本文選題：磁共振成像 + 腦腫瘤　； 參考：《重慶醫(yī)科大學(xué)》2014年碩士論文

【摘要】：第一部分腦轉(zhuǎn)移瘤的MRI特征研究 目的探討腦轉(zhuǎn)移瘤磁共振成像（magnetic resonance imaging,MRI）的特征性表現(xiàn)，以提高腦轉(zhuǎn)移瘤檢出的準(zhǔn)確率。 方法對原發(fā)灶經(jīng)病理證實的68例腦轉(zhuǎn)移瘤患者，均行磁共振常規(guī)MRI平掃及增強(qiáng)掃描，觀察并記錄腦轉(zhuǎn)移瘤的發(fā)生部位、大小、數(shù)目、形態(tài)、強(qiáng)化特點、瘤周水腫及周圍組織受累情況等特征，分析腦轉(zhuǎn)移瘤在MRI各序列上的表現(xiàn)及檢出率。 結(jié)果68例腦轉(zhuǎn)移瘤各序列共檢出867個病灶。單發(fā)腦轉(zhuǎn)移瘤19例(19/68,27.94%)，多發(fā)轉(zhuǎn)移瘤46例(46/68,67.65%)，顱骨轉(zhuǎn)移3例(3/68,4.41%)；發(fā)生在幕上轉(zhuǎn)移者38例(38/68,55.88%)，額葉最多見，幕下轉(zhuǎn)移者2例(2/68,2.94%)，幕上幕下均有轉(zhuǎn)移者25例(25/68，36.76%)。其中，有瘤周水腫者49例；伴囊變、壞死者56例，出血者11例；伴腦膜轉(zhuǎn)移者22例。平掃：T1WI檢出165個（165/867,19.38%），其中高信號為36個（36/165,21.82%），余病灶多為等或低信號；T2WI、T2-FLAIR、DWI，病灶多為等或高信號。增強(qiáng)掃描：增強(qiáng)T1WI檢出病灶867個（867/867,100%）。強(qiáng)化方式：結(jié)節(jié)型強(qiáng)化541個，環(huán)形強(qiáng)化為223個，，混合型強(qiáng)化為103個。單發(fā)腦轉(zhuǎn)移瘤病灶大小為0.50～5.77cm，平均2.43cm±1.48cm，其表現(xiàn)與腦轉(zhuǎn)移瘤的共同特征相符。 結(jié)論研究腦轉(zhuǎn)移瘤MRI特征性表現(xiàn)，有利于腦轉(zhuǎn)移瘤的診斷及鑒別診斷，可提高腦轉(zhuǎn)移瘤的檢出率及診斷的準(zhǔn)確率。 第二部分腦轉(zhuǎn)移瘤的MRI序列優(yōu)化研究 目的探討MRI常規(guī)序列、T1加權(quán)三維成像（three-dimensional T1weighted imaging,3D-T1WI）序列診斷腦轉(zhuǎn)移瘤的價值，優(yōu)化腦轉(zhuǎn)移瘤MRI掃描方案。 方法收集原發(fā)灶經(jīng)病理證實的35例腦轉(zhuǎn)移瘤患者，均行MR常規(guī)序列及3D-T1WI平掃和增強(qiáng)掃描，分析各序列對腦轉(zhuǎn)移瘤的檢出率，并對比常規(guī)掃描方案與優(yōu)化掃描方案的掃描時間。 結(jié)果35例腦轉(zhuǎn)移瘤各序列共檢出609個病灶；平掃T1WI序列檢出病灶101個（101/609,16.58%）， T2WI序列檢出155個（155/609,25.45%），T2-FLAIR序列檢出235個（235/609,38.59%），DWI（b=0）序列檢出176個（176/609,28.90%），3D-T1WI序列檢出228個（228/609,37.44%）；增強(qiáng)T1WI序列檢出427個（427/609,70.11%），增強(qiáng)3D-T1WI序列檢出609個（609/609,100%）；其中病灶直徑1.0cm者547個，直徑為1.0~3.0cm者60個，直徑3.0cm者2個；有瘤周水腫者263個；常規(guī)方案MRI掃描共用時638s，優(yōu)化后3D-T1WI序列掃描方案用時575s。平掃及增強(qiáng)3D-T1WI序列對腦轉(zhuǎn)移瘤的檢出率明顯高于平掃及增強(qiáng)T1WI序列(p均＜0.05)；DWI（b=0）序列與T2WI序列對腦轉(zhuǎn)移瘤的檢出率差異無統(tǒng)計學(xué)意義（p＞0.05）。 結(jié)論3D-T1WI序列及增強(qiáng)掃描的運用，可顯著提高腦轉(zhuǎn)移瘤的檢出率，尤其對于＜1.0cm且未見明確瘤周水腫的轉(zhuǎn)移灶，其診斷意義更大。優(yōu)化腦轉(zhuǎn)移瘤磁共振掃描方案，可用3D-T1WI序列替代常規(guī)T1WI序列掃描，DWI（b=0）序列替代T2WI序列，以提高腦轉(zhuǎn)移瘤檢出率，縮短掃描時間。
[Abstract]:Part I MRI features of brain metastases objective to investigate the (magnetic resonance imaging features of brain metastases in order to improve the accuracy of detection of brain metastases. Methods Sixty-eight patients with brain metastases confirmed by pathology were examined with conventional MRI and enhanced MRI. The location, size, number, morphology and enhancement of brain metastases were observed and recorded. The features of peritumoral edema and surrounding tissue involvement were analyzed and the MRI findings and detection rate of brain metastases were analyzed. Results A total of 867 lesions were detected in 68 cases of brain metastases. There were 19 cases of single brain metastases (19 / 68 27.94%), 46 cases of multiple metastases (46 / 6867.65%), 3 cases of skull metastases (3 / 686.41%), 38 cases of supratentorial metastases (38 / 68 / 55.88%), 2 cases of subtentorial metastasis (2 / 68 / 2.94%) and 25 cases of subtentorial metastases (25 / 6836.76%). Among them, there were 49 cases with peritumoral edema, 56 cases with cystic degeneration, 11 cases with hemorrhage and 22 cases with meningeal metastasis. 