本文選題：磁共振成像　切入點：超聲造影　出處：《中國人民解放軍醫(yī)學院》2016年博士論文　論文類型：學位論文

【摘要】：背景：小腎腫瘤是臨床常見病,MRI(magetic reasoance imaging,磁共振)和CEUS (contrast enhanced ultrasound,超聲造影)是常用的影像學檢查方法,比較兩者哪種檢查更優(yōu),對臨床具有指導意義。目的：通過回顧性分析常見小腎腫瘤MRI主要征象,判斷哪些征象在診斷中起主要作用。在此基礎(chǔ)上,通過前瞻性分析比較兩種檢查方法的診斷正確率,進而比較哪種方法成本效果較高。材料與方法：第一至第四部分,采用多元回歸分析自2009年1月年至2015年6月間病理證實的良惡性腎腫瘤80例,分析其主要診斷征象。采取病例對照分析法,惡性組為病例組,良性組為對照組。MRI征象分為定性和定量兩種。定性征象有：有無肉眼所見脂肪、假包膜、囊變及壞死、T2WI信號、出血、楔形變、匍匐式生長、暈環(huán)結(jié)節(jié)。定量指標有：反相位信號改變,增強掃描皮質(zhì)期、皮髓期、分泌期強化程度、性別、年齡.第五部分通過前瞻性分析經(jīng)病理證實的良惡性腎腫瘤94例,比較MRI和超聲造影對不同直徑小腎腫瘤的檢出率。第六至第七部分采用前瞻性分析MRI和超聲造影對小腎良惡性腎腫瘤的診斷正確率,并對兩者的成本效果進行比較分析。本研究應用SPSS19.0和CHISS統(tǒng)計軟件,主要采用Logistic多元回歸分析多種征象之間的相互關(guān)系,少部分采用單因素分析及卡方檢驗、t或t’檢驗、單向有序列聯(lián)表等分析數(shù)據(jù).結(jié)果：腎腫瘤主要征象中,按重要性關(guān)系依次為脂肪(良性征象)、囊變等級高和“暈環(huán)結(jié)節(jié)”征(惡性征象)。次要征象為假包膜、出血(惡性征象)、匍匐征(良性征象)。無或少脂肪的AML(angiomyolipoma,血管平滑肌脂肪瘤)和chRCC(chromophobe renal cell carcinoma,嫌色細胞癌)相比,有假包膜、囊變級別高、T2MI信號級別高的腫瘤診斷為惡性的可能性大；有楔形征或匍匐征其中之一的診斷良性的可能性大。定量指標中,反相位信號降低較多,皮質(zhì)期增高較高的診斷為無或少脂肪的AMI,可能性大。無或少脂肪的AML與pRCC (papillary renal cell carcinoma,乳頭狀細胞癌)相比：T2信號、囊變和出血級別越高者,診斷乳頭狀癌的可能性越大。定量指標中皮質(zhì)期強化級別越高者診斷良性的可能性越大。ccRCC(clear cell renal cell carcinoma,透明細胞癌)和chRCC目比：有假包膜、囊變級別高、“暈環(huán)結(jié)節(jié)”征的腫瘤診斷透明細胞癌的可能性大。定量指標中,反相位信號降低程度越高,診斷ccRCC的可能性越大。小于1.5cm組的腎腫瘤中,無論是否含有脂肪,MRI的檢出率均高于超聲造影(p0.008).MRI和超聲造影對小腎腫瘤診斷正確率分別為93.62%、84.04%。成本效果分析顯示后者高于前者。改良MRI增強的成本效果高于后者。結(jié)論：脂肪是良性腫瘤的主要征象,囊變程度高和“暈環(huán)結(jié)節(jié)”征是惡性腫瘤的主要征象。MRJ和超聲造影對小腎腫瘤診斷正確率比較前者高于后者。超聲造影成本效果更高。
[Abstract]:Background: MRImagetic reasoance imaging (MRI) and CEUS contrast enhanced ultrasound (ultrasound) are commonly used imaging methods for small renal tumors. Objective: to analyze the main signs of MRI in common small renal tumors and to determine which signs play an important role in the diagnosis. On the basis of this, the diagnostic accuracy of the two methods was compared by prospective analysis. Materials and methods: part 1 to 4th, 80 cases of benign and malignant renal tumors confirmed by pathology from January 2009 to June 2015 were analyzed by multivariate regression analysis. The main diagnostic signs were analyzed. The malignant group was the case group, and the benign group was the control group. The MRI signs were classified into qualitative and quantitative methods. The qualitative signs included fat, pseudocapsule, cystic degeneration and necrotic T2WI signal. Haemorrhage, wedge-shaped change, creeping growth, halo ring nodule. Quantitative indicators: change of anti-phase signal, enhancement of cortical phase, enhancement of medullary phase, enhancement of secretory phase, sex, Age. 5th. 94 cases of benign and malignant renal neoplasms confirmed by pathology were analyzed prospectively. To compare the detectable rate of MRI and contrast-enhanced