本文選題：腮腺 + 腫瘤　； 參考：《上海交通大學(xué)》2014年碩士論文

【摘要】：目的： ①探究不同b值條件下，腮腺腫瘤中不同區(qū)域（實質(zhì)區(qū)和囊變區(qū)）對表觀彌散系數(shù)（apparent diffusion coefficient, ADC）的影響。 ②評價磁共振彌散加權(quán)成像（diffusion-weighted MR imaging, DW-MRI）區(qū)別腮腺不同腫瘤的診斷價值。 ③對ADC區(qū)別腮腺腫瘤的價值做進一步驗證。 材料和方法： ①對經(jīng)過手術(shù)病理證實并于術(shù)前行DWI檢查的32例腮腺囊實性腫瘤（良性腫瘤22例，惡性腫瘤10例）進行回顧性分析。分別在b值取0，500s/mm2和0，1000s/mm2時，對腫瘤整體、腫瘤實質(zhì)區(qū)和腫瘤囊變區(qū)的ADC均值進行測量，并比較其間差異。 ②對經(jīng)手術(shù)病理證實并于術(shù)前行DWI檢查的162例腮腺腫瘤（良性腫瘤108例，惡性腫瘤54例）進行回顧性分析。在b值取0，1000s/mm2的情況下，選取各個腫瘤實質(zhì)部分作為ROI獲取其ADC均值。比較不同腫瘤之間ADC均值的差異。 ③收集69例擬診腮腺腫瘤并將行手術(shù)治療的病人，術(shù)前行DWI檢查后根據(jù)先前回顧性分析獲得的結(jié)果給予影像學(xué)診斷，并對照病理結(jié)果進行可靠性評估。 結(jié)果： ①32例囊實性腫瘤組：b值取500s/mm2時，腫瘤囊變部分ADC均值為2.44±0.31×10-3mm2/s；實質(zhì)部分為1.35±0.23×10-3mm2/s；整體部分的ADC均值為1.73±0.35×10-3mm2/s。b值取1000s/mm2時，腫瘤囊變部分ADC均值為1.94±0.30×10-3mm2/s；實質(zhì)部分為1.12±0.22×10-3mm2/s；整體部分為1.35±0.28×10-3mm2/s。上述三種取樣法所測腫瘤ADC均值間存在明顯統(tǒng)計學(xué)差異（P0.01）。此外，在選用腫瘤實質(zhì)部分為ROI獲取的ADC均值在惡性腫瘤、腮腺腺淋巴瘤、多形性腺瘤與其他良性腫瘤之間亦存在統(tǒng)計學(xué)差異（P0.01）。 ②169例腮腺腫瘤病例組：腮腺良性腫瘤組ADC均值，，多形性腺瘤（1.46±0.29×10-3mm2/s），腺淋巴瘤（0.86±0.14×10-3mm2/s）和其他良性上皮性腫瘤（1.15±0.36×10-3mm2/s），兩兩間P 0.05；惡性腮腺腫瘤組ADC均值，惡性上皮性腫瘤0.96±0.21×10-3mm2/s和其他惡性腫瘤（包括淋巴瘤和肉瘤，0.71±0.13×10-3mm2/s）兩者間P 0.01。此外，腮腺良性腫瘤（1.15±0.36×10-3mm2/s）和惡性腫瘤（0.88±0.22×10-3mm2/s）的ADC均值之間P 0.01。若以1.125×10-3mm2/s（b=1000s/mm2）為良惡性腫瘤的閾值，獲得的靈敏度是88.9%，特異度50.0%，準(zhǔn)確率63.0%。 ③69例病人研究組中，單純采用ADC值來區(qū)別腮腺良性腫瘤與惡性腫瘤，靈敏度為82.6%，特異度為65.2%，準(zhǔn)確率為71.0%；加入常規(guī)影像學(xué)表現(xiàn)作為參考后診斷腮腺惡性腫瘤的靈敏度為73%，特異度為87%，準(zhǔn)確率為81%。 結(jié)論： ①腮腺腫瘤中囊變和實質(zhì)區(qū)能分別導(dǎo)致不同ADC均值的產(chǎn)生。在b值為0,1000s/mm2時從腮腺腫瘤實質(zhì)區(qū)取樣的ADC均值能為其鑒別診斷提供更多有益信息。 ②DWI對腮腺良性和惡性腫瘤的鑒別診斷能夠提供有價值的信息。 ③ADC值結(jié)合傳統(tǒng)影像學(xué)表現(xiàn)能提高腮腺腫瘤良惡性診斷的準(zhǔn)確率。
[Abstract]:Objective: 1 to explore the conditions of different b values, The effect of different regions (parenchyma and cystic zone) on the apparent diffusion coefficient (apparent diffusion coefficient,) in parotid tumors. 2 to evaluate the diagnostic value of diffusion-weighted diffusion weighted imaging (DW-MRI) in differentiating different tumors of parotid gland. 3 the value of ADC in differentiating parotid gland tumors was further verified. Materials and methods: 1 A retrospective analysis of 32 cases of parotid cystic solid tumor (benign tumor 22 cases, malignant tumor 10 cases) proved by operation and pathology and performed DWI before operation was carried out. The mean values of 0500s/mm2 of the whole tumor, tumor parenchyma and cystic zone were measured at b values of 0500s/mm2 and 0 ~ 1000s / mm ~ 2, respectively. The difference was analyzed retrospectively in 162 cases of parotid gland tumors (108 benign tumors and 54 malignant tumors) proved by operation and pathology and examined by DWI before operation. When b value is 0 ~ 1000s / mm ~ 2, each tumor substance is selected as the ADC mean value of ROI. To compare the difference of ADC mean value among different tumors. 