【摘要】：目的：評價彌散張量成像FA值及ADC值在膠質(zhì)瘤分級和腫瘤浸潤中應(yīng)用的價值和意義 方法：不受限于盲法及發(fā)表狀態(tài)，以“彌散張量成像”、“部分各向異性”、“表觀彌散系數(shù)”、“膠質(zhì)瘤”、“Diffusion Tensor Imaging”、“Glioma”、“apparentdiffusioncoefficient”、“fractional anisotropy”、“ADC”、“FA”為關(guān)鍵詞或主題詞，經(jīng)兩名系統(tǒng)評價員共同商議后，以“關(guān)鍵詞:表觀彌散系數(shù)or關(guān)鍵詞:ADC or關(guān)鍵詞:部分各向異性or FA and關(guān)鍵詞:膠質(zhì)瘤”為檢索式在中國生物醫(yī)學(xué)文獻數(shù)據(jù)庫（CBM）、中國知網(wǎng)（CNKI）、萬方數(shù)據(jù)庫、維普數(shù)據(jù)庫中行計算機檢索；以“(apparent diffusion coefficient) OR ADC OR (fractional anisotropy) OR FA ANDGlioma[MeSH Terms] AND humans[MeSH Terms]”為檢索式在Pubmed數(shù)據(jù)庫、EMBASE數(shù)據(jù)庫中行計算機檢索；在神經(jīng)外科學(xué)雜志、神經(jīng)影像學(xué)雜志和神經(jīng)外科學(xué)領(lǐng)域的學(xué)術(shù)會議論文集中，行手工檢索；查閱相關(guān)綜述性文章的參考文獻，行手工檢索；通過與著作者聯(lián)系的方式追蹤還未發(fā)表的文章。應(yīng)用NICE推薦的評分標準對納入的文獻進行質(zhì)量評價。在膠質(zhì)瘤的分級和膠質(zhì)瘤的腫瘤浸潤兩個方面行Meta分析。 結(jié)果：最終有15篇關(guān)于FA值及ADC值在膠質(zhì)瘤分級和腫瘤浸潤中應(yīng)用的文獻被納入本研究中。首先對這些文獻進行異質(zhì)性檢驗，如果存在異質(zhì)性，采用隨機效應(yīng)模型；如果存在同質(zhì)性，采用固定效應(yīng)模型。合并分析結(jié)果如下： ⑴LGG腫瘤實質(zhì)區(qū)的FA值低于HGG腫瘤實質(zhì)區(qū)的FA值（WMD合并=-0.02，95％CI[-0.03，-0.01]），結(jié)果有統(tǒng)計學(xué)意義；LGG腫瘤實質(zhì)區(qū)的ADC值高于HGG腫瘤實質(zhì)區(qū)的ADC值（WMD合并=0.15，95％CI[0.02，0.28]），結(jié)果有統(tǒng)計學(xué)意義。 ⑵LGG腫瘤實質(zhì)區(qū)的FA值低于瘤周水腫區(qū)的FA值（WMD合并=-0.13，95％CI[-0.19，-0.07]），結(jié)果有統(tǒng)計學(xué)意義；LGG腫瘤實質(zhì)區(qū)的ADC值高于瘤周水腫區(qū)的ADC值（WMD合并=0.21，95％CI[0.05，0.37]），結(jié)果有統(tǒng)計學(xué)意義。LGG瘤周水腫區(qū)的FA值低于正常白質(zhì)區(qū)的FA值（WMD合并=-0.08，95％CI[-0.14，-0.03]），結(jié)果有統(tǒng)計學(xué)意義；LGG瘤周水腫區(qū)的ADC值高于正常白質(zhì)區(qū)的ADC值（WMD合并=0.38，95％CI[0.14，0.61]），結(jié)果有統(tǒng)計學(xué)意義。LGG腫瘤實質(zhì)區(qū)的FA值低于正常白質(zhì)區(qū)的FA值（WMD合并=-0.25，95％CI[-0.29，-0.21]），結(jié)果有統(tǒng)計學(xué)意義；LGG腫瘤實質(zhì)區(qū)的ADC值高于正常白質(zhì)區(qū)的ADC值（WMD合并=0.57，95％CI[0.24，0.89]），結(jié)果有統(tǒng)計學(xué)意義。 ⑶HGG腫瘤實質(zhì)區(qū)的FA值低于瘤周水腫區(qū)的FA值（WMD合并=-0.07，95％CI[-0.12，-0.02]），結(jié)果有統(tǒng)計學(xué)意義；HGG腫瘤實質(zhì)區(qū)的ADC值與瘤周水腫區(qū)無差異（WMD合并=-0.02，95％CI[-0.12，0.08],結(jié)果無統(tǒng)計學(xué)意義）。HGG瘤周水腫區(qū)的FA值低于正常白質(zhì)區(qū)的FA值（WMD合并=-0.20，95％CI[-0.27，-0.13]），結(jié)果有統(tǒng)計學(xué)意義；HGG瘤周水腫區(qū)的ADC值高于正常白質(zhì)區(qū)的ADC值（WMD合并=0.52，95％CI[0.39，0.66]），結(jié)果有統(tǒng)計學(xué)意義。HGG腫瘤實質(zhì)區(qū)的FA值低于正常白質(zhì)區(qū)的FA值（WMD合并=-0.27，95％CI[-0.34，-0.19]），結(jié)果有統(tǒng)計學(xué)意義；HGG腫瘤實質(zhì)區(qū)的ADC值高于正常白質(zhì)區(qū)的ADC值（WMD合并=0.47，95％CI[0.42，0.52]），結(jié)果有統(tǒng)計學(xué)意義。 結(jié)論: ⑴彌散張量成像FA值和ADC值有助于確定膠質(zhì)瘤的分級。 ⑵彌散張量成像FA值有助于判定LGG和HGG的腫瘤浸潤程度，有助于手術(shù)方案的制定；ADC值有助于判定LGG的腫瘤浸潤情況，對于判定HGG的腫瘤浸潤情況無意義。 ⑶由于我們納入的各項研究間存在異質(zhì)性，，某些研究質(zhì)量偏低，以及存在潛在的發(fā)表偏倚和語種偏倚，所以還需要進一步的高質(zhì)量的病例系列研究，從而對FA值及ADC值在膠質(zhì)瘤分級和腫瘤浸潤中的應(yīng)用進行更為系統(tǒng)、全面、深入的評價。
[Abstract]:Objective: To evaluate the value and significance of diffusion tensor imaging (FA) and ADC in glioma grading and tumor invasion.
