本文選題：偽連續(xù)性動(dòng)脈自旋標(biāo)記 + 高級(jí)別膠質(zhì)瘤��； 參考：《河北醫(yī)科大學(xué)》2014年碩士論文

【摘要】：原發(fā)性惡性腦腫瘤較常見，以高級(jí)別膠質(zhì)瘤居多，而原發(fā)性中樞神經(jīng)系統(tǒng)淋巴瘤相對(duì)少見，但近年來發(fā)病率呈逐漸上升趨勢(shì)。高級(jí)別膠質(zhì)瘤以手術(shù)治療為主，而化療和放射治療對(duì)淋巴瘤比較敏感，因此正確地鑒別高級(jí)別膠質(zhì)瘤與淋巴瘤對(duì)制定最佳的臨床治療方案至關(guān)重要。傳統(tǒng)MRI常不容易鑒別腦膠質(zhì)瘤與淋巴瘤。 對(duì)于很多疾病來說，研究組織的灌注能提供病變的特征、診斷及功能改變的信息。目前臨床上有多種技術(shù)可以研究組織灌注，如CT灌注成像，MRI灌注加權(quán)成像（MR perfusion weighted imaging，PWI）以及核素成像。但是這些技術(shù)都需要注射對(duì)比劑，或/和有電離輻射。從20世紀(jì)90年代發(fā)展起來的磁共振動(dòng)脈自旋標(biāo)記技術(shù)（Arterial Spin Labeling,ASL）可以顯示組織灌注，而不用對(duì)比劑，也沒有輻射。由于其技術(shù)復(fù)雜，對(duì)軟硬件要求高，近幾年才初步用于臨床。 偽連續(xù)性動(dòng)脈自旋標(biāo)記技術(shù)（pseudo-continuous arterial spin labeling，pCASL）是在原有ASL技術(shù)基礎(chǔ)上的發(fā)展和改進(jìn)，比原有ASL技術(shù)更加穩(wěn)定和可靠。與傳統(tǒng)應(yīng)用廣泛的MR灌注成像不同，它不需應(yīng)用對(duì)比劑，利用磁化標(biāo)記的動(dòng)脈血質(zhì)子作為內(nèi)源性示蹤劑定量測(cè)量腫瘤的血流灌注信息，更容易為患者所接受。目前這項(xiàng)新技術(shù)在腦腫瘤鑒別診斷中的作用還沒有得到充分的評(píng)估和認(rèn)識(shí)。 目的： 1進(jìn)一步認(rèn)識(shí)高級(jí)別膠質(zhì)瘤與淋巴瘤的病理學(xué)表現(xiàn)，有效地將病理學(xué)表現(xiàn)與影像學(xué)結(jié)果結(jié)合起來。 2應(yīng)用pCASL技術(shù)定量評(píng)估腫瘤的血流灌注情況，分析pCASL技術(shù)在鑒別高級(jí)別膠質(zhì)瘤與原發(fā)性腦膠質(zhì)瘤方面的應(yīng)用價(jià)值，為臨床尋找一種可靠的影像學(xué)方法鑒別腦腫瘤，幫助制定正確的診療決策。 方法： 1查閱2010-2013年于河北省邯鄲市中心醫(yī)院放射科行MR檢查的所有膠質(zhì)瘤及淋巴瘤患者的影像資料； 2找到同時(shí)進(jìn)行了常規(guī)MR檢查及pCASL檢查的患者； 3排除數(shù)據(jù)資料不完整的患者，如只進(jìn)行了常規(guī)MR檢查而沒有pCASL圖像的高級(jí)別膠質(zhì)瘤患者或在pCASL檢查前進(jìn)行過化療或類固醇激素治療的淋巴瘤患者； 4對(duì)每個(gè)腫瘤在其增強(qiáng)部位各選擇5個(gè)感興趣區(qū)，每個(gè)感興趣區(qū)大小一致，均為17.56mm2，先分別測(cè)量腫瘤的血流量，再取平均值，得到腫瘤的平均血流量（mTBF）； 5于腫瘤感興趣區(qū)相同掃描層面的對(duì)側(cè)正常腦灰質(zhì)部分去5個(gè)感興趣區(qū)，以同樣的方法計(jì)算平均血流量，即mBFgm；計(jì)算腫瘤的相對(duì)血流量：rTBF=（mTBF/mBFgm）×100； 6對(duì)比分析高級(jí)別膠質(zhì)瘤與淋巴瘤的mTBF及rTBF值有無統(tǒng)計(jì)學(xué)差異； 7繪制ROC曲線，找到鑒別兩種腫瘤的最佳臨界值； 8對(duì)比兩灌注參數(shù)的ROC曲線下面積有無差異，分析兩參數(shù)鑒別腫瘤的能力有無明顯差別. 