnostic thresholds were determined , and their respective diagnostic efficacy were analyzed and assessed .

Results : As mentioned earlier , there was a positive correlation between the nCBF values of tumor nCBF and the value of nCBF , the correlation coefficient was 0.790 ( P < 0.001 ) , and the accuracy of 95.3 % , 97.7 % , 81.3 % , 87.5 % specificity and 85.4 % , 91.9 % accuracy respectively . The correlation coefficients were as follows : R = - 0.519 ( P & lt ; 0.001 ) and R = - 0.537 ( P & lt ; 0.001 ) .

Conclusion : Combination of two perfusion imaging techniques and multi - b - value DWI can significantly improve the classification and diagnostic efficacy of brain neuroepithelial tumors , especially in three - dimensional quasi - continuous artery spin - labeled perfusion imaging combined with multi - b - value DWI , which has a wider clinical application prospect due to the use of contrast agents .
【學(xué)位授予單位】：中國人民解放軍醫(yī)學(xué)院
【學(xué)位級別】：博士
【學(xué)位授予年份】：2014
【分類號】：R739.41;R445.2

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