本文選題：3.0T~1H-MRS + 肝臟��； 參考：《河北醫(yī)科大學(xué)》2012年碩士論文

【摘要】：第一部分3.0T1H-MRS在正常肝臟與脂肪肝的定量研究 目的:采用3.0T多射頻核磁共振儀對正常志愿者及脂肪肝患者行1H-MRS檢查，提出肝臟1H-MRS代謝物正常值范圍，并進一步探討其對脂肪肝的診斷價值。 方法：38名正常志愿者，年齡25～75歲，平均年齡41.22±14.67歲，男19例，女19例；27名脂肪肝患者，年齡25～62歲，平均年齡45.86±9.49歲，男17例，，女10例，分別按年齡分為兩組：≥45歲組及＜45歲組，按照性別分為男、女兩組；采用3.0T磁共振儀對所有正常志愿者及脂肪肝患者行肝臟1H-MRS掃描，隨機抽取16名志愿者重復(fù)2次掃描，統(tǒng)計其水峰峰值、水峰峰下面積、脂峰峰值、脂峰峰下面積及脂肪分數(shù)，并進行統(tǒng)計學(xué)比較分析。 結(jié)果：①16名正常志愿者行2次1H-MRS掃描，取同一位置、相同大小ROI，2次測量代謝物數(shù)值無統(tǒng)計學(xué)差異（p＞0.05）；②按照年齡分組，≥45歲組及＜45歲組，兩組正常志愿者水峰峰值、水峰下面積、脂峰峰值、脂峰下面積及脂肪分數(shù)均無統(tǒng)計學(xué)差異（p＞0.05）；③不同性別正常志愿者兩組間進行比較，除水峰峰值外，余代謝物數(shù)值男女兩組未見差別（p＞0.05）；④≥45歲和＜45歲組正常志愿者均與同年齡組脂肪肝患者間比較，除水峰峰值差別不明顯外，其余水峰下面積、脂峰峰值、脂峰下面積及脂肪分數(shù)均存在統(tǒng)計學(xué)差異（p＞0.05）；⑤對于不同性別，正常志愿者與脂肪肝患者1H-MRS代謝物比較，男性組正常志愿者與脂肪肝患者水峰峰值差別不明顯，余代謝物數(shù)值存在明顯統(tǒng)計學(xué)差異；女性組正常志愿者與脂肪肝患者代謝物數(shù)值均顯示明顯差別（p＞0.05）；⑥正常肝臟MRS代謝物95%可信區(qū)間：水峰下面積為163.05±27.45，脂肪峰值為6.89±2.72，脂肪峰下面積為4.22±4.98，脂肪分數(shù)為2.51±2.61%；⑦得出判定正常肝臟與脂肪肝MRS代謝物閾值：脂肪峰值為9.55（敏感性0.909，1-特異性0），脂肪峰下面積為8.65（敏感性0.955，1-特異性0.029），脂肪分數(shù)4.97%（敏感性0.955，1-特異性0.029）。 結(jié)論：3.0T1H-MRS可應(yīng)用于正常人肝內(nèi)代謝及脂肪肝的定量研究；肝臟水及脂肪含量的正常值范圍對肝臟代謝性疾病診斷提供重要參考價值。 第二部分3.0T磁共振彌散成像在正常肝臟的定量研究 目的：采用3.0T多射頻核磁共振儀對正常志愿者的肝臟行彌散加權(quán)成像，對肝臟ADC值進行定量測量；提出正常肝臟ADC值范圍，并探討與年齡及性別的相關(guān)性，研究其臨床價值。 方法：38名健康志愿者，年齡25～75歲，平均年齡41.22±14.67歲，男19例，女19例，分別按年齡≥45和＜45分為兩組，并按性別分為男組、女組。采用3.0T核磁共振儀行DWI掃描，并采集b值分別為500，800，1000s/mm2時的ADC值，進行統(tǒng)計學(xué)分析比較。 結(jié)果：b值分別為500、800、1000s/mm2時，正常人肝臟ADC值的95%可信區(qū)間分別為：1448.75±313.31mm2/s、1221.29±258.54mm2/s、1153.53±218.21mm2/s；同一b值時，不同年齡及不同性別之間的ADC值均無統(tǒng)計學(xué)差異。同一年齡段或同一性別間，其b值=500s/mm2時，均與b=800，1000s/mm2時存在差異（p＜0.05），而b=800s/mm2與b=1000s/mm2時均無統(tǒng)計學(xué)差異（p＞0.05）。 結(jié)論：采用3.0T多射頻核磁共振儀可以對正常肝臟的水分子彌散進行定量測量，對正常肝臟ADC值的范圍正常參考值的提出，為肝臟彌漫性病變的診斷提供了重要參考價值。 第三部分3.0T質(zhì)子磁共振及DWI的聯(lián)合應(yīng)用對肝硬化的診斷研究 目的：應(yīng)用3.0T多射頻磁共振1H-MRS及DWI對正常志愿者和肝硬化患者的肝臟進行定量研究，并從肝臟代謝及水分子彌散水平探討肝硬化的機制。 方法：38名正常志愿者，男19例，女19例，年齡25～75歲，平均年齡41.22±14.67歲；肝硬化患者30例，男22例，女8例，年齡34～65歲，平均年齡50.19±8.61歲。全部志愿者行~1H-MRS及DWI檢查（其中，b值取500，800,1000s/mm~2），采集其水峰峰值、水峰下面積、脂肪峰峰值、脂肪峰下面積、脂肪分數(shù)以及肝臟彌散成像ADC值，并對正常志愿者組與肝硬化患者組所采集到的數(shù)據(jù)進行統(tǒng)計學(xué)分析。 結(jié)果：正常志愿者組與肝硬化組之間，~1H-MRS所測得的水峰峰值、水峰下面積存在明顯統(tǒng)計學(xué)差異（p＜0.05），肝硬化組水峰峰值、水峰下面積均低于正常組；而兩組間脂肪峰高、脂肪峰下面積、脂肪分數(shù)無明顯差異（p＞0.05）。正常志愿者組與肝硬化組之間，b=500s/mm~2時，兩組間ADC值明顯不同，肝硬化組存在水分子彌散障礙，但b=800s/mm~2和b=1000s/mm~2時，正常肝臟組及肝硬化組間ADC值差別不明顯。 結(jié)論：3.0T~1H-MRS及DWI可以作為一種檢查肝硬化的新手段，可從分子水平進一步闡明肝硬化機制。~1H-MRS及DWI對臨床肝硬化定性及定量診斷及治療預(yù)后評估具有重要價值。
[Abstract]:Part one quantitative study of 3.0T1H-MRS in normal liver and fatty liver
