本文選題：體素內(nèi)不相干運動　切入點：急性白血病　出處：《山西醫(yī)科大學》2017年碩士論文　論文類型：學位論文

【摘要】：目的:對規(guī)范化治療前急性白血病(acute leukemia,AL)患者、增生性貧血患者腰椎行基于體素內(nèi)不相干運動(intravoxel incoherent motion,IVIM)的多b值DWI技術(shù)掃描,明確ADC值、D、D*及?參數(shù)值對疾病的評估價值;并闡明IVIM參數(shù)值與骨髓病理學、血清改變、年齡的相關(guān)性。方法:收集山西醫(yī)科大學第二醫(yī)院血液科2016年8月~2017年2月經(jīng)病理確診為初發(fā)急性白血病、增生性貧血的患者共43例,其中初發(fā)急性白血病患者28例、增生性貧血患者15例。1.腰椎MRI檢查。MRI檢查采用1.5T超導型磁共振掃描儀,序列為矢狀位自旋回波序列T1加權(quán)像、傳統(tǒng)DWI(b=500s/mm~2)、基于IVIM的多b值DWI(b=0,10,25,50,100,200,400,600,800,1000,1200s/mm~2,逐漸遞增共11個b值)。經(jīng)Functool、MADC軟件后處理,分別測量腰2-4椎體的ADC、D、D*及?值。2.采集初發(fā)急性白血病、增生性貧血共43例患者清晨空腹血樣約1ml,離心后提取血清,并置于-80℃冷凍保存。用博士德人血管內(nèi)皮細胞生長因子ELISA試劑盒,對血清中血管內(nèi)皮生長因子(vascular endothelial growth factor,VEGF)含量進行測定。3.用CD34染色計數(shù)微血管密度(microvascular density,MVD)。先在低倍鏡(10×10)下尋找血管密度最高的區(qū)域,再換為高倍鏡(10×20)。計數(shù)視野內(nèi)被染色的血管數(shù),選取3個視野讀取其平均值。比較初發(fā)急性白血病組與增生性貧血組ADC、D、D*及f值的差異。采用ROC曲線下面積評估各參數(shù)值對良惡性骨髓增生疾病的評估能力。分析IVIM各參數(shù)值與VEGF、MVD、年齡的相關(guān)性。結(jié)果:1.D值、?值、D*值在兩組間差異均有統(tǒng)計學意義(P0.05)。相較于增生性貧血組,AL組D值顯著減低(P0.01),f值顯著高(P=0.01),D*值減低(P0.01)。ADC值組間差別不具有統(tǒng)計學意義(P=0.18)。2.對AL組、增生性貧血組患者做ROC曲線分析,可知AUCD=0.880,敏感度為0.964,特異度為0.667,臨界點為D=0.28×10~(-3)mm~2/s;AUCf=0.776,敏感度為0.679,特異度為0.800,臨界點為f=24.93%;AUCD*=0.917,敏感度為0.964,特異度為0.733,臨界點為D*=9.75%,即D值、f值、D*值對疾病良惡性有一定評估價值。3.骨髓MVD、外周血VEGF、D、D*、f值做相關(guān)性分析可知,f與MVD之間r=0.419、f與VEGF之間r=0.407,呈正相關(guān);D*與MVD之間r=-0.512、D*與VEGF之間r=-0.418,D與MVD之間r=-0.407、D與VEGF之間r=-0.443,呈負相關(guān)。ADC(r=0.197)、D(r=0.955)、D*(r=0.533)、f(r=0.060)值與年齡無統(tǒng)計學相關(guān)。結(jié)論:基于IVIM的多b值DWI技術(shù)對疾病有一定的評估意義,使無創(chuàng)性評估患者預后成為可能。當患者f24.93%,D0.28×10~(-3)mm~2/s,D*9.75%時惡性疾病可能性大。IVIM參數(shù)與MVD、VEGF有相關(guān)性,可以反映骨髓的血管新生。其中,f與MVD、VEGF呈正相關(guān),D、D*與MVD、VEGF呈負相關(guān)。IVIM參數(shù)與年齡無統(tǒng)計學相關(guān)。
[Abstract]:Objective: to scan the lumbar vertebrae of patients with acute leukemia and hyperplastic anemia based on intra voxel incoherent motionless IVIMI before standardized treatment, and to determine the ADC value of D * and D *? The evaluation value of parameter value to disease, and to clarify the parameter value of IVIM and bone marrow pathology, serum changes, Methods: from August 2016 to 2017, 43 patients with primary acute leukemia and proliferative anemia were collected from Department of Hematology, second Hospital of Shanxi Medical University, including 28 patients with primary acute leukemia. 15 patients with proliferative anemia were examined by 1.5T superconducting magnetic resonance scanner. The sequences were T1 weighted images of sagittal spin echo sequences, conventional DWII-BX 500s / mmm-2, and IVIM based multi-b values DWIIBX / 10 ~ 2550,100400400600 / 1000000s/ mmmm-2, which were gradually increased by a total of 11 b / mm2, and were processed by the Functool-MADC software. The ADCA D * and D * of lumbar 2-4 vertebrae were measured respectively. The fasting blood samples were collected from 43 patients with primary acute leukemia and proliferative anemia. The serum was extracted after centrifugation and cryopreserved at -80 鈩，

本文編號：1620583