本文關(guān)鍵詞： 膠質(zhì)瘤 彌散峰度成像 病理分級(jí) 微觀結(jié)構(gòu)　出處：《山東大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:探討磁共振彌散峰度成像(diffusional kurtosis imaging,DKI)在腦膠質(zhì)瘤分級(jí)中的應(yīng)用價(jià)值,以及彌散峰度參數(shù)與腫瘤病理組織學(xué)參數(shù)的相關(guān)性,以明確DKI是否可以評(píng)估腦膠質(zhì)瘤微觀結(jié)構(gòu)的變化。方法:本研究使用3.0 T MR掃描儀,對(duì)37名經(jīng)病理證實(shí)為腦膠質(zhì)瘤的患者(男性23例,女性14例,年齡23歲-66歲,平均年齡47歲)行MRI常規(guī)序列及DKI序列掃描。經(jīng)后處理軟件得到各項(xiàng)異性分?jǐn)?shù)(fractional anisotropy,FA)、平均擴(kuò)散系數(shù)(mean diffusivity,MD)以及平均擴(kuò)散峰度(mean kurtosis,MK)參數(shù)圖,由一名經(jīng)驗(yàn)豐富的磁共振診斷醫(yī)師分別在瘤體、瘤周及對(duì)側(cè)正常腦白質(zhì)(contralateral normal appearing white matter,NAWMc)色畫感興趣區(qū).(region of interest,ROI),以NAWMc為參照對(duì)瘤體及瘤周的各參數(shù)值進(jìn)行標(biāo)準(zhǔn)化處理,最終得到標(biāo)準(zhǔn)化參數(shù)(nFA、nMD和nMK)。應(yīng)用獨(dú)立樣本t檢驗(yàn)比較標(biāo)準(zhǔn)化參數(shù)在高低級(jí)別膠質(zhì)瘤瘤體中的差異。應(yīng)用受試者工作特性曲線(receiver operating characteristic,ROC)分析標(biāo)準(zhǔn)化參數(shù)在鑒別高-低級(jí)別膠質(zhì)瘤中的敏感性及特異性。采用配對(duì)t檢驗(yàn)比較標(biāo)準(zhǔn)化參數(shù)在瘤體及瘤周中的差異。術(shù)中神經(jīng)外科醫(yī)生根據(jù)常規(guī)MRI定位分別切取對(duì)應(yīng)的瘤體及瘤周組織,并對(duì)其分別進(jìn)行單克隆Ki-67、CD34 和微管相關(guān)蛋白(microtubule-associated protein 2,MAP2)抗體的免疫組化染色。采用Pearson相關(guān)分析檢測(cè)標(biāo)準(zhǔn)化DKI參數(shù)值(nFA、nMD及nMK)與病理組織學(xué)參數(shù)(腫瘤細(xì)胞密度,微血管總面積(total vascular area,TVA)以及Ki-67標(biāo)記指數(shù)(labe1ingindex,LI))的相關(guān)性。結(jié)果:1.高級(jí)別膠質(zhì)瘤瘤體nFA和nMK參數(shù)值明顯高于低級(jí)別膠質(zhì)瘤(P=0.02和P0.001),而nMD參數(shù)值明顯低于低級(jí)別膠質(zhì)瘤(P=0.001)。2.在鑒別高低級(jí)別膠質(zhì)瘤ROC曲線分析中,nMK具有最大的曲線下面積(area underthecurve,AUC)(0.889),最高的靈敏度(80%)和特異度(100%),差異具有統(tǒng)計(jì)學(xué)意義(P值均0.05)。3.nFA和nMD參數(shù)值在膠質(zhì)瘤瘤體及瘤周中有顯著性差異(P0.001和P=0.006),nMK參數(shù)值在兩者間無顯著性差異(P=0.28),然而,在低級(jí)別膠質(zhì)瘤中,瘤體nMK值顯著低于瘤周(P0.001),在高級(jí)別膠質(zhì)瘤中,瘤體nMK值顯著高于瘤周(P=0.002)。4.膠質(zhì)瘤腫瘤實(shí)質(zhì)nMK值與腫瘤細(xì)胞密度(r = 0.596,P=0.006)、TVA(r = 0.764,P0.001)以及Ki-67 LI(r = 0.766,P0.001)均存在顯著的正相關(guān)關(guān)系,然而nFA值僅與腫瘤細(xì)胞密度這一個(gè)指標(biāo)存在顯著的正相關(guān)關(guān)系(r = 0.534,P=0.01),nMD 僅與腫瘤細(xì)胞密度(r =-0.467,P=0.03)和 Ki-67LI(r =-0.630,P=0.003)存在顯著的負(fù)相關(guān)關(guān)系。結(jié)論:1.DKI尤其是MK參數(shù)在高低級(jí)別膠質(zhì)瘤中存在顯著性差異,而且具有較高的特異度和敏感度,與傳統(tǒng)的擴(kuò)散成像參數(shù)(FA及MD)相比,可以更好地鑒別高-低級(jí)別膠質(zhì)瘤。2.DKI尤其是MK參數(shù)與膠質(zhì)瘤細(xì)胞的增殖活性、腫瘤內(nèi)微血管密度和形態(tài)以及腫瘤細(xì)胞密度密切相關(guān),可以作為無創(chuàng)性MRI技術(shù)來評(píng)估膠質(zhì)瘤微觀結(jié)構(gòu)的變化。
[Abstract]:Objective: to evaluate the value of diffusional kurtosis imaging (DKI) in the classification of gliomas. And the correlation between diffusion kurtosis parameters and tumor histopathological parameters to determine whether DKI can be used to evaluate the microstructural changes of gliomas. Methods: 3. 0 T Mr scanner was used in this study. Thirty-seven patients (23 males and 14 females, aged 23 to 66 years) with pathologically confirmed gliomas were enrolled. The average age was 47 years). MRI routine sequence and DKI sequence scanning were performed. After the post-processing software, the fractional anisotropic fractions were obtained. Mean diffusion coefficient and mean diffusion kurtosis mean kurtosism (MK). By an experienced magnetic resonance diagnostic physician in the tumor. Contralateral normal appearing white