本文選題：磁共振成像 + 彌散加權(quán)成像　； 參考：《蘭州大學(xué)》2017年碩士論文

【摘要】：第一部分DWI、MRS在腦膠質(zhì)瘤診斷和分級中的價值研究目的探討DWI和MRS在腦膠質(zhì)瘤術(shù)前診斷及分級中的臨床應(yīng)用價值。方法80例腦膠質(zhì)瘤患者行常規(guī)MRI、DWI及1H-MRS檢查,并與術(shù)后病理進行對照;其中高級別44例、低級別36例,分別測量瘤體區(qū)、瘤周區(qū)(≤1.0 cm)、對照區(qū)的r ADC、NAA/Cho、NAA/Cr、Cho/Cr值,比較各區(qū)間的差異;繪制DWI、MRS測量值的ROC曲線,分析其在高、低級別膠質(zhì)瘤鑒別診斷中的價值。結(jié)果(1)常規(guī)MRI依據(jù)腫瘤部位、形態(tài)、信號、占位效應(yīng)及強化程度對膠質(zhì)瘤分級診斷的準(zhǔn)確率為88.75%;(2)高、低級別膠質(zhì)瘤瘤體區(qū)r ADC值(1.313±0.101、1.656±0.045)低于瘤周區(qū)r ADC值(1.451±0.102、1.841±0.040)(P0.01);高、低級別膠質(zhì)瘤組內(nèi)瘤體區(qū)和瘤周區(qū)r ADC值均有統(tǒng)計學(xué)差異(P0.01);(3)高級別膠質(zhì)瘤瘤體區(qū)NAA/Cho(0.536±0.177)、NAA/Cr(1.121±0.246)、Cho/Cr(3.216±0.497)與低級別膠質(zhì)瘤瘤體區(qū)NAA/Cho(0.760±0.161)、NAA/Cr(1.305±0.158)、Cho/Cr(2.439±0.231)間差異均有統(tǒng)計學(xué)意義(P0.05);高級別膠質(zhì)瘤瘤周區(qū)NAA/Cho(0.613±0.110)、NAA/Cr(1.333±0.061)、Cho/Cr(2.236±0.197)與低級別膠質(zhì)瘤瘤周區(qū)NAA/Cho(1.202±0.162)、NAA/Cr(1.587±0.189)、Cho/Cr(2.041±0.148)間差異具統(tǒng)計學(xué)意義(P0.05);高和低級別膠質(zhì)瘤瘤體區(qū)與瘤周區(qū)NAA/Cho、NAA/Cr、Cho/Cr差異亦有統(tǒng)計學(xué)意義(P0.05);高和低級別膠質(zhì)瘤瘤體區(qū)、瘤周區(qū)與對照區(qū)的NAA/Cho、NAA/Cr、Cho/Cr值間有統(tǒng)計學(xué)差異(P0.05);(4)瘤體區(qū)r ADC值1.59作為高、低級別膠質(zhì)瘤鑒別診斷的閾值時,其靈敏度、特異度、準(zhǔn)確度分別為83.3%、93.2%和92.50%;(5)Cho/Cr值2.72作為鑒別診斷的閾值時,其靈敏度、特異度、準(zhǔn)確度分別為100%、80.6%和91.25%,明顯優(yōu)于NAA/Cho、NAA/Cr。結(jié)論DWI、1H-MRS有助于膠質(zhì)瘤的術(shù)前診斷及分級評價,其準(zhǔn)確率高于常規(guī)MRI。第二部分高級別膠質(zhì)瘤浸潤范圍的DTI研究目的探討DTI在高級別膠質(zhì)瘤浸潤范圍中的臨床價值。方法54例高級別腦膠質(zhì)瘤患者行常規(guī)MRI、DTI檢查,其中Ⅲ級25例、Ⅳ29例;ADC、FA圖上分別測定腫瘤瘤體、瘤周區(qū)(≤1cm/1.1-2cm/2.1-3cm)和對照區(qū)平均ADC值、FA值,比較各區(qū)間的差異。結(jié)果(1)瘤體區(qū)、瘤周區(qū)、對照區(qū)的ADC值分別為1047.46±82.21,1157.73±88.08/1193.89±89.14/1062.34±66.69和797.66±16.14,中瘤周區(qū)ADC值達最大值;瘤體、近瘤周區(qū)、中瘤周區(qū)與遠瘤周區(qū)間差異顯著(P0.01),而近瘤周區(qū)與中瘤周區(qū)間差異無統(tǒng)計學(xué)意義(P0.05);瘤體至遠瘤周區(qū)ADC值與對照區(qū)間比較差異均有統(tǒng)計學(xué)意義(P0.05)。(2)瘤體區(qū)、瘤周三區(qū)至對照區(qū)FA值分別為0.238±0.010、0.249±0.011/0.253±0.011/0.257±0.009和0.260±0.008,呈逐漸升高趨勢,瘤體區(qū)與近瘤周區(qū)FA值差異有統(tǒng)計學(xué)意義(P0.05),其余相鄰兩組間差異均無統(tǒng)計學(xué)意義;瘤體至中瘤周區(qū)與對照區(qū)FA值間有顯著性差異(P0.01),而近瘤周區(qū)與遠瘤周區(qū)間有統(tǒng)計學(xué)差異(P0.05)。結(jié)論DTI對高級別膠質(zhì)瘤瘤周區(qū)腫瘤細胞浸潤范圍的界定具有一定的指導(dǎo)價值。第三部分DWI、MRS在腦膠質(zhì)瘤放療后早期療效評價中的價值研究目的探討DWI和MRS在腦膠質(zhì)瘤放射治療早期療效評價中的價值。方法18例腦膠質(zhì)瘤患者分別在放療前、放療后3~4周行常規(guī)MRI、DWI、1H-MRS檢查,其中Ⅱ級3例、Ⅲ級7例、Ⅳ級8例;測量瘤體區(qū)/瘤床區(qū)、瘤周區(qū)r ADC和MRS(NAA/Cho、NAA/Cr、Cho/Cr)值,并比較這些功能成像參數(shù)值在放療前和放療后的差異。結(jié)果(1)放療前、放療后瘤體/瘤床區(qū)Cho/NAA、NAA/Cr、Cho/Cr值分別為2.54±1.56/2.09±1.30、1.31±0.84/1.29±0.94和3.18±1.97/2.31±1.24,放療后Cho/Cr值較放療前顯著下降(P0.01);放療前、放療后瘤周區(qū)Cho/NAA、NAA/Cr、Cho/Cr值分別為1.33±1.09/1.24±0.88、1.59±0.79/1.06±0.59、1.85±0.78/1.48±0.66,放療后Cho/Cr值與放療前相比具有統(tǒng)計學(xué)意義(P0.05)。(2)放療前瘤體/瘤床區(qū)、瘤周區(qū)r ADC值分別為1.313±0.101和1.425±0.118,而放療后分別為1.761±0.134和1.774±0.152,放療后瘤體/瘤床區(qū)r ADC值較放療前顯著升高(P0.05)。結(jié)論DWI、1H-MRS對腦膠質(zhì)瘤放療療效的早期評價具有一定輔助價值。