165 cases (165 / 867 / 19.38%) were detected on T1WI, of which 36 were hyperintense (36 / 165 / 21.82%), others were iso-or hypointense T2WIMr T2-FLAIRDWI, and most of the lesions were isointense or hyperintense. Enhanced scan: 867 lesions were detected on T 1WI (867 / 867100%). Enhancement pattern: 541 nodular enhancement, 223 ring enhancement and 103 mixed enhancement. The lesion size of single brain metastases was 0.50 ~ 5.77 cm (mean 2.43cm 鹵1.48 cm), which was consistent with the common features of brain metastases. Conclusion studying MRI features of brain metastases is helpful to the diagnosis and differential diagnosis of brain metastases, and can improve the detection rate and diagnostic accuracy of brain metastases. Part II study on MRI sequence Optimization of brain Metastases objective to evaluate the value of conventional three-dimensional T1-weighted three-dimensional imaging (three-dimensional T1-weighted imaging 3D-T1WI) in the diagnosis of brain metastases, and to optimize the MRI scanning scheme of brain metastases. Methods 35 patients with brain metastases confirmed by pathology were examined with conventional Mr sequence and 3D-T1WI plain scan and enhanced scan. The detectable rate of brain metastases was analyzed and the scanning time between conventional and optimized scanning schemes was compared. Results A total of 609 lesions were detected in 35 cases of brain metastases, 101 lesions were detected on plain T1WI (101 / 609 / 16.8%), 155 on T2WI (155 / 60925.45%) and 235 (235 / 6038.59%) by T2-flair, 176 (176p / 60928.90%) / 3D-T1WI were detected on 3D-T1WI (228r-60937.44%). 427 (427 / 609) and 609 (609 / 609100%) were detected on enhanced T1WI and 609 / 609100% on enhanced 3D-T1WI, among them, 547 lesions were 1.0cm, 60 were 1.0~3.0cm, 2 were 3.0cm, 263 were peritumoral edema. The routine MRI scan time was 638s, and the optimized 3D-T1WI sequence was 575s. The detection rate of brain metastases on plain and enhanced 3D-T1WI sequences was significantly higher than that on plain and enhanced T1WI sequences (p < 0.05). There was no significant difference in the detectable rate of brain metastases between DWI and T2WI (p > 0.05). Conclusion 3D-T1WI sequence and contrast-enhanced scan can significantly improve the detection rate of brain metastases, especially for the metastases with less than 1.0cm and without definite peritumoral edema, which is of great significance in the diagnosis of brain metastases. In order to improve the detection rate and shorten the scanning time of brain metastases, 3D-T1WI sequence can replace the conventional T1WI (bt0) sequence instead of T2WI sequence.
【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R445.2

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