ultrasonography in small renal tumors with different diameters. From 6th to 7th, the diagnostic accuracy of MRI and contrast-enhanced ultrasonography for benign and malignant renal tumors of small kidney was analyzed prospectively. In this study, SPSS19.0 and CHISS statistical software were used to analyze the correlation between the multiple signs, and a few of them were analyzed by single factor analysis and chi-square test (t or t 'test). Results: among the main signs of renal tumors, fat (benign sign, high cystic grade) and "halo ring nodule" (malignant sign) were the main signs of renal neoplasms. Hemorrhage (malignant sign, prostrate sign) and chRCC(chromophobe renal cell carcinoma (chRCC(chromophobe renal cell carcinoma) were more likely to be diagnosed as malignant than those with false capsule and higher signal level of cystic T2MI. The results showed that: (1) Hemorrhage (malignant sign), prostrate sign (benign sign: AML-angiomyolipoma) and chRCC(chromophobe renal cell carcinoma (chromophobe cell carcinoma) were more likely to be diagnosed as malignant than those with false capsule and high cystic grade T2MI signal level. One of the wedge-shaped or creeping signs is more likely to diagnose benign. The higher the cortical phase was, the more likely the diagnosis was that the amis had no or no fat. Compared with pRCC papillary renal cell carcinoma, AML with no or no fat had higher signal signal on T2, cystic degeneration and bleeding grade. The more the possibility of diagnosing papillary carcinoma is, the higher the degree of enhancement in cortical phase is, the higher the probability of diagnosing benign is. CcRCC clear cell renal cell carcinoma (transparent cell carcinoma) and chRCC ratio: false capsule. The higher the cystic grade, the greater the possibility of diagnosing transparent cell carcinoma with halo ring nodule sign. In quantitative indexes, the higher the degree of decrease of anti-phase signal, the greater the possibility of diagnosing ccRCC. The positive rate of MRI with or without fat was higher than that of contrast-enhanced MRI and contrast-enhanced MRI were 93.62or 84.04, respectively. Cost-effect analysis showed that the latter was higher than the former. The cost effect of modified MRI was higher than that of the latter. Conclusion: fat is the main sign of benign tumor. High degree of cystic degeneration and "halo ring nodule" sign were the main signs of malignant tumors. MRJ was higher than contrast-enhanced ultrasonography in the diagnosis of small renal tumors. The cost of contrast-enhanced ultrasound was higher than that of the latter.
【學位授予單位】：中國人民解放軍醫(yī)學院
【學位級別】：博士
【學位授予年份】：2016
【分類號】：R445;R737.11

【參考文獻】

相關(guān)碩士學位論文 前1條

1 董偉;我國醫(yī)療費用過快增長作用機制定量研究[D];復旦大學;2010年

，

本文編號：1583768