本文選題：星形細胞腫瘤　切入點：磁共振成像　出處：《河北醫(yī)科大學》2014年碩士論文　論文類型：學位論文

【摘要】：第一部分3D-ASL與DSC對腦星形細胞腫瘤血流灌注評估的相關(guān)性研究 目的：探討腦星形細胞腫瘤3D-ASL與DSC腦血流量評估的相關(guān)性。 方法：70例病理證實的腦星形細胞腫瘤，行常規(guī)MR平掃、3D-ASL、DSC及增強MR檢查，包括毛細胞型星形細胞腫瘤（I級）4例、彌漫性星形細胞腫瘤（II級）28例、間變性星形細胞腫瘤（III級）22例、膠質(zhì)母細胞瘤（IV級）16例。分別測量腫瘤實性區(qū)最大CBF、近瘤周區(qū)及鏡像區(qū)CBF，計算腫瘤實性區(qū)及近瘤周區(qū)rCBF；應(yīng)用Spearman相關(guān)分析評估兩種灌注方法rCBF的相關(guān)性。 結(jié)果：70例腦星形細胞腫瘤3D-ASL和DSC法實性區(qū)rCBF（中位數(shù)與四分位數(shù)間距，下同）分別為3.069與2.151及3.7943與3.825，相關(guān)系數(shù)r=0.944；兩者近瘤周區(qū)rCBF分別為0.913與0.576及1.095與0.783，r=0.732。38例HGG組3D-ASL和DSC法實性區(qū)rCBF分別為3.662與2.054及4.179與3.468，r=0.918；兩者近瘤周區(qū)rCBF分別為1.171與0.760及0.974與0.703，r=0.757。32例LGG組3D-ASL和DSC實性區(qū)rCBF分別為2.109與2.205及2.591與3.988，r=0.931；兩者近瘤周區(qū)rCBF分別為0.781與0.438及0.965與0.944，r=0.840。 結(jié)論：3D-ASL與DSC法測量腦星形細胞腫瘤實性及近瘤周區(qū)rCBF值均有很好的相關(guān)性，LGG組兩個區(qū)域rCBF的相關(guān)性均優(yōu)于HGG組，提示3D-ASL對星形細胞腫瘤CBF的評估較可靠。 第二部分3D-ASL對環(huán)形強化高級別膠質(zhì)瘤與轉(zhuǎn)移瘤鑒別診斷價值的研究 目的：探討3D-ASL灌注成像鑒別環(huán)形強化HGG與腦單發(fā)轉(zhuǎn)移瘤的價值。 方法：86例病理證實的環(huán)形強化HGG48例與腦單發(fā)轉(zhuǎn)移瘤38例，行常規(guī)MR平掃、3D-ASL灌注成像及MR增強檢查，高級別星形細胞腫瘤包括間變性星形細胞瘤22例（III級），膠質(zhì)母細胞瘤（IV級）26例，，腦內(nèi)單發(fā)轉(zhuǎn)移瘤包括肺癌14例、乳腺癌8例、結(jié)腸癌6例、食管癌4例、腎癌6例。分別測量腫瘤實性區(qū)最大CBF、瘤周區(qū)CBF及鏡像區(qū)CBF，采用計算腫瘤實性區(qū)及瘤周區(qū)相對CBF（rCBF），比較兩組腫瘤rCBF值之間是否存在差異，采用ROC曲線確定最佳閾值及其鑒別兩種腫瘤的敏感度和特異度。 結(jié)果：HGG與腦內(nèi)單發(fā)轉(zhuǎn)移瘤實性區(qū)rCBF值分別為（中位數(shù)與四分位數(shù)間距）：（3.612，2.100）與（3.123，5.99），兩組間差異無統(tǒng)計學意義（P0.05）。HGG與腦單發(fā)轉(zhuǎn)移瘤瘤周區(qū)rCBF值分別為（中位數(shù)與四分位數(shù)間距）：（1.101，0.900）與（0.720，0.280），兩組之間差異有統(tǒng)計學意義（P0.05），采用ROC曲線分析，當rCBF閾值為0.895時，鑒別兩種腫瘤的敏感度及特異度分別為70.8%與84.2%。 結(jié)論：3D-ASL測量腫瘤實性區(qū)rCBF對區(qū)分環(huán)形強化的HGG與腦單發(fā)轉(zhuǎn)移瘤無價值，而近瘤周區(qū)的rCBF值有助于鑒別兩種腫瘤。
[Abstract]:The correlation between 3D-ASL and DSC in the evaluation of cerebral astrocytic tumor perfusion. Objective: to investigate the correlation between 3 D ASL and DSC cerebral blood flow assessment in brain astrocytoma. Methods 70 cases of pathologically proved brain astrocytoma were examined by conventional Mr 3D-ASLCT DSC and enhanced Mr, including 4 cases of hair cell type astrocytoma, 28 cases of diffuse astrocytoma and 28 cases of diffuse astrocytoma, and 22 cases of anaplastic astrocytoma. In 16 cases of glioblastoma, we measured the maximum CBF in solid tumor area, the surrounding tumor area and mirrored area respectively, calculated the rCBF of tumor solid area and adjacent tumor area, and evaluated the correlation of rCBF by Spearman correlation analysis. Results in 70 cases of brain astrocytoma, 3D-ASL and DSC were used to determine the interval between median and quartile. The correlation coefficient r = 0.944, rCBF near tumor area was 0.913 and 0.576 and 1.095 and 0.783ru 0.732.38 cases of HGG group were 3.662 and 2.054 and 4.179 and 3.468r0.918, respectively. The rCBF of adjacent tumor area was 1.171,0.760 and 0.760, respectively, and that of DSC method was 3.662 and 2.054 and 4.179 and 3.468r0.918, respectively, and that of HGG group was 3.669 and 2.151, and 3.7943 and 3.825, respectively, and