本文選題：磁共振 + 軟組織肉瘤��； 參考：《山東大學(xué)》2014年博士論文

【摘要】：目的： 觀察軟組織肉瘤的磁共振圖像特征并分析病理高級別與低級別軟組織肉瘤的顯著差異,確定能夠預(yù)測高級別軟組織肉瘤的圖像特征。 材料與方法： 研究經(jīng)本機構(gòu)倫理委員會批準,無需簽署知情同意書�；仡�2010年1月至2013年1月于骨外科及腫瘤科就診的患者臨床資料,順序選取符合條件的患者：經(jīng)病理證實患有軟組織肉瘤的患者；從腫瘤手術(shù)切除的病理結(jié)果中能得到明確的軟組織肉瘤等級；在活檢及任何治療之前,患者曾行MRI檢查,MRI圖像由數(shù)據(jù)庫可得。軟組織肉瘤病理等級按FNCLCC (French Federation of Cancer Centers Sarcoma Group)系統(tǒng)分級。所有病人磁共振圖像(包括平掃及增強掃描圖像)均由兩位經(jīng)驗豐富的骨骼肌肉放射醫(yī)生進行盲法閱片,并達到意見一致。首先,評價并記錄每個病例磁共振序列的圖像質(zhì)量是否達到診斷要求。記錄病變位置,病變大小等。觀察并記錄腫瘤平掃T1/T2加權(quán)磁共振圖像特征：腫瘤信號強度高低,信號均勻性,腫瘤邊界是否清晰；是否有瘤周囊性征象、T2加權(quán)圖像上腫瘤內(nèi)低信號分隔征象、瘤周高信號等；是否有瘤周骨反應(yīng)、是否侵犯骨皮質(zhì)、骨髓等。記錄腫瘤是否有神經(jīng)血管組織包繞,血管是否閉塞。在增強掃描圖像上記錄腫瘤邊界,腫瘤強化程度,以及是否存在瘤周強化。應(yīng)用STATA10.0進行統(tǒng)計分析。病理等級為1級的腫瘤為低級別腫瘤,等級為2級和3級的為高級別腫瘤。Wilcoxon秩和檢驗分析男性與女性病人間年齡差異。x2檢驗評價高級別與低級別軟組織肉瘤的平掃及增強磁共振圖像特征有無顯著差異。計算腫瘤磁共振圖像特征對高級別腫瘤檢出的敏感度、特異度。合并高級別與低級別肉瘤有顯著差異的圖像特征及高敏感度、特異度的特征,以及部分患者信息,建立多變量Logistic回歸分析模型,分析識別出可以獨立預(yù)測高級別腫瘤價值的磁共振圖像特征。 結(jié)果： 在156例病人中,連續(xù)選取了95例符合條件的病例(年齡1-95歲,平均年齡55.5歲)。1級軟組織肉瘤16例,2級34例,3級45例。95例的平掃磁共振圖像質(zhì)量均達到診斷要求,除了一例T2加權(quán)圖像未達到診斷要求,其T2加權(quán)圖像被排除分析。高級別與低級別軟組織肉瘤在以下磁共振特征方面有顯著差異：腫瘤大小(p.01),T2加權(quán)圖像腫瘤信號均勻性(p.01),T2加權(quán)圖像瘤周高信號(p.05),平掃及增強圖像的腫瘤邊界(p.01),瘤周強化表現(xiàn)(p.01)。腫瘤邊界欠清的特征對檢出高級別腫瘤有較高的敏感度、特異度(平掃T1/T2加權(quán)、增強T1加權(quán)圖像分別為：72%和69%,76%和73%,74%和86%)。在95例符合條件的病例中,有82例磁共振檢查有增強掃描圖像。增強掃描圖像質(zhì)量均達到診斷要求。Logistic回歸分析表明,增強掃描T1加權(quán)圖像上瘤周增強表現(xiàn)是獨立預(yù)測高級別軟組織肉瘤的最強特征(比值比13.6；95%可信區(qū)間：2.9,64.6)。 結(jié)論： 在軟組織肉瘤的特點及其磁共振圖像特征中,腫瘤的大小、邊界、部分T2加權(quán)圖像特征及增強表現(xiàn)可以幫助鑒別與低級別有顯著差異的高級別腫瘤；瘤周強化表現(xiàn)可以獨立檢出高級別肉瘤。軟組織肉瘤的MRI圖像征象可以作為活檢的重要補充,提供高級別肉瘤的信息。
[Abstract]:Objective:
The magnetic resonance imaging features of soft tissue sarcoma were observed and the significant difference between high and low grade soft tissue sarcoma was analyzed, and the image features of the advanced soft tissue sarcoma could be predicted.
Materials and methods:
The study, approved by the institutional ethics committee, did not need to sign the informed consent. Review the clinical data of the patients in the osteossurics and oncology department from January 2010 to January 2013, in order to select eligible patients: Patients with soft tissue sarcomas confirmed by pathology; a clear soft group can be obtained from the pathological results removed from the tumor operation. Sarcoma grade; before biopsy and any treatment, MRI examination was performed in patients, MRI images were obtained by database. The pathological grade of soft tissue sarcoma was classified according to FNCLCC (French Federation of Cancer Centers Sarcoma Group) system. All patients' magnetic resonance images (including plain and enhanced scan images) were two experienced skeletal muscles First, evaluate and record the image quality of the MRI sequence of each case, and record the location of the lesion, the size of the lesion, and so on. Observe and record the features of the T1/T2 weighted MRI images: the intensity of the tumor signal, the uniformity of the signal, and the boundary of the tumor. Is it