Objective: to examine the normal volunteers and patients with fatty liver by 3.0T multi radiofrequency magnetic resonance imaging (1H-MRS), and to discuss the range of normal value of liver 1H-MRS metabolites, and to further explore the diagnostic value of the liver.
Methods: 38 normal volunteers, aged 25~75 years, with an average age of 41.22 + 14.67 years old, 19 males and 19 women, 27 fatty liver patients, 25~62 years old, average age 45.86 + 9.49 years, 17 men and 10 cases, were divided into two groups according to age, divided into male and female groups according to sex. The 3.0T magnetic resonance apparatus was used for all Liver 1H-MRS scan was performed in normal volunteers and patients with fatty liver. 16 volunteers were randomly selected to repeat 2 scans. The peak peak of water peak, the area under the peak of water peak, the peak of lipid peak, the area under the peak of lipid peak, and the fat fraction were statistically compared.
Results: (1) 16 normal volunteers were treated with 2 1H-MRS scans, the same size, the same size ROI, and the 2 measurements of metabolites (P > 0.05). (2) the peak value of the peak of water peak, the area under the peak of water, the peak of the fat peak, the area under the lipid peak and the fat fraction were not statistically different according to age group, the group of 45 years old and the 45 years old group. Difference (P > 0.05); (3) comparison between the two groups of normal volunteers, except for the peak value of the peak water peak, there was no difference between the two groups of the residual metabolite value (P > 0.05). (4) the normal volunteers over 45 years old and 45 years old were compared with the same age group of fatty liver, except the peak value of the water peak, the rest of the water peak area, the peak of fat peak, and the fat. There was a statistical difference between the area of the peak and the fat fraction (P > 0.05). 5. For the 1H-MRS metabolites of the normal volunteers and the fatty liver patients, there was no significant difference in the peak value of the peak water peak in the normal volunteers and the fatty liver patients. The number of metabolites showed significant differences (P > 0.05); (6) the 95% confidence interval of normal liver MRS metabolites: the area under the peak of water was 163.05 + 27.45, the peak of fat was 6.89 + 2.72, the area under the fat peak was 4.22 + 4.98 and the fat fraction was 2.51 + 2.61%, and the threshold of the MRS metabolite of the normal liver and fatty liver was determined: the peak of fat was 9.55 (sensitivity). The sensitivity 0.909,1- specificity was 0, the area under the fat peak was 8.65 (sensitivity 0.955,1- specificity 0.029), and the fat fraction was 4.97% (sensitivity 0.955,1- specificity 0.029).