the correlation coefficient was 0.944; the rCBF of adjacent tumor area was 0.913 and 0.576, and 1.095 and 0.783.732.38 cases of HGG group, respectively. The rCBF of 3D-ASL and DSC were 2.109,2.205,2.591 and 3.988in 0.757.32 cases of LGG, respectively, and the rCBF of the adjacent tumor area were 0.781 and 0.438 and 0.965 and 0.944 respectively. Conclusion there is a good correlation between the measurement of the density of brain astrocytic tumor by DSC and the measurement of rCBF in the surrounding area by DSC. The correlation of rCBF between the two regions in LGG group is better than that in HGG group, which suggests that 3D-ASL is more reliable in the evaluation of CBF in astrocytoma. The value of 3D-ASL in differential diagnosis of high grade gliomas and metastatic tumors with ring enhancement. Objective: to evaluate the value of 3 D-ASL perfusion imaging in differentiating ring-enhanced HGG from single brain metastases. Methods 86 cases of pathologically proved ring-enhanced HGG48 and 38 cases of single metastatic tumor of brain were examined by conventional plain Mr 3D-ASL perfusion imaging and Mr enhancement. High-grade astrocytoma included 22 cases of anaplastic astrocytoma, 26 cases of glioblastoma grade IV, 14 cases of solitary brain metastases, 8 cases of breast cancer, 6 cases of colon cancer and 4 cases of esophageal carcinoma. In 6 cases of renal cell carcinoma, the largest CBFs in solid tumor area, CBF in surrounding tumor area and CBF in mirror region were measured, and the difference of rCBF values between the two groups was compared by calculating the relative CBFr CBFs of tumor solid area and surrounding tumor area. ROC curve was used to determine the optimal threshold and its sensitivity and specificity. Results the rCBF values of the solid region of the brain with single metastatic tumor were (median to quartile distance: 3.6122.100) and 3.123 (5.99N), respectively. There was no significant difference between the two groups in the rCBF value of the peri-tumor region of single metastatic tumor (median and quartile) (P < 0.05) and the value of rCBF in the perioperative region of single brain metastases was not significantly different between the two groups (median and quartile). The distance between the two groups was 1.101 / 0.900) and 0.720 / 0.280 respectively. The difference between the two groups was statistically significant (P 0.05). The ROC curve was used to analyze the difference between the two groups. When the rCBF threshold was 0.895, the sensitivity and specificity of the two tumors were 70.8% and 84.2, respectively. Conclusion the measurement of rCBF in solid area of tumor by 1: 3D-ASL is of no value in differentiating circular enhanced HGG from single metastatic tumor, while the rCBF value near the peri-tumor area is helpful to differentiate the two types of tumors.
【學位授予單位】：河北醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R445.2;R739.41

【引證文獻】

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1 王洋;基于多圖譜的人腦MR圖像的分析與可視化[D];上海交通大學;2015年

本文編號：1568532