本文選題：擴散加權(quán)成像 + 頸部　； 參考：《山西醫(yī)科大學(xué)》2013年碩士論文

【摘要】：研究背景及目的磁共振擴散加權(quán)成像(diffusion-weightedimaging，DWI)是近年來核磁檢查一項新技術(shù)，是目前唯一一種觀察活體組織中水分子擴散運動的成像方法，其宏觀表現(xiàn)用表觀擴散系數(shù)(apparentdiffusioncoefficient，ADC)表示。目前已成為腦缺血、腦梗死超急性期診斷的常規(guī)序列。腫瘤病變的組織學(xué)類型、細胞密實程度、分化程度及腫瘤病理分型與ADC值有很高的相關(guān)性，使根據(jù)ADC值進行定性診斷及鑒別診斷成為可能。本研究重點探討ADC值對頸部淋巴瘤與鱗癌淋巴結(jié)轉(zhuǎn)移瘤二者之間的鑒別價值；對不同b值，計算ROC曲線下面積，并選取最佳ADC值對二者鑒別有較高的敏感性和特異性。 材料和方法收集我院2012年10月至2013年2月初診的頸部淋巴瘤及鱗癌淋巴結(jié)轉(zhuǎn)移瘤患者，男性35例，女性16例，年齡4-79歲，平均年齡50歲。其中淋巴瘤27例，包括20例非霍奇金淋巴瘤、7例霍奇金淋巴瘤；頸部鱗癌淋巴結(jié)轉(zhuǎn)移瘤24例。均經(jīng)淋巴結(jié)穿刺活檢或術(shù)后病理證實。 使用荷蘭飛利浦公司生產(chǎn)的飛利浦Achieva3.0TTX多源發(fā)射磁共振成像系統(tǒng)，使用SENSE-NV-16通道頭頸聯(lián)合線圈，除常規(guī)頭頸部掃描外，DWI掃描使用單次激發(fā)自旋回波平面回波成像(Singleshot-EchoPlanarImagingSE-EPI)技術(shù)，掃描層厚、層間距及范圍均與軸位T1WI及T2WI相同，以便于能對頸部淋巴結(jié)位置進行準確判斷。在X、Y、Z軸三個方向上施加敏感梯度脈沖，分別取0、600s/mm2、800s/mm2、1000s/mm2四組b值，得到不同b值下淋巴結(jié)病變DWI圖像及ADC圖像，分別測得各個b值下淋巴結(jié)病變的ADC值。 計量資料以均數(shù)±標準差（x±S），組間比較采用兩樣本t檢驗，P0.05認為差別有統(tǒng)計學(xué)意義。 結(jié)果b值為600s/mm2時，淋巴瘤與轉(zhuǎn)移瘤ADC值分別為0.75±0.14×10-3mm2/s和1.12±0.12×10~(-3)mm~2/s，b值為800s/mm2時，淋巴瘤與轉(zhuǎn)移瘤ADC值分別為0.68±0.11×10-3mm2/s和1.02±0.13×10-3mm2/s，，b值為1000s/mm2時，淋巴瘤和轉(zhuǎn)移瘤ADC值分別為0.64±0.10×10-3mm2/s和0.96±0.13×10-3mm2/s，在各個b值下，頸部淋巴瘤和鱗癌頸部淋巴結(jié)轉(zhuǎn)移瘤之間的ADC值差異均有統(tǒng)計學(xué)意義（P0.05）。在不同b值下，淋巴瘤在b值取800s/mm2和1000s/mm2時二者之間差別無統(tǒng)計學(xué)意義（P0.05），余各組間差別有統(tǒng)計學(xué)意義（P0.05）；轉(zhuǎn)移瘤在b值取800s/mm2和1000s/mm2時二者之間差別無統(tǒng)計學(xué)意義（P0.05），余各組間差別有統(tǒng)計學(xué)意義（P0.05）。通過ROC曲線分析，不同b值下，淋巴瘤與鱗癌頸部淋巴結(jié)轉(zhuǎn)移瘤的ADC值均可以對二者進行鑒別，且在b值為1000s/mm2時曲線下面積最大，診斷效能最高，此時ADC診斷最佳閾值為0.741×10-3mm2/s。 結(jié)論對頸部淋巴瘤和鱗癌頸部淋巴結(jié)轉(zhuǎn)移瘤可通過ADC值的測定進行鑒別。
[Abstract]:Background and objective Diffusion-weighted imaging (DWI) is a new technique for nuclear magnetic examination in recent years. It is the only imaging method for observing the diffusion motion of water molecules in living tissues, and its macroscopic manifestations are expressed by the apparent diffusion coefficient apparentdiffusion-diffusion coefficient (ADCA). At present, it has become a routine sequence for the diagnosis of cerebral ischemia and cerebral infarction. The histological type, cell density, differentiation degree and pathological type of tumor were highly correlated with ADC value, which made it possible to make qualitative diagnosis and differential diagnosis according to ADC value. This study focused on the value of ADC value in the differential diagnosis between cervical lymphoma and squamous cell carcinoma lymph node metastasis, and calculated the area under ROC curve for different b values, and selected the best ADC value to distinguish them with high sensitivity and specificity. Materials and methods from October 2012 to February 2013, 35 patients with cervical lymphoma and squamous cell carcinoma with lymph node metastasis were collected, including 35 males and 16 females, aged 4-79 years, with an average age of 50 