Conclusion: 3.0T1H-MRS can be applied to the quantitative study of liver metabolism and fatty liver in normal people, and the normal range of liver water and fat content can provide important reference value for diagnosis of liver metabolic diseases.
The second part is a quantitative study of 3.0T diffusion weighted imaging in normal liver.
Objective: 3.0T multi radiofrequency magnetic resonance imaging (rfMRI) was used for the liver diffusion weighted imaging of normal volunteers, the quantitative measurement of liver ADC value, the ADC range of normal liver, and the correlation between age and sex, and its clinical value were studied.
Methods: 38 healthy volunteers, aged 25~75 years, average age 41.22 + 14.67 years old, male 19 cases and 19 women, were divided into two groups according to age > 45 and 45 respectively, and divided into male group and female group according to sex. 3.0T MRI was used for DWI scan, and the value of B was 5008001000s/ mm2 respectively, and the statistical analysis was compared.
Results: when the value of B was 5008001000s/mm2, the 95% confidence intervals of the normal liver ADC value were 1448.75 + 313.31mm2/s, 1221.29 + 258.54mm2/s, 1153.53 + 218.21mm2/s, and the ADC values of different ages and sexes were not statistically different when the same b value. The b value =500s/mm2 of the same age or the same sex, all and b=. There was a difference in 8001000s/mm2 (P < 0.05), but there was no significant difference between b=800s/mm2 and b=1000s/mm2 (P > 0.05).
Conclusion: the quantitative measurement of water molecular diffusion in normal liver can be measured by 3.0T multi radiofrequency MRI, and the normal reference value of normal liver ADC value provides an important reference value for the diagnosis of liver diffuse lesions.
The third part is the application of 3.0T proton magnetic resonance and DWI in the diagnosis of liver cirrhosis.
Objective: To study the liver of normal volunteers and patients with liver cirrhosis by 3.0T multiple radiofrequency MRI 1H-MRS and DWI, and to explore the mechanism of liver cirrhosis from liver metabolism and water molecular diffusion.
Methods: 38 normal volunteers, 19 male and 19 female, age 25~75 years old, with an average age of 41.22 + 14.67 years old, 30 cases of cirrhosis, 22 male, 8 women, 34~65 years old, average age 50.19 + 8.61 years, all volunteers were examined by ~1H-MRS and DWI (b value was 5008001000s/mm~2), and the peak of water peak, area under water peak and peak peak of fat were collected. The value, the area under the fat peak, the fat fraction and the ADC value of the liver diffusion imaging, and statistical analysis of the data collected from the normal volunteers and the patients with liver cirrhosis.
Results: the peak peak of water peak measured by ~1H-MRS between the normal volunteers and the liver cirrhosis group was significantly different (P < 0.05). The peak value of the water peak of the liver cirrhosis group was lower than that of the normal group. The fat peaks of the two groups were higher, the area under the fat peak and the fat fraction were not significantly different (P > 0.05). The ADC values between the two groups were significantly different between the two groups. There was a water diffusion barrier in the liver cirrhosis group, but there was no significant difference in the ADC value between the normal liver group and the liver cirrhosis group at the time of b=800s/mm~2 and b=1000s/mm~2.
Conclusion: 3.0T~1H-MRS and DWI can be used as a novice section of liver cirrhosis. It is of great value to further clarify the mechanism of liver cirrhosis.~1H-MRS and DWI from the molecular level to determine the qualitative and quantitative diagnosis of liver cirrhosis and to evaluate the prognosis of the liver cirrhosis.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2012
【分類號】：R816.5

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