本文選題：擴(kuò)散張量成像 + 子宮內(nèi)膜癌��； 參考：《大連醫(yī)科大學(xué)》2014年碩士論文

【摘要】：目的：初探1.5T磁共振擴(kuò)散張量成像（Diffusion tensor imaging，DTI）對(duì)子宮內(nèi)膜癌淺肌層浸潤(rùn)的診斷效能評(píng)估。 材料與方法：回顧性研究行MR掃描子宮內(nèi)膜癌淺肌層浸潤(rùn)患者35例。分析分別采用DTI參數(shù)（ADC值、FA值）、T2WI、動(dòng)態(tài)增強(qiáng)掃描評(píng)估子宮內(nèi)膜癌淺肌層浸潤(rùn)的敏感性。每例患者以T2WI-DWI融合圖定位，在DTI同一層面上選取感興趣區(qū)（regionof interest，，ROI）：子宮腔內(nèi)癌組織(ROI1)、癌區(qū)淺肌層(ROI2)、非癌區(qū)淺肌層(ROI3)、癌區(qū)相應(yīng)的深肌層(ROI4)、非癌區(qū)相應(yīng)的深肌層(ROI5)；獲得ADC值、FA值及所選層面的纖維示蹤圖(FT)。分別比較ROI1和ROI2、ROI2和ROI3、ROI4和ROI5的ADC值、FA值，兩兩間比較采用Wilcoxon signed-rank test（經(jīng)Bonferroni法校正）。并采用受試者工作特征曲線（receiver operatingcharacteristic curves，ROC）評(píng)估DTI參數(shù)（ADC值、FA值）的診斷效能，并對(duì)T2WI、動(dòng)態(tài)增強(qiáng)評(píng)估子宮內(nèi)膜癌淺肌層浸潤(rùn)的敏感性與DTI參數(shù)評(píng)估的敏感性進(jìn)行比較。 結(jié)果：子宮內(nèi)膜癌癌區(qū)淺肌層（ROI2）ADC值顯著低于非癌區(qū)淺肌層（ROI3）ADC值[中位數(shù)（median）：1.16*e-9vs.1.48*e-9, P 0.001]，相應(yīng)的癌區(qū)淺肌層（ROI2）FA值顯著高于非癌區(qū)淺肌層（ROI3）FA值[中位數(shù)（median）：0.41vs.0.27;P 0.001]。對(duì)淺肌層癌區(qū)、非癌區(qū)(ROI2vs. ROI3)ADC值、FA值分別行ROC曲線分析，得到ADC值、FA值評(píng)估淺肌層浸潤(rùn)的敏感性、特異性、陽(yáng)性預(yù)測(cè)值、陰性預(yù)測(cè)值分別為74.3%,88.6%,86.7%,77.5%和88.6%,97.1%,96.9%,89.5%。相應(yīng)FT圖均顯示癌區(qū)浸潤(rùn)的肌層對(duì)比健側(cè)肌層可見(jiàn)纖維顏色不均，走行、分布紊亂。分別單獨(dú)采用T2WI及增強(qiáng)掃描評(píng)估子宮內(nèi)膜癌淺肌層浸潤(rùn)的敏感性為80%、77.4%，與DTI參數(shù)評(píng)估的敏感性進(jìn)行比較，可見(jiàn)FA值評(píng)估子宮內(nèi)膜癌淺肌層浸潤(rùn)的敏感性最高（88.6%）。 結(jié)論：DTI參數(shù)中ADC值、FA值均能很好地評(píng)估子宮內(nèi)膜癌侵及淺肌層，F(xiàn)A值較ADC值更加敏感、準(zhǔn)確；且FA值評(píng)估子宮內(nèi)膜癌淺肌層浸潤(rùn)的敏感性均優(yōu)于ADC值、T2WI及動(dòng)態(tài)增強(qiáng)掃描； FT圖可以直觀地顯示子宮肌層纖維受侵、排列紊亂的情況。
[Abstract]:Objective: to evaluate the diagnostic efficacy of 1.5T diffusion Zhang Liang imaging tensor imaging in the diagnosis of superficial myometrium invasion of endometrial carcinoma. Materials and methods: 35 patients with superficial myometrial invasion of endometrial carcinoma were studied retrospectively. The sensitivity of DTI parameters and FA value to evaluate the superficial myometrium invasion of endometrial carcinoma was evaluated by dynamic contrast enhanced scanning. Each patient was located by T2WI-DWI fusion map. At the same level of DTI, the region of interest was selected as follows: intrauterine carcinoma tissue, superficial muscular layer, non-cancerous superficial muscle layer, and the corresponding deep muscle layer, and the corresponding depth muscle layer, and the ADC value and the fiber tracer of the selected layer were obtained. The ADC value and FA value of ROI1 and ROI2, ROI2, ROI3, ROI4 and ROI5 were compared respectively, and Wilcoxon signed-rank testwas used in the comparison. The diagnostic efficacy of DTI parameters was evaluated by receiver operatingcharacteristic curvessroc. The sensitivity of T2WI, dynamic enhanced evaluation of superficial myometrium invasion of endometrial carcinoma was compared with that of DTI parameters. Results: the ADC value of superficial muscle layer in endometrial carcinoma area was significantly lower than that of superficial muscle layer in non-cancerous area [median value was 1.16e-9vs.1.48e -9, P 0.001]. The corresponding value of ROI2FFA in superficial muscular layer of carcinoma area was significantly higher than that in non-cancerous superficial muscle layer (median medianine: 0.41vs.0.27P 0.001). To the superficial muscle layer cancer area, not the cancer area, the ROI 2 vs. The ROI3)ADC value and FA value were analyzed by ROC curve, and the sensitivity, specificity, positive predictive value and negative predictive value of ADC value and FA value to evaluate superficial muscle invasion were obtained. The negative predictive values were 77.5% and 86.7% respectively. The corresponding FT images showed that the muscle layer infiltrated in the cancer area showed that the color of the fibers in the contralateral myometrium was uneven, and the distribution of the fibers was disordered. The sensitivity of T2WI alone and enhanced scanning in assessing superficial myometrium invasion of endometrial carcinoma was 80 ~ 77.4, which was compared with that of DTI. The sensitivity of FA in assessing superficial myometrium invasion of endometrial carcinoma was 88.6T. Conclusion the FA value of ADC in the ratio of 1: DTI is more sensitive and accurate than that of ADC in evaluating the invasion of endometrial carcinoma into the superficial muscle layer of endometrial carcinoma. The sensitivity of FA in assessing superficial myometrium invasion of endometrial carcinoma was superior to that of ADC and dynamic enhanced scanning. FT images could visualize the invasion and disarrangement of myometrium fibers.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類(lèi)號(hào)】：R737.33;R445.2

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