[Abstract]:The value of DWI and MRS in the diagnosis and classification of glioma objective to explore the clinical value of DWI and MRS in the preoperative diagnosis and classification of glioma. Methods 80 patients with glioma underwent routine MRI, DWI and 1H-MRS examination and compared with the postoperative pathology; of them, 44 cases of high grade and 36 low grade, respectively, measured the tumor area, Peritumoral region (less than 1 cm), R ADC, NAA/Cho, NAA/Cr, Cho/Cr values in the control area, and comparison of the differences in each interval; the value of ROC curves of DWI and MRS measurements was drawn to analyze their value in the differential diagnosis of high and low grade gliomas. Results (1) conventional MRI based on the tumor location, morphology, signal, occupying effect and strengthening degree for the diagnosis of glioma classification accuracy. For 88.75%, (2) high, low grade glioma area R ADC value (1.313 + 0.101,1.656 + 0.045) was lower than that of R ADC (1.451 + 0.102,1.841 + 0.040) in peritumoral region (P0.01); high, low grade glioma group and peritumoral region R ADC values were statistically different (P0.01); (3) high grade glioma region NAA/Cho (0.536 + 0.177), NAA/Cr (1.121 + 0.246), 1.121 /Cr (3.216 + 0.497) and low grade glioma area were NAA/Cho (0.760 + 0.161), NAA/Cr (1.305 + 0.158), Cho/Cr (2.439 + 0.231), NAA/Cho (0.613 + 0.110), NAA/Cr (1.333 + 0.061), Cho/Cr (2.236 + 0.061), Cho/Cr (1.333 + 0.061), and NAA/Cr (NAA/Cr). 587 + 0.189), Cho/Cr (2.041 + 0.148) had statistical significance (P0.05); high and low grade glioma area and peritumoral region NAA/Cho, NAA/Cr, Cho/Cr also had statistical significance (P0.05); high and low grade glioma area, the peritumoral region and the control area of NAA /Cho, NAA/Cr, Cho/Cr values were statistically different (P0.05); (4) the tumor region R 1.59 as a threshold for differential diagnosis of high and low grade gliomas, their sensitivity, specificity, and accuracy are 83.3%, 93.2% and 92.50%, respectively. (5) Cho/Cr value 2.72 as a threshold for differential diagnosis, its sensitivity, specificity, and accuracy are 100%, 80.6% and 91.25%, respectively, superior to NAA/Cho, NAA/Cr. conclusion DWI, 1H-MRS can help the preoperative glioma surgery Diagnostic and graded evaluation, its accuracy is higher than the DTI study of the invasive range of high grade glioma in MRI. second. Objective to explore the clinical value of DTI in the range of high grade glioma infiltration. Methods 54 cases of high grade glioma patients underwent conventional MRI, DTI examination, of which 25 cases of grade III, IV 29 cases, ADC, FA diagram, respectively, to determine tumor tumor body, tumor, tumor and tumor respectively. The average ADC value and FA value of the week area (< < 1cm/1.1-2cm/2.1-3cm) and the control area were compared. Results (1) the ADC values of the tumor body area, the peritumor region and the control area were 1047.46 + 82.211157.73 + 88.08/1193.89 + 66.69 and 797.66 + 16.14 respectively, and the maximum value of