years. There were 27 cases of lymphoma including 20 cases of non-Hodgkin's lymphoma 7 cases of Hodgkin's lymphoma and 24 cases of cervical squamous cell carcinoma lymph node metastasis. All cases were confirmed by lymph node biopsy or postoperative pathology. Using Philips Achieva3.0TTX multi-source emission magnetic resonance imaging system produced by Philips Company in the Netherlands, using SENSE-NV-16 channel head and neck coils, using single excitation spin echo plane echo imaging Singleshot-Echo Planar ImagingSE-EPI technique, scanning slice thickness, in addition to routine head and neck scanning. The interlaminar spacing and range are the same as axial T1WI and T2WI so as to accurately judge the location of cervical lymph nodes. The sensitive gradient pulse was applied in three directions of the X _ (Y) Z axis. Four groups of b values (0.600 s / mm ~ (2) 2800s / mm ~ (2) and 1000s / mm ~ (2) were taken respectively. The DWI images and ADC images of lymph node lesions were obtained under different b values, and the ADC values of lymph node lesions under each b value were measured respectively. The mean 鹵standard deviation was used as the measurement data, and the difference was statistically significant by using two samples t test (P0.05). Results when b value was 600s/mm2, the ADC value of lymphoma and metastatic tumor was 0.75 鹵0.14 脳 10-3mm2/s and 1.12 鹵0.12 脳 10 ~ (-1) 脳 10 ~ (-3) mm ~ (-2) 800s/mm2, respectively. When the ADC value of lymphoma and metastatic tumor was 0.68 鹵0.11 脳 10-3mm2/s and 1.02 鹵0.13 脳 10 ~ (-3) mm ~ (2) 路s ~ (sb) respectively, the ADC value of lymphoma and metastatic tumor was 0.64 鹵0.10 脳 10-3mm2/s and 0.96 鹵0.13 脳 10 ~ (-3) mm ~ (-2) s, respectively. Under each b value, the ADC value of lymphoma and metastatic tumor was 0.64 鹵0.10 脳 10-3mm2/s and 0.96 鹵0.13 脳 10 ~ (-3) mm ~ (-2) / s, respectively. There were significant differences in ADC between cervical lymphomas and squamous cell carcinomas (P 0.05). At different b values, There was no significant difference between 800s/mm2 and 1000s/mm2 when b value was taken from lymphoma, but there was significant difference between other groups (P 0.05), but there was no significant difference between 800s/mm2 and 1000s/mm2 in metastatic tumor (P 0.05), but there was significant difference between other groups (P 0.05). By ROC curve analysis, the ADC values of lymphomas and squamous cell carcinoma cervical lymph node metastases can be distinguished under different b values. When b value is 1000s/mm2, the area under the curve is the largest and the diagnostic efficiency is the highest. The best threshold value for ADC diagnosis is 0.741 脳 10 ~ (-3) mm ~ (2) / s. Conclusion Cervical lymph node metastasis of cervical lymphoma and squamous cell carcinoma can be distinguished by ADC.
【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2013
【分類號】：R730.44

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