clear whether there are signs of peritumoral cysts, signs of low signal separation in T2 weighted images, high signal peritumoral, whether there is periosteal reaction, invasion of bone cortex, bone marrow, or not, whether the tumor has neurovascular wound, or whether the blood vessels are obliterated. Whether there was peritumoral enhancement. Statistical analysis was performed with STATA10.0. The pathological grade 1 was a low grade tumor with grade 2 and grade 3 for the rank of high grade tumor.Wilcoxon. The age difference between male and female patients was analyzed by.X2 test for the evaluation of high grade and low grade soft group sarcoma and enhanced MRI. The sensitivity, specificity, specificity, high sensitivity, high sensitivity, specificity, and information of some patients with high level and low grade sarcomas, and a multivariable Logistic regression model were established. A magnetic resonance imaging feature of the value of a high level tumor.
Result:
Of 156 patients, 95 consecutive cases (age 1-95, average age 55.5 years old) were selected in 156 cases, 16 cases of grade soft tissue sarcoma, 34 cases of grade 2, and 3 level 45 cases of plain scan magnetic resonance imaging quality met the diagnostic requirements. Except for one case of T2 weighted images, the T2 weighted image was excluded and analyzed. High grade and low grade There were significant differences in the following magnetic resonance characteristics of soft tissue sarcoma: tumor size (P.01), T2 weighted image tumor signal uniformity (P.01), T2 weighted image high signal (p.05), plain scan and enhanced image tumor boundary (P.01), peritumoral enhancement (P.01). The characteristics of the tumor boundary were highly sensitive to the detection of high grade tumors. Sensitivity, specificity (T1/T2 weighted, enhanced T1 weighted images were 72% and 69%, 76% and 73%, 74% and 86%). In 95 cases of eligible cases, there were 82 MRI enhanced scan images. The enhanced scan image quality reached the diagnostic requirement.Logistic regression analysis, and the enhanced scan T1 weighted image on the tumor Zhou Zengqiang performance was Independent prediction of the strongest features of high-grade soft tissue sarcoma (odds ratio 13.6; 95% confidence interval: 2.9,64.6).
Conclusion:
In the characteristics of soft tissue sarcoma and its magnetic resonance imaging features, the size, boundary, T2 weighted image features and enhanced performance of the tumor can help identify high grade tumors with significant differences in the low level. High grade sarcomas can be detected independently of the fortified peritumoral performance. The MRI image of the soft tissue sarcoma can be used as a biopsy. To supplement the information of high grade sarcoma.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2014
【分類號】：R445.2;R738.6

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相關(guān)期刊論文 前1條

1 劉慶余;李海剛;陳建宇;梁碧玲;;59例軟組織肉瘤的MRI特征與組織病理分級的關(guān)系[J];癌癥;2008年08期

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