the median tumor peritumoral zone ADC value; the tumor body, the near tumor peritumor area, the middle tumor peritumor area and the far tumor peritumor interval The difference was significant (P0.01), but there was no significant difference between the near tumor peritumoral area and the middle tumor peritumor interval (P0.05), and the difference of the ADC value between the tumor and the far zone was statistically significant (P0.05). (2) the FA value of the tumor from Wednesday area to the control area was 0.238 + 0.010,0.249 + 0.010,0.249 + 0.011/0.257 + 0.009 and 0.260 + 0.008, respectively. There was significant difference in the FA value between the tumor and the peritumoral region in high trend (P0.05), and there was no significant difference between the two groups of the other adjacent groups, and there was a significant difference between the peritumoral area and the control area (P0.01), but there was a statistical difference between the peritumoral area and the far zone (P0.05). Conclusion DTI was used for the high grade glioma tumor cells in the peripheral region of the tumor (P0.05). The definition of the scope of infiltration has certain guiding value. The value of the third part DWI and MRS in the early evaluation of brain glioma after radiotherapy. Objective to explore the value of DWI and MRS in the early evaluation of brain glioma radiotherapy. Methods 18 cases of glioma patients were treated with routine MRI, DWI, 1H-MRS examination before radiotherapy and 3~4 weeks after radiotherapy respectively. There were 3 cases of grade II, 7 cases of grade III and 8 cases of grade IV, and the values of R ADC and MRS (NAA/Cho, NAA/Cr, Cho/Cr) in the tumor area / tumor bed area were measured, and the differences of these functional imaging parameters before and after radiotherapy were compared. Results (1) before radiotherapy, Cho/NAA, NAA/Cr, and Cho/Cr value of the tumor / tumor bed region after radiotherapy were 2.54 + 1.56/2.09 + 1.30,1.31 + 0.84/1.29. The Cho/Cr values of 0.94 and 3.18 + 1.97/2.31 + 1.24 were significantly lower than that before radiotherapy (P0.01). Before radiotherapy, the Cho/NAA, NAA/Cr, Cho/Cr values were 1.33 + 1.09/1.24 + 0.88,1.59 + 0.59,1.85 + 0.66 respectively. The ratio of Cho/Cr value to before radiotherapy was statistically significant. (2) the tumor / tumor bed area before radiotherapy. The R ADC values in the peritumoral region were 1.313 + 0.101 and 1.425 + 0.118 respectively, and 1.761 + 0.134 and 1.774 + 0.152 respectively after radiotherapy. The value of R ADC in the tumor / tumor bed region after radiotherapy was significantly higher than that before radiotherapy (P0.05). Conclusion DWI, 1H-MRS has a certain auxiliary value for the early evaluation of the therapeutic effect of brain glioma.
【學(xué)位授予單位】：蘭州大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R739.41;R445.2

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