matter. The region of interest is drawn by NAW McC. The parameters of the tumor and its circumference are standardized with NAWMc as the reference. Finally, the standardized parameters (nFA) were obtained. NMD and nMK. The differences of standardized parameters in high and low grade gliomas were compared using independent sample t test. Receiver operating characteristic. Rock). The sensitivity and specificity of standardized parameters in differentiating high and low grade gliomas were analyzed. The difference of standardized parameters in tumor and surrounding tumor was compared by paired t test. Neurosurgeon's localization was based on conventional MRI during operation. The corresponding tumor and peri-tumor tissue were removed respectively. The monoclonal Ki-67mCD34 and microtubule-associated protein 2 were used respectively. Pearson correlation analysis was used to detect the normalized DKI parameters, nFA-nMD and nMK) and histopathological parameters (tumor cell density). Total vascular area (TVA) and Ki-67 labeling index (labe1ing index). Results the parameters of nFA and nMK in high grade gliomas were significantly higher than those in low grade gliomas (P 0. 02 and P 0. 001). NMD parameters were significantly lower than those of low grade gliomas (P < 0. 001). In the analysis of ROC curve for differentiating high and low grade gliomas. NMK has a maximum area under the curve (0.889), with the highest sensitivity (80) and specificity (100). The difference was statistically significant (P = 0.05nFA, P = 0.05nFA, P < 0.05) and nMD parameters were significantly different (P 0.001 and P ~ (0.006)) in glioma tumor and its peritumour (P ~ (0.001) and P ~ (0.006)). There was no significant difference in nMK parameter between the two groups. However, in the low grade glioma, the nMK value of the tumor was significantly lower than that of the surrounding tumor (P 0.001), and in the high grade glioma. The nMK value of the tumor was significantly higher than that of the surrounding tumor. The nMK value of the tumor parenchyma and the density of the tumor cell were significantly higher than that of the surrounding tumor (r = 0. 596 P0. 006). TVA(r = 0.764P0.001) and Ki-67 LI(r = 0.766P0.001). However, there was only a significant positive correlation between nFA value and tumor cell density (r = 0.534P0. 01). NMD was only associated with tumor cell density (r = -0.467) and Ki-67LI(r ~ (-0.630). Conclusion: 1. DKI, especially MK parameters, have significant differences in high and low grade gliomas, and have high specificity and sensitivity. Compared with the conventional diffusion imaging parameters (FA and MDD), DKI and MK parameters can be used to identify the proliferation of glioma cells. 2. DKI, especially MK parameters, can be used to differentiate glioma cells from high to low grade gliomas. 2. Microvessel density (MVD), morphology and tumor cell density are closely related to tumor cell density, and can be used as a noninvasive MRI technique to evaluate the microstructural changes of gliomas.
【學(xué)位授予單位】：山東大學(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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