結(jié)果 1按照本研究的納入排除標(biāo)準(zhǔn)，最后研究對(duì)象共包括31例患者，其中20例為高級(jí)別膠質(zhì)瘤患者，11例為原發(fā)性腦淋巴瘤患者。 2高級(jí)別膠質(zhì)瘤患者年齡22-65歲，平均年齡47.4歲，包括12例多形性膠質(zhì)細(xì)胞瘤、3例星形細(xì)胞瘤及5例復(fù)發(fā)性多形性膠質(zhì)細(xì)胞瘤； 3淋巴瘤患者年齡38-82歲，平均年齡60.9歲，其中包含一例對(duì)化療無效的復(fù)發(fā)性淋巴瘤患者。 4高級(jí)別膠質(zhì)瘤mTBF值明顯高于淋巴瘤（92.1±34.7mL/min/100mgvs.53.6±30.5mL/min/100mg，P=0.008）。兩腫瘤比較，rTBF值的差異也有統(tǒng)計(jì)學(xué)意義（182.3±69.5vs.92.5±44.9，P=0.002）。 5根據(jù)ROC曲線分析可得，mTBF鑒別高級(jí)別膠質(zhì)瘤與淋巴瘤的最佳臨界值為57.9mL/min/100mg，靈敏度為90%，特異度為54.6%；rTBF鑒別診斷兩種腫瘤的最佳臨界值為141.1，靈敏度為65%，特異度為100%。 6對(duì)兩個(gè)參數(shù)的ROC曲線下面積分析顯示，兩者曲線下面積無明顯統(tǒng)計(jì)學(xué)差異(0.873vs.0.909，P=0.287)。 結(jié)論 1高級(jí)別膠質(zhì)瘤與原發(fā)性腦淋巴瘤比較，腫瘤的灌注參數(shù)--mTBF及rTBF均明顯增高，說明應(yīng)用這兩個(gè)參數(shù)可以有效鑒別高級(jí)別膠質(zhì)瘤與淋巴瘤。 2分別以mTBF57.9mL/min/mg及rTBF141.1作為最佳臨界值鑒別診斷高級(jí)別膠質(zhì)瘤與原發(fā)性腦淋巴瘤，具有較高的診斷敏感度及特異度。對(duì)兩者ROC曲線下面積對(duì)比分析，，無明顯統(tǒng)計(jì)學(xué)差異，說明兩者鑒別腫瘤的能力相當(dāng)，無明顯差別。 3pCASL技術(shù)是一項(xiàng)新的技術(shù)，可以作為一種可靠、簡便、準(zhǔn)確的方法來鑒別診斷腦腫瘤，幫助臨床醫(yī)師制定正確的診療方案，具有重要臨床意義，是未來ASL技術(shù)發(fā)展的趨勢(shì)。
[Abstract]:Primary malignant brain tumors are common in high - grade gliomas , while primary central nervous system lymphoma is relatively rare , but the incidence of primary central nervous system lymphoma is gradually increasing in recent years . High - grade gliomas are mainly surgical treatment , and chemotherapy and radiotherapy are very sensitive to lymphoma . Therefore , it is important to correctly identify high - grade gliomas and lymphomas for the development of optimal clinical treatment regimens . Traditional MRI is often not easy to distinguish between glioma and lymphoma .

