本文選題：卵巢腫瘤　切入點：DWI　出處：《福建中醫(yī)藥大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的探討多b值彌散加權(quán)成像、DCE-MRI及兩者聯(lián)合應(yīng)用對診斷卵巢腫瘤的價值及可行性,為卵巢腫瘤的良、惡性鑒別提供無創(chuàng)、可復(fù)性及一定的參考依據(jù)。方法收集40例經(jīng)手術(shù)病理證實為卵巢腫瘤病例的MRI檢查資料,所有患者術(shù)前均采用SIEMENS Verio 3.0T超導(dǎo)磁共振掃描儀行常規(guī)MRI平掃、多b值DWI及DCE-MRI檢查,分析病變的影像學(xué)特征作出定性診斷,與術(shù)后組織病理結(jié)果進行對照得出敏感性(Se)、特異性(Sp)、陽性預(yù)測值(PPV)、陰性預(yù)測值(NPV)及準確度;其次分別測量卵巢腫瘤實性與囊性部分的ADC值,得出卵巢腫瘤實性部分的TIC曲線及相對應(yīng)的定量參數(shù)Ktrans值、Kep值及Ve值,分別對上述數(shù)據(jù)進行統(tǒng)計分析。最后,利用ROC曲線分析得出各個參數(shù)值對鑒別卵巢腫瘤良、惡性的最優(yōu)參數(shù)值及最佳診斷閾值,及相對應(yīng)的敏感性、特異性、陽性預(yù)測值及陰性預(yù)測值。結(jié)果(1)多b值DWI聯(lián)合DCE-MRI檢查對卵巢腫瘤的診斷效能較單一檢查方式高,敏感性為94.7%,特異性為100%,陽性預(yù)測值為100%,陰性預(yù)測值為95.5%,準確度97.5%;(2)兩組卵巢腫瘤病例的年齡組間差異無統(tǒng)計學(xué)意義(P0.05),不同類型的TIC曲線在卵巢腫瘤良、惡性的鑒別上具有顯著的統(tǒng)計學(xué)意義(P0.01);(3)卵巢良、惡性腫瘤實性部分的各組間ADC值、Ktrans值、Kep值及Ve值差異均具有統(tǒng)計學(xué)意義(P0.05);囊性部分的各組間ADC值差異無統(tǒng)計學(xué)意義(P0.05);(4)利用ROC曲線分析,參考Youden指數(shù)的最大值得出診斷卵巢腫瘤良、惡性的臨界值,當b值為1200s/mm2時具有最佳診斷效能,ADC值的AUC為0.937,閾值為1.17×10-3mm2/s,敏感性為90.5%,特異性為89.5%,陽性預(yù)測值為89.6%,陰性預(yù)測值為90.4%;DCE-MRI定量分析中定量參數(shù)Ktrans值具有更高的診斷效能,Ktrans值的AUC為0.857,最佳診斷閾值為0.093min-1,敏感性為85.7%,特異性為72.2%,陽性預(yù)測值為75.5%,陰性預(yù)測值為83.5%。結(jié)論(1)b值為1200s/mm2是鑒別卵巢腫瘤良、惡性的最佳掃描參數(shù),ADC值對卵巢腫瘤的定性具有肯定的診斷價值;(2)Ktrans值是DCE-MRI定量分析中對卵巢腫瘤良、惡性診斷效能最高的定量參數(shù)值;(3)多b值DWI聯(lián)合DCE-MRI掃描提高了卵巢腫瘤術(shù)前診斷的準確性。
[Abstract]:Objective to evaluate the value and feasibility of DCE-MRI and DCE-MRI in the diagnosis of ovarian neoplasms, so as to provide noninvasive differential diagnosis between benign and malignant ovarian tumors. Methods 40 cases of ovarian neoplasms proved by operation and pathology were examined by MRI. All patients were examined by SIEMENS Verio 3.0T superconducting magnetic resonance scanner (SIEMENS Verio 3.0T) before operation, including routine MRI scan, multi-b value DWI and DCE-MRI examination. The qualitative diagnosis was made by analyzing the imaging features of the lesions, and the sensitivity, specificity, positive predictive value and negative predictive value of NPV were obtained by comparing with the postoperative histopathological results. Secondly, the ADC values of solid and cystic parts of ovarian tumors were measured, and the TIC curves of solid parts of ovarian tumors and the corresponding quantitative parameters, Ktrans value and ve value, were obtained, and the above data were statistically analyzed. By using ROC curve analysis, the optimal parameter values and diagnostic thresholds for differentiating benign and malignant ovarian tumors were obtained, as well as their sensitivity and specificity. Positive predictive value and negative predictive value. Results: Multi-b DWI combined with DCE-MRI was more effective in the diagnosis of ovarian tumor than that in single mode. The sensitivity was 94.7 and the specificity was 100. The positive predictive value was 100. The negative predictive value was 95.5and the accuracy was 97.50.There was no significant difference between the two groups in the age of ovarian neoplasms (P 0.05). The TIC curves of different types were good in ovarian tumors. The differentiation of malignancy was statistically significant (P 0.01). There were significant differences in ADC value, Ktrans value, Kep value and ve value among groups in solid part of malignant tumor (P 0.05), but there was no significant difference in ADC value among groups in cystic part (P 0.05). Referring to the maximum value of Youden index, the critical value for the diagnosis of benign and malignant ovarian tumors is obtained. When b value is 1200s / mm2, the AUC with the best diagnostic efficiency and ADC value is 0.937, the threshold is 1.17 脳 10 ~ (-3) mm ~ (-2) / s, the sensitivity is 90.5 and the specificity is 89.5, the positive predictive value is 89.6 and the negative predictive value is 90.4 / DCE-MRI quantitative analysis, the quantitative parameter Ktrans value has higher diagnostic efficacy and Ktrans value. AUC was 0.857, the best diagnostic threshold was 0.093 min-1, the sensitivity was 85.7, the specificity was 72.2, the positive predictive value was 75.5 and the negative predictive value was 83.5.Conclusion the best diagnostic threshold is 0.92 min -1, the sensitivity is 85.7 min, the specificity is 72.2%, the positive predictive value is 75.5 and the negative predictive value is 83.5%. The best scanning parameter of malignant tumor and the value of ADC have positive diagnostic value for the qualitative analysis of ovarian tumor. The Ktrans value is good for ovarian tumor in quantitative analysis of DCE-MRI. Multiple b DWI combined with DCE-MRI enhanced the accuracy of preoperative diagnosis of ovarian tumors.
【學(xué)位授予單位】：福建中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R737.31;R445.2

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