本文選題：磁共振擴(kuò)散張量成像 + 灌注成像　； 參考：《西南醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:本研究采用磁共振擴(kuò)散張量成像(DTI)及灌注成像技術(shù)(PWI)對腦膜瘤進(jìn)行定量檢測,探討其與腦膜瘤病理學(xué)分型和免疫組化的相關(guān)性,為區(qū)別腦膜瘤的良惡性,提供新的依據(jù),并用于術(shù)前評估腫瘤的質(zhì)地,明確腫瘤與周圍白質(zhì)纖維解剖關(guān)系,指導(dǎo)術(shù)中神經(jīng)功能的保護(hù)及評估患者的預(yù)后。方法:收集于2015年6月-2017年1月經(jīng)西南醫(yī)科大學(xué)附屬中醫(yī)院影像和病理證實(shí)為腦膜瘤的患者,術(shù)前均行磁共振平掃、常規(guī)增強(qiáng)掃描、DTI、PWI檢查,依據(jù)2007年WHO腦膜瘤病理分級,分為I級、II級、III級。本研究將I級腦膜瘤歸為良性,II級和III級腦膜瘤歸惡性,研究分成兩組,良性為A組,惡性為B組,對腦膜瘤腫瘤實(shí)質(zhì)區(qū)、瘤周水腫區(qū)、對側(cè)正常白質(zhì)纖維的ADC值、FA值和rCBV值進(jìn)行測量。在研究不同病理類型FA值時(shí),按照病理學(xué)分型分為三組,第一組為非典型性和惡性腦膜瘤,第二組為纖維型腦膜瘤,第三組為其它類型良性腦膜瘤。術(shù)中將腫瘤的質(zhì)地分為三級,質(zhì)地柔軟(吸引器可以吸除腫瘤),質(zhì)地較硬(完全不能被吸除腫瘤),質(zhì)地中等(介于二者之間)。術(shù)后對手術(shù)切除的腦膜瘤標(biāo)本分別進(jìn)行伊紅-蘇木素染色,檢測血管內(nèi)皮生長因子(VEGF),檢測腫瘤微血管密度(MVD)采用鏈菌素-生物素-過氧化酶鏈接法。依據(jù)dti,顯示白質(zhì)纖維的走形及與腫瘤之間的解剖關(guān)系。選擇我院術(shù)前未行磁共振擴(kuò)散張量成像的腦膜瘤患者20例(包括i級腦膜瘤16例、ii級腦膜瘤2例,iii級腦膜瘤1例)及術(shù)前行磁共振擴(kuò)散張量成像的腦膜瘤患者21例,選用karnofsky功能狀態(tài)評分(kps)表對其神經(jīng)功能恢復(fù)進(jìn)行評分。采用spss17.0軟件進(jìn)行統(tǒng)計(jì)學(xué)處理,正態(tài)分布的資料以?x±s表示,比較a組與b組腦膜瘤相應(yīng)部位的adc值、fa值和rcbv值及對比術(shù)后kps評分采用雙側(cè)配對t檢驗(yàn),檢測rcbv值與vegf、mvd關(guān)系采用pearson相關(guān)分析法;采用spearman相關(guān)分析法檢測fa值與腫瘤質(zhì)地之間的關(guān)系;選用秩和檢驗(yàn)對三組不同病理類型fa值進(jìn)行檢驗(yàn);雙側(cè)檢驗(yàn)以p0.05為差異有統(tǒng)計(jì)學(xué)意義。結(jié)果:a組腦膜瘤腫瘤實(shí)質(zhì)區(qū)的adc值大于b組,差異具有統(tǒng)計(jì)學(xué)意義(p0.05),在瘤周水腫區(qū)和對側(cè)白質(zhì)纖維兩組差異沒有統(tǒng)計(jì)學(xué)意義(p0.05),a組腦膜瘤實(shí)質(zhì)區(qū)rcbv值大于b組,而在瘤周水腫區(qū)則相反,差均有統(tǒng)計(jì)學(xué)意義(p0.05),a組和b組各部位fa值均無統(tǒng)計(jì)學(xué)意義(p0.05)。腦膜瘤腫瘤實(shí)質(zhì)區(qū)rcbv值與vegf及mvd均成正相關(guān)性(p0.05)。當(dāng)fa值0.3時(shí),腫瘤質(zhì)地較硬,不易于手術(shù)切除。術(shù)后3月,在術(shù)前行磁共振擴(kuò)散張量成像患者的kps評分明顯高于未行擴(kuò)散張量成像的患者,差異有統(tǒng)計(jì)學(xué)意義(p0.05)。結(jié)論:腦膜瘤患者術(shù)前行磁共振擴(kuò)散張量成像及灌注成像,結(jié)合adc值、rcbv值是腦膜瘤診斷和病理分級的有效的輔助手段,rcbv值還可以作為術(shù)前評估腦膜瘤微血管狀態(tài)的輔助手段之一,FA值在術(shù)前評估腦膜瘤質(zhì)地、手術(shù)切除腦膜瘤難易程度有重要的價(jià)值,術(shù)前DTI成像對明確腫瘤與周圍白質(zhì)纖維關(guān)系、術(shù)后預(yù)測患者的病情有重要作用。
[Abstract]:Objective: in this study, the quantitative detection of meningiomas by magnetic resonance diffusion tensor imaging (DTI) and perfusion imaging (PWI) was used to investigate the correlation between the pathological and immunohistochemical features of meningiomas, to provide a new basis for distinguishing the benign and malignant meningioma, and to evaluate the texture of the tumor before operation, and to clarify the fibrinization of the tumor and the surrounding white matter. To guide the protection of nerve function and to evaluate the prognosis of the patients. Methods: the patients with meningioma confirmed by the image and pathology of the affiliated Chinese Medicine Hospital of Southwest Medical University in June 2015 -2017, -2017, were all performed by magnetic resonance imaging, routine enhanced scan, DTI, PWI examination, and classified into I grade, II according to the pathological grade of WHO meningioma in 2007. Grade, III grade. This study classified I meningioma as benign, II and III meningiomas were malignant. The study was divided into two groups. The study was divided into two groups, benign A group and malignant group B. The meningioma tumor parenchyma, peritumoral edema area, ADC value, FA value and rCBV value of contralateral normal white matter fibers were measured. In the study of FA values of different pathological types, the pathological classification was divided into pathological types. The three group, the first group was atypical and malignant