發(fā)布時(shí)間：2018-06-19 11:50

  本文選題：膠質(zhì)瘤 + 彌散加權(quán)成像�。� 參考：《大連醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:探討彌散加權(quán)圖像(diffusion weighted imaging,DWI)和磁敏感加權(quán)成像(susceptibility weighted imaging,SWI)對(duì)腦高、低級(jí)別膠質(zhì)瘤的鑒別診斷價(jià)值。材料與方法:本實(shí)驗(yàn)采用回顧性研究,分析經(jīng)病理證實(shí)的不同級(jí)別腦膠質(zhì)瘤20例。根據(jù)2007年WHO中樞神經(jīng)系統(tǒng)腫瘤分類標(biāo)準(zhǔn),將患者分為高、低級(jí)別組2組,每組各10人。所有患者均應(yīng)用Siemens Magnetom Trio A Tim 3.0T MR行常規(guī)MRI平掃,DWI、SWI掃描及MRI增強(qiáng)掃描檢查。結(jié)合常規(guī)MRI圖像確定腫瘤實(shí)質(zhì)部分。(1)分別測(cè)量三種b值(b=1000、2000、3000s/mm2)ADC圖腫瘤實(shí)質(zhì)部分及對(duì)側(cè)對(duì)應(yīng)部位腦實(shí)質(zhì)的最小ADC值(ADCmin)的平均值。(2)將腫瘤實(shí)質(zhì)部分ADCmin除以對(duì)側(cè)相對(duì)應(yīng)腦實(shí)質(zhì)ADCmin,即作rADCmin。(3)ADC參數(shù)值的差異采用獨(dú)立樣本t檢驗(yàn)和秩和檢驗(yàn)分析,并繪制ROC曲線分析各參數(shù)診斷效能。(4)采用獨(dú)立樣本t檢驗(yàn)分析高、低級(jí)別組腫瘤ITSS評(píng)分是否具有統(tǒng)計(jì)學(xué)差異。對(duì)膠質(zhì)瘤的ITSS評(píng)分與其組織病理學(xué)分級(jí)對(duì)照的相關(guān)性采用Spearman相關(guān)法檢驗(yàn),并繪制ROC曲線分析各參數(shù)診斷效能。(5)分析聯(lián)合DWI和SWI兩種技術(shù),檢出高級(jí)別膠質(zhì)瘤的敏感性、特異性。結(jié)果:(1)隨著b值得升高,大多數(shù)高級(jí)別膠質(zhì)瘤DWI顯示病灶均表現(xiàn)為高信號(hào),而大部分低級(jí)別膠質(zhì)瘤DWI圖像顯示病灶信號(hào)減低,表現(xiàn)為等、低信號(hào)。(2)在三種b值條件下,膠質(zhì)瘤的級(jí)別與ADCmin、rADCmin值之間均呈明顯負(fù)相關(guān)性,并且高b值時(shí)(rADCmin3000,r=-0.8172,P0.0001)相關(guān)性最大。(3)b值相同時(shí),ADCmin值、rADCmin值隨膠質(zhì)瘤級(jí)別升高而減低,并且在b=3000s/mm2時(shí),ADCmin值差異最大。(4)無論高、低級(jí)別組,三種b值A(chǔ)DCmin兩兩之間比較差異均有統(tǒng)計(jì)學(xué)意義(P0.05)。三種b值rADCmin兩兩之間比較差異均無統(tǒng)計(jì)學(xué)意義(P0.05)。(5)b=3000s/mm2時(shí),rADCmin的診斷效能最大。(6)不同級(jí)別組膠質(zhì)瘤的ITSS評(píng)分之間差異具有顯著性(t=8.497,P=0.000),且兩者呈高度正相關(guān)(r=0.8947,P0.001)。當(dāng)把ITSS評(píng)分閾值設(shè)定為1時(shí),高級(jí)膠質(zhì)瘤診斷的敏感度、特異度分別為90.91%、88.89%。(7)兩指標(biāo)聯(lián)合篩檢敏感性、特異性分別100%、90%,較各指標(biāo)單獨(dú)檢查的效能均高。結(jié)論:(1)DWI量化參數(shù)ADCmin值、rADCmin值在高、低級(jí)別膠質(zhì)瘤中差異具有顯著性,有助于腦膠質(zhì)瘤分級(jí),其中以rADCmin值(b=3000s/mm2)的對(duì)膠質(zhì)瘤分級(jí)診斷意義最大。(2)SWI對(duì)膠質(zhì)瘤分級(jí)診斷意義重大,其ITSS評(píng)分與膠質(zhì)瘤病理分級(jí)呈高度正相關(guān)(3)DWI與SWI作為臨床常用功能磁共振技術(shù),將兩者聯(lián)合應(yīng)用,可以提高對(duì)腦膠質(zhì)瘤分級(jí)診斷效能,是常規(guī)MRI的重要補(bǔ)充。
[Abstract]:Objective: to investigate the value of diffusion weighted imaging (DWI) and magnetic sensitive weighted imaging (MRI) in differential diagnosis of high and low grade gliomas. Materials and methods: 20 cases of gliomas with different grades proved by pathology were analyzed retrospectively. According to WHO classification criteria of central nervous system tumors in 2007, the patients were divided into two groups: high grade group and low grade group with 10 persons in each group. All patients were examined with Siemens Magnetom Trio A Tim 3.0T Mr. Combined with conventional MRI imaging to determine the tumor parenchyma. 