本文關(guān)鍵詞： 宮頸癌 磁共振功能成像 灌注加權(quán)成像 波譜成像　出處：《大連醫(yī)科大學(xué)》2014年碩士論文　論文類型：學(xué)位論文

【摘要】：目的：應(yīng)用磁共振灌注加權(quán)成像（PWI）和磁共振波譜成像（MRS）技術(shù)，通過分析比較宮頸癌與正常宮頸之間的PWI時間-信號曲線（TIC）特點(diǎn)及其灌注參數(shù)、MRS特點(diǎn)，探討宮頸癌與正常宮頸的PWI、MRS表現(xiàn)特征及臨床應(yīng)用價值。 材料和方法：收集正常宮頸15例，宮頸癌35例(均經(jīng)手術(shù)病理或活檢證實)，其中，宮頸癌患者中15例行手術(shù)治療、20例行根治性放療為主的治療，根據(jù)放療后效果分為有效組和無效組。所有入組人員均接受MR檢查，包括常規(guī)MR平掃、DWI、MRS、PWI和增強(qiáng)掃描，其中，20例接受放療的患者在放療后3周再次進(jìn)行與放療前相同序列的MR檢查，獲取其感興趣區(qū)的MRS圖像、PWI的TIC曲線及其相關(guān)灌注參數(shù)：強(qiáng)化峰值（PH）、最大上升斜率（MSI）、達(dá)峰時間（TTP）。分別比較正常宮頸與宮頸癌之間的MRS、TIC曲線及灌注參數(shù)差異，宮頸鱗癌與腺癌之間的TIC曲線及灌注參數(shù)差異，放療前與放療后之間的TIC曲線及灌注參數(shù)差異，有效組和無效組在放療前的TIC曲線及灌注參數(shù)差異。 結(jié)果： 1．TIC曲線間的比較：(1)35例宮頸癌患者多以速升緩降型為主，具體表現(xiàn)為：上升支較為陡峭，迅速達(dá)到峰值，達(dá)峰后曲線呈現(xiàn)為較長的平臺期，其中，速升緩降型29例、速升速降型4例以及緩慢上升型2例；(2)15例正常宮頸多以緩慢上升型為主，具體表現(xiàn)為：緩慢而持續(xù)性上升，其中，緩慢上升型11例、速升緩降型4例。 2．PWI灌注參數(shù)間的比較：(1)宮頸癌組的PH、MSI值高于正常宮頸組， TTP值低于正常宮頸組，差異均有統(tǒng)計學(xué)意義(PPH=0.000,PMSI=0.000,PTTP=0.000)；(2)鱗癌組的PH、MSI值略低于腺癌組，，TTP值略高于腺癌組，差異均無統(tǒng)計學(xué)意義(PPH=0.321,PMSI=0.586,PTTP=0.082)；(3)放療前的PH、MSI值高于放療后， TTP值低于放療后，差異均有統(tǒng)計學(xué)意義(PPH=0.000,PMSI=0.000,PTTP=0.000)；(4)放療有效組的PH、MSI值略高于無效組，TTP值略低于無效組，只有PH、MSI值的差異具有統(tǒng)計學(xué)意義(PPH=0.025,PMSI=0.004)， TTP值差異無統(tǒng)計學(xué)意義(PTTP=0.324)。 3．MRS分析顯示：（1）宮頸癌組的MRS形態(tài)大致可歸納為：Cho峰、Lip峰及Cr峰三峰共同出現(xiàn)，但Cho峰較高、Lip峰顯著增高，即Lip峰Cho峰Cr峰。（2）正常宮頸組MRS未見明顯Cho峰、Lip峰及Cr峰。 結(jié)論： 1．PWI通過TIC曲線和灌注參數(shù)來反映組織的的灌注情況和血流動力學(xué)變化，可用于鑒別宮頸癌與正常宮頸組織，對宮頸癌的定性診斷、治療療效監(jiān)測及預(yù)測放化療的敏感性有重要價值。 2．1H MRS能活體無創(chuàng)地監(jiān)測宮頸癌的代謝改變，能為宮頸癌的診斷和治療提供分子代謝水平的信息。
[Abstract]:Objective: to apply Mr perfusion weighted imaging (PWI) and magnetic resonance spectroscopy (MRS) techniques. By analyzing and comparing the characteristics of PWI time-signal curve and its perfusion parameter Mrs between cervical cancer and normal cervix, we discussed the PWI of cervical cancer and normal cervix. MRS features and clinical application value. Materials and methods: 15 cases of normal cervix and 35 cases of cervical carcinoma were collected. According to the effect of radiotherapy, the patients were divided into effective group and non-effective group. All the patients were examined by Mr, including conventional Mr plain scan, DWII-MRSPWI and enhanced Mr scan. Twenty patients who received radiotherapy underwent the same sequence of Mr imaging at 3 weeks after radiotherapy to obtain MRS images of their region of interest. The TIC curve of PWI and its related perfusion parameters were compared between normal cervix and cervical cancer. The difference of TIC curve and perfusion parameter, the difference of TIC curve and perfusion parameter between squamous cell carcinoma of cervix and adenocarcinoma, and the difference of TIC curve and perfusion parameter before and after radiotherapy. The difference of TIC curve and perfusion parameters between effective group and ineffective group before radiotherapy. Results: 1. Comparison of TIC curves among 35 patients with cervical cancer, most of them were characterized by rapid rise and slow decrease. The specific manifestation was that the ascending branch was steep and reached the peak rapidly, and the curve after reaching the peak presented a long plateau period. There were 29 cases of rapid ascending and slow descending type, 4 cases of rapid rising and falling type and 2 cases of slow rising type. In 15 cases of normal cervix, the main type of normal cervix was slow rise type, including 11 cases of slow rising type and 4 cases of rapid rising and decreasing type. 2. Comparison of perfusion parameters of PWI: 1) the TTP of cervical carcinoma group was higher than that of normal cervix group, and the TTP value was lower than that of normal cervix group. The differences were statistically significant (P < 0.05), PPH 0.000, PMSI 0.000, PTTP0.000; (2) the MSI value of PHN in squamous cell carcinoma group was slightly lower than that in adenocarcinoma group and TTP level was slightly higher than that in adenocarcinoma group, and there was no significant difference between them in PPH 0.321 and PMSI 0.586. PTTPN 0.082; 3) before and after radiotherapy, the value of PHI was higher than that after radiotherapy, and the TTP value was lower than that after radiotherapy. The difference was statistically significant (P < 0.05). PTTPN 0.000; (4) the value of PHN MSI in the effective radiotherapy group was slightly higher than that in the ineffective group, and only the difference in the MSI value of PHN was statistically significant (P < 0.05). There was no significant difference in TTP value between the two groups. 3. Mrs analysis showed that the morphology of MRS in cervical cancer group could be summed up as the peak of Lip of Cho and the peak of Cr, but the peak of Cho was higher than that of Lip. That is, Lip peak, Cho peak, Cr peak. 2) in normal cervix group, there was no obvious Cho peak, Lip peak and Cr peak in MRS. Conclusion: 1. PWI can be used to distinguish cervical cancer from normal cervical tissue and to diagnose cervical cancer qualitatively by TIC curve and perfusion parameters. Monitoring the therapeutic efficacy and predicting the sensitivity of radiotherapy and chemotherapy are of great value. 2.1H MRS can monitor the metabolic changes of cervical cancer in vivo and provide molecular metabolic information for the diagnosis and treatment of cervical cancer.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R737.33;R445.2

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