Tissue perfusion , such as CT perfusion imaging , MR perfusion weighted imaging ( PWI ) , and nuclear imaging , are currently available in the study of tissue perfusion for many diseases . However , these techniques require injection of contrast agents , or / and ionizing radiation . Magnetic resonance arterial spin labeling techniques developed in the 1990s may exhibit tissue perfusion without contrast agents and no radiation .

The pseudo - continuous arterial spin labeling ( pCASL ) has been developed and improved on the basis of the original technique , which is more stable and reliable than the original one . Compared with the conventional MR perfusion imaging , it does not need to apply contrast agent , and it is more easy to measure tumor ' s blood perfusion information by using magnetized labeled arterial blood proton as the endogenous tracer .

Purpose :

1 . To further understand the pathological manifestations of high - grade glioma and lymphoma , and to effectively combine pathological findings with imaging findings .

2 . Using the technique of pCASL to quantitatively evaluate the perfusion of tumor , the application value of pCASL technique in identifying high - grade gliomas and primary glioma was analyzed , and a reliable imaging method was used to identify brain tumors and help formulate correct diagnosis and treatment decisions .

Method :

1 Refer to the image data of all glioma and lymphoma patients who underwent MR examination at the central hospital of Handan City , Hebei Province , 2010 - 2013 ;


2 patients with simultaneous normal MR examination and pCASL examination were found ;


3 Patients with incomplete data data , such as patients with high - grade glioma without the pCASL image or lymphoma patients who had undergone chemotherapy or steroid hormone treatment prior to the pCASL examination , for example only with routine MR examination ;


4 , 5 regions of interest were selected for each tumor in each region of interest , and the size of each region of interest was consistent with 17.56mm2 , respectively , the blood flow rate of tumor was measured , and then the average value was taken to obtain the mean blood flow ( mTBF ) of the tumor ;


5 regions of interest on the contralateral normal gray matter at the same scanning level in the region of interest of the tumor , and the mean blood flow rate , i.e . , mBFgm , was calculated by the same method ;
Relative blood flow of tumor was calculated : rTBF = ( mTBF / mBFgm ) 脳 100 ;


6 . There was no statistical difference between mTBF and rTBF in high - grade gliomas and lymphoma .


7 Draw ROC curve , find the best critical value for identifying two kinds of tumors ;


8 Compared with the ROC curve of the two perfusion parameters , there was no significant difference in the ability of the two parameters to identify the tumor .

Results

1 According to the exclusion criteria of this study , the final study consisted of 31 patients , of whom 20 were high - grade glioma patients and 11 were primary brain lymphoma patients .

2 high - grade glioma patients ranged from 22 to 65 years , with a mean age of 47.4 years .


Patients with lymphoma aged 38 - 82 years with an average age of 60.9 years , including one case of recurrent lymphoma with ineffective chemotherapy .

The mTBF value of high - grade glioma was significantly higher than that of lymphoma ( 92.1 鹵 34.7mL / min / 100mgvs . 53.6 鹵 30.5 mL / min / 100 mg , P = 0.008 ) . The difference of rTBF between the two tumors was statistically significant ( 182.3 鹵 69.5vs . 92.5 鹵 44.9 , P = 0.002 ) .

5 According to ROC curve analysis , the optimal critical value of mTBF was 57.9 mL / min / 100mg , sensitivity was 90 % and specificity was 54.6 % .
The optimal critical value of rTBF was 141.1 , the sensitivity was 65 % , and the specificity was 100 % .

The area under ROC curve of two parameters showed that there was no statistically significant difference between the two curves ( 0.873 vs . 0.909 , P = 0.287 ) .

Conclusion

1 High - grade glioma was compared with primary brain lymphoma , and the perfusion parameters of tumor - mTBF and rTBF increased significantly , indicating that the two parameters could be used to identify high - grade gliomas and lymphoma .

2 The diagnosis of high grade gliomas and primary brain lymphoma with mTBF57.9 mL / min / mg and rTBF141.1 were used as the best critical value .

3pCASL technology is a new technique , which can be used as a reliable , simple and accurate method for the differential diagnosis of brain tumors . It can help clinicians to develop the correct diagnosis and treatment plan , which has important clinical significance and is the trend of future development .

【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R739.41

【參考文獻(xiàn)】

相關(guān)期刊論文 前6條

1 許曉琴;周林江;姚振威;林含舜;;原發(fā)性腦內(nèi)淋巴瘤的影像學(xué)表現(xiàn)[J];醫(yī)學(xué)影像學(xué)雜志;2010年04期

2 陳發(fā)軍;周東;黃飚;詹升全;楊萬群;周德祥;余漢輝;;腦膠質(zhì)瘤分級(jí)診斷的新方法:動(dòng)脈自旋標(biāo)記技術(shù)[J];中華神經(jīng)外科疾病研究雜志;2010年01期

3 范麗;陶曉峰;劉士遠(yuǎn);施增儒;肖湘生;;ASL在中樞神經(jīng)系統(tǒng)疾病診斷中的初步應(yīng)用體會(huì)[J];放射學(xué)實(shí)踐;2007年07期

4 溫洋,戴建平,高培毅,李少武,孫學(xué)進(jìn);ASL在膠質(zhì)瘤分級(jí)中的初步應(yīng)用[J];中國醫(yī)學(xué)影像技術(shù);2005年09期

5 耿承軍,陳君坤,盧光明,石群立,陳自謙,李蘇建,許建,吳新生,儲(chǔ)成奇;原發(fā)性中樞神經(jīng)系統(tǒng)淋巴瘤的CT、MRI表現(xiàn)與病理對(duì)照研究[J];中華放射學(xué)雜志;2003年03期

6 沈天真,張玉林,陳星榮;世界衛(wèi)生組織腦腫瘤分類的進(jìn)展[J];中國醫(yī)學(xué)計(jì)算機(jī)成像雜志;2000年04期

本文編號(hào)：1739554