Methods: not limited to blind and published state, with "diffuse tensor imaging", "partial anisotropy", "apparent diffusion coefficient", "glioma", "Diffusion Tensor Imaging", "Glioma", "apparentdiffusioncoefficient", "fractional anisotropy", "ADC", "FA" as key words or subject words, through two families. After the common negotiators, "Keywords: apparent diffusion coefficient or keywords: ADC or key words: partial anisotropic or FA and key words: glioma" as the retrieval type in the Chinese biomedical literature database (CBM), Chinese knowledge network (CNKI), Wanfang database, and the vitamin database, with "apparent diffusion coeffi" Cient) OR ADC OR (fractional anisotropy) OR FA ANDGlioma[MeSH Terms] AND humans[MeSH. The references of the sex articles were made by hand; the unpublished articles were traced by the authors' contact with the authors. The quality of the included literature was evaluated with the NICE recommended scoring criteria. The Meta analysis was performed in two aspects of glioma classification and glioma infiltration.
Results: in the final 15 papers on the application of FA and ADC values in glioma classification and tumor infiltration were included in this study. First of all, the heterogeneity of the literature was tested. If there was heterogeneity, a random effect model was used. If there was a homogeneity, a fixed effect model was used. The results of the combined analysis were as follows:
The FA value of the parenchymal area of LGG was lower than the FA value of HGG tumor parenchyma (WMD with =-0.02,95%CI[-0.03, -0.01]), and the results were statistically significant. The ADC value of the parenchymal area of LGG was higher than the ADC value of the HGG tumor parenchyma (WMD merged), and the results were statistically significant.
The FA value of LGG tumor parenchyma was lower than the FA value of the peritumoral edema area (WMD combined with =-0.13,95%CI[-0.19, -0.07]), and the results were statistically significant. The ADC value of the parenchyma region of LGG was higher than the ADC value of the edema area in the peritumoral area (WMD combined =0.21,95%CI[0.05,0.37]). MD combined with =-0.08,95%CI[-0.14, -0.03]), the results were statistically significant. The ADC value in the edema area of LGG was higher than that of the normal white matter region (WMD with =0.38,95%CI[0.14,0.61]). The results showed statistically significant FA values in the parenchymal area of.LGG lower than that of the normal white matter region. The ADC value of LGG tumor parenchyma was higher than that of normal white matter (WMD = 0.57,95% CI [0.24,0.89]), and the results were statistically significant.
(3) the FA value of HGG tumor parenchyma was lower than the FA value of the peritumoral edema area (WMD combined with =-0.07,95%CI[-0.12, -0.02]), and the results were statistically significant. The ADC value of the parenchymal area of HGG was not different from that of the peritumoral edema area (WMD combined =-0.02,95%CI[-0.12,0.08], the results were not statistically significant). D combined with =-0.20,95%CI[-0.27, -0.13]), the results were statistically significant. The ADC value in the edema area of HGG was higher than that of the normal white matter region (WMD with =0.52,95%CI[0.39,0.66]). The results showed statistically significant FA values in the parenchymal area of.HGG lower than that of the normal white matter region. The ADC value of HGG tumor parenchyma was higher than that of normal white matter (WMD combined = 0.47,95% CI [0.42,0.52]), the results were statistically significant.
Conclusion:
Diffusion tensor imaging FA and ADC values are helpful in determining the grading of gliomas.
(2) the FA value of diffusion tensor imaging helps to determine the degree of tumor infiltration in LGG and HGG, which is helpful to the formulation of the operation scheme, and the ADC value helps to determine the invasion of the tumor in LGG, and is meaningless to determine the infiltration of the tumor in the HGG.
(3) because of the heterogeneity, low quality, potential publication bias and language bias, further high quality case studies are needed to make a more systematic, comprehensive and in-depth evaluation of the FA value and ADC value in glioma classification and tumor infiltration.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R739.41

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