3 69 patients with parotid gland tumors who were diagnosed as parotid gland tumors and treated by operation were examined by DWI before operation, and the imaging diagnosis was performed according to the results obtained from previous retrospective analysis. The reliability was evaluated according to the pathological results. Results: the mean value of 500s/mm2 was 2.44 鹵0.31 脳 10 ~ (-3) mm ~ (-2) / s in cystic tumor group, 1.35 鹵0.23 脳 10 ~ (-3) mm ~ (-2) / s in solid part, 1.94 鹵0.30 脳 10 ~ (-3) mm ~ (-2 / s) in whole part and 1.12 鹵0.22 脳 10 ~ (-3) mm ~ (-2 / s) in whole part. The whole part is 1.35 鹵0.28 脳 10 ~ (-3) mm ~ (-2) / s. There was significant difference in ADC between the three methods (P0.01). In addition, the ADC mean value of ROI obtained in the selection of tumor parenchyma was found in malignant tumors, parotid gland lymphoma, There was also statistical difference between pleomorphic adenoma and other benign tumors (P0.01). In 2169 cases of parotid benign tumors, the mean ADCs of parotid benign tumors, pleomorphic adenomas (1.46 鹵0.29 脳 10-3mm2/s), adenomatous lymphoma (0.86 鹵0.14 脳 10-3mm2/s) and other benign epithelial tumors (1.15 鹵0.36 脳 10-3mm2/s) were observed (P 0.05). The mean value of ADC in malignant parotid tumors was 0.96 鹵0.21 脳 10-3mm2/s for malignant epithelial tumors and 0.71 鹵0.13 脳 10-3mm2/s for other malignant tumors (including lymphoma and sarcoma) (P 0.01). In addition, the mean value of ADCs between benign parotid tumors (1.15 鹵0.36 脳 10-3mm2/s) and malignant tumors (0.88 鹵0.22 脳 10-3mm2/s) was P 0.01. If 1.125 脳 10-3mm2/s (b=1000s/mm2) was used as the threshold value for benign and malignant tumors, the sensitivity was 88.9, the specificity was 50.0 and the accuracy was 63.0. The sensitivity, specificity and accuracy were 82.6, 65.2 and 71.0 respectively, and the sensitivity, specificity and accuracy were 73, 87 and 81, respectively. Conclusion: 1 in parotid gland neoplasms, cystic degeneration and parenchymal region can lead to different ADC mean values. When the b value is 0 ~ 1000s / mm2, the ADC mean value from the parotid tumor parenchyma area can provide more useful information for differential diagnosis. 2DWI can provide valuable information for the differential diagnosis of parotid benign and malignant tumors. ADC value combined with traditional imaging findings can improve the accuracy of benign and malignant diagnosis of parotid tumors.
【學(xué)位授予單位】：上海交通大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R739.8;R445.2

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