meningioma, the second group was fibrous meningioma, and the third group was other type of benign meningioma. The texture of the tumor was divided into three grades, the texture was soft (the suction device could absorb the tumor), the texture was hard (completely unable to be sucked out), and the texture was medium (between two cases). The operation was excised after operation. The meningioma specimens were stained with eosin and hematoxylin to detect vascular endothelial growth factor (VEGF), and to detect tumor microvascular density (MVD) using streptomycin biotin peroxidase linking method. According to DTI, the shape of white matter fiber and the anatomical relationship between the tumor and the tumor were revealed. The meninges were selected before operation in our hospital. 20 cases of tumor (including 16 cases of I meningioma, 2 cases of II meningioma, 1 cases of III meningioma) and 21 cases of meningioma with magnetic resonance diffusion tensor imaging before operation, the neurological functional recovery was scored by Karnofsky function state score (KPS). The data of normal distribution were treated with SPSS17.0 software, and the data of normal distribution were expressed as x + s. The ADC value, FA value and rCBV value of the corresponding parts of the meningioma in group A and group B were compared with the t test of bilateral paired KPS, and rCBV value was detected with VEGF, the relationship between MVD was Pearson correlation analysis, and the relationship between the value and the texture of the tumor was detected by Spearman correlation analysis, and the rank sum test was used for the three groups of pathological types. The results showed that the ADC value of the tumor parenchyma of the meningioma in group A was greater than that of the group B, and the difference was statistically significant (P0.05), and there was no statistical significance between the two groups of the peritumoral edema area and the contralateral white matter fiber (P0.05), and the rCBV value of the meninoma in the a group was greater than that of the B group, but the difference in the peritumoral edema area was the opposite, and the difference was poor in the peritumoral edema area. There were statistical significance (P0.05). The FA values in group A and B were not statistically significant (P0.05). The rCBV value of meningioma tumor parenchyma was positively correlated with VEGF and MVD (P0.05). When FA value was 0.3, the tumor texture was hard and not easy to be excised. In March, the KPS score of patients undergoing MR diffusion tensor imaging before operation was significantly higher than that of non expansion. The difference is statistically significant (P0.05). Conclusion: the patients with meningioma undergo magnetic resonance diffusion tensor imaging and perfusion imaging before operation, combined with the value of ADC, rCBV value is an effective auxiliary means for the diagnosis and pathological classification of meningioma, and the value of rCBV can also be used as one of the auxiliary methods for evaluating the microvascular status of meningioma before operation, FA value Preoperative evaluation of meningioma is of great value in surgical resection of meningiomas. Preoperative DTI imaging has an important role in identifying the relationship between tumor and peripheral white matter fiber and predicting the patient's condition after operation.
【學(xué)位授予單位】：西南醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R739.45

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