1) to measure the mean value of the minimum ADC value of the tumor parenchyma and the brain parenchyma in the contralateral brain parenchyma and the contralateral brain parenchyma by measuring the mean value of ADCmin of the tumor parenchyma divided by the contralateral corresponding brain solid brain respectively. The difference of ADC parameters was analyzed by independent sample t test and rank sum test. The diagnostic efficacy of each parameter was analyzed by ROC curve. 4) the ITSS score of tumor in the low grade group was statistically different from that in the low grade group. The correlation between ITSS score and histopathological grade of glioma was examined by Spearman correlation method, and the diagnostic efficacy of ROC curve was plotted. The sensitivity and specificity of high grade glioma were detected by DWI and SWI. Results with the increase of b value, most high-grade gliomas showed high signal intensity on DWI, while most low-grade gliomas showed low signal intensity on DWI images. There was a significant negative correlation between the grade of glioma and the value of rADCmin in gliomas, and the highest correlation was found between the grade of glioma and the value of rADCmin3000r-0.8172P0.0001 at high b value. The value of rADCmin decreased with the increase of grade of glioma at the same value, and the difference of the value of ADCmin at b=3000s/mm2 was the biggest. 4) in the group of high and low grade, the value of rADCmin decreased with the increase of grade of glioma. The difference of ADCmin between the three groups was statistically significant (P 0.05). There was no significant difference between the three groups of b value rADCmin. There was no significant difference in the ITSS score of rADCmin between the three groups. There was a significant difference between the ITSS scores of different grades of gliomas at the time of 3000s / mm2), and there was a highly positive correlation between the two groups. When the threshold value of ITSS was set to 1, the sensitivity and specificity of the diagnosis of advanced glioma were 90.91 and 88.89.7respectively, and the specificity was 100 ~ 90, which was higher than that of each index alone. Conclusion the difference of ADCmin value and rADCmin value in high and low grade gliomas is significant, and it is helpful to grade gliomas. The value of rADCmin is the most significant in the diagnosis of glioma grading. The ITSS score is highly positively correlated with the pathological grade of gliomas. As a common functional magnetic resonance imaging technique, the combination of ITSS and SWI can improve the diagnostic efficacy of glioma grading and is an important supplement to conventional MRI.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R445.2;R739.41